中段心房利钠肽原对呼吸困难人群心力衰竭的诊断价值

摘要

目的:评价中段心房利钠肽原(MR-proANP)对呼吸困难人群心力衰竭(心衰)的诊断价值.方法:前瞻性纳入203例因呼吸困难就诊的病人,包括96例心衰病人和107例非心衰病人.以KRYPTOR平台检测病人就诊时血浆中MR-proANP水平.采用受试者工作特征曲线法分析MR-proANP对心衰的诊断价值,同时与B型利钠肽前体N端(NT-proBNP)进行比较.采用logistic回归模型将NT-proBNP和MR-proANP合并为一个参数(NT-proBNP+MR-proANP),并分析其诊断心衰的准确性.分析纽约心脏病协会(NYHA)心功能分级、NT-proBNP水平与MR-proANP的相关性.并收集120名健康体检者的血浆,用于分析MR-proANP的参考范围.结果:心衰病人血浆MR-proANP水平明显高于非心衰病人(P0.05).NT-proBNP和MR-proANP联合诊断心衰的ROC曲线下面积均高于MR-proANP和NT-proBNP曲线下面积(P0. 05). The area under ROC curve of the joint diagnosis of heart failure with NT-proBNP and MR-proANP was higher than that in MR-proANP or NT-proBNP(P<0. 05). The optimal threshold,sensitivity and specificity of MR-proANP were 100 pmol/L,0. 91(0. 83 to 0. 96) ad 0. 64(0. 55 to 0. 74),respectively. With the cardiac function classification of NYHA increasing,the level of MR-proANP increased(P<0. 01),and the MR-proANP was positively correlated with NT-proBNP(rs =0. 64,P<0. 01). Conclusions:MR-proANP is a useful diagnostic marker for HF in dyspnea patients. The combined detection of MR-proANP and NT-proBNP can improve the diagnostic accuracy of HF.