降钙素原及超敏C-反应蛋白和N-端脑利钠肽前体在慢性心力衰竭诊断中的应用价值

摘要

目的 探讨降钙素原(procalcitonin, PCT),超敏C-反应蛋白(high sensitive C-reactive pro-tein, hs-CRP)和N-端脑利钠肽前体(N-terminal brain natriuretic peptide precursor, NT-proBNP)在慢性心力衰竭(chronic heart failure, CHF)诊断中的临床应用价值. 方法 选择2015年1月至2015年6月于我院就诊的CHF患者80例为CHF组,用NYHA分级方法将CHF患者进行分级,其中心功能Ⅱ级患者38例,心功能Ⅲ级患者30例,心功能Ⅳ级患者12例,另选择我院健康体检者80例为正常对照组,检测所有受试者血清中PCT、hs-CRP和NT-proBNP的水平,对检测结果进行统计学处理并分析. 结果 CHF组血清PCT、hs-CRP和NT-proBNP检测结果均显著高于正常对照组, 且差异均具有统计学意义(t= 63.689,22.015,35.600,P均<0.05). 心功能Ⅱ级、Ⅲ级、Ⅳ级CHF患者间血清PCT、hs-CRP和NT-proBNP检测结果差异均有统计学意义(F= 601.284,973.150,4.829,P均<0.05). 且随着心衰严重程度的增加,血清中PCT、hs-CRP和NT-proBNP水平均呈上升趋势,组间两两比较,差异均有统计学意义(P均<0.05). CHF 组中,PCT、hs-CRP 及 NT-proBNP 的阳性率分别为 85.0%(68/80)、92.5%(74/80)和93.8%(75/80),三者联合检测的阳性率为96.3%(77/80).血清PCT、hs-CRP及NT-proBNP单独检测诊断CHF的灵敏度分别为85.0%、92.5%和93.8%,特异性分别为65.2%、73.9%和78.2%,三者联合检测诊断CHF的灵敏度、特异性及Youden指数分别为96.3%、82.6%和0.79. 三者联合检测诊断CHF的其他诊断性能指标均优于各指标单独检测. 结论 血清PCT,hs-CRP和NT-proBNP的水平可用于CHF的诊断和心功能分级. 三者联合检测可提高诊断CHF的准确度.%Objective To evaluate the clinical value of procalcitonin (PCT), high sensitive C-reac-tive protein(hs-CRP) and N-terminal brain natriuretic peptide precursor(NT-proBNP) in chronic heart fail-ure(CHF) diagnosis. Methods 80 cases patients with CHF from January 2015 to June 2015 in our hospital were collected. The patients were divided into different cardiac function group according to NYHA method in-cluding 38 cases gradeⅡ, 30 cases gradeⅢand 12 cases gradeⅣ. 80 cases healthy controls were selected as control group. The serum PCT, hs-CRP and NT-proBNP of all the subjects were detected, and the results were analyzed statistically. Results The levels of PCT, hs-CRP and NT-proBNP in CHF group were all higher than that of control group, and the differences all had statistical significance(t=63.689,22.015,35.600, Pall<0.05). There were statistical significance in the difference of PCT , hs-CRP and NT-proBNP levels among three dif-ferent cardiac function groups (F= 601.284,973.150,4.829, Pall<0.05). The serum PCT, hs-CRP and NT-proBNP levels in CHF patients were all increasing along with the severity of the disease , and there were statisti-cal significance in the difference of PCT, hs-CRP and NT-proBNP levels between each two groups(Pall<0.05). The positive rates of PCT, hs-CRP and NT-proBNP in CHF patients were 85.0%(68/80), 92.5%(74/80) and 93.8%(75/80), and the positive rate of combine detection was 96.3%(77/80). The sensitivity of PCT, hs-CRP and NT-proBNP in diagnosis CHF were 85.0%, 92.5% and 93.8%, respectively. Thespecificity were 65.2%, 73.9%, 78.2% , respectively. The sensitivity, specificity and Youden index of com-bine detection were 96.3%, 82.6%and 0.79. The other diagnosis index of combine detection were all higher than that of index lonely detection. Conclusion The detection of PCT, hs-CRP and NT-proBNP can be used for diagnosis and cardiac function grading , and the combine detection can improve the accuracy of CHF diag-nosis.