急性呼吸困难病因分布和N末端B型利钠肽原对病因诊断的作用

摘要

目的 观察急性呼吸困难的常见病因,探讨N末端B型利钠肽原( N-terminalpro-B-type natriuretic peptide,NT-proBNP)对急性呼吸困难早期病因诊断的价值.方法 选择2010年1月-2010年12月在我院急诊科以急性气喘或呼吸困难为主诉就诊的患者290例,根据病史、查体、辅助检查和治疗反应确定病因诊断,统计急性呼吸困难患者的病因；然后将所有患者分为急性心衰组(AHF组)和非心衰组(NHF组),比较两组血浆NT-proBNP水平.结果 (1)导致急性呼吸困难的病因比例前4位依次为:慢性阻塞性肺疾病急性发作110例(37.9％)、急性心力衰竭85例(29.3％)、支气管哮喘急性发作36例(12.4％)和自发性气胸26例(9.0％).(2)急性心衰组患者Nt-ProBNP水平明显高于非心衰组(P＜0.01).(3)以血浆NT-proBNP水平≥1 500 pg/ml为诊断临界值时,诊断急性心力衰竭的敏感性、特异性和附性预测值分别为91.8％、95.1％和88.6％.结论慢性阻塞性肺疾病急性发作、急性心力衰竭、支气管哮喘急性发作和自发性气胸是急诊科急性呼吸困难患者的最常见原因.血浆NT-proBNP对于急性呼吸困难病因初步筛查具有重要意义,对心源性呼吸困难和非心源性呼吸困难的诊断和鉴别诊断有实际意义.%Objective To investigate the causes of acute dyspnea and the clinical value of Nterminal pro-B-type natriuretic peptide ( NT-proBNP ) in identification of the early etiologies of acute dyspnea.Methods 290 patients presenting with acute wheezing or dyspnea during the period of Juanary 2010 to December 2010 were recruited.The etiologic diagnosis was made based on disease history,physical examination,lab tests,and responses to therapies.The causes of acute dyspnea were statistically analyzed and the patients were assigned to acute heart failure ( AHF ) group and non-heart failure ( NHF )group.Plasma NT-proBNP levels were compared between the two groups.Besults The four common causes of acute dyspnea were acute exacerbation of chronic obstructive pulmonary disease ( AECOPD )(n=110,37.9％),AHF (n=85,29.3％),acute asthma (n=36,12.4％),andpneumothorax (n =26,9.0％ ).NT-proBNP levels were markedly higher in AHF group than in NHF group ( P ＜ 0.01 ).As the cutoff value of plasma NT-proBNP was =1500 pg/ml,the sensitivity,specificity,and positive predictive value for diagnosing AHF were 91.8％,95.1％,and 88.6％.Conclusions The most frequent causes of acute dyspnea were AECOPD,AHF,acute asthma,and pneumothorax.Plasma NT-proBNP level is of importance in the primary screening of the causes of acute heart failure and the differentiation of cardiogenic from non-cardiogenic dyspnea.