急性呼吸困难的病因分析和血浆N末端B型利钠肽原检测的应用价值

摘要

目的 分析急性呼吸困难的病因,探讨检测血浆N末端B利钠肽原(NT-proBNP)对急性呼吸困难中充血性心力衰竭的诊断价值.方法分析211例急性呼吸困难患者的临床资料,将患者分为充血性心力衰竭组和非充血性心力衰竭组.比较两组患者血浆NT-proBNP水平.结果 211例急性呼吸困难患者中,充血性心力衰竭的发生率96例(45.5%).充血性心力衰竭患者血浆NT-proBNP水平[3947.6 pg/ml,1421.1~11378.3 pg/ml]显著高于非充血性心力衰竭患者[412.4 pg/ml,41.2-1123.2 pg/ml](P<0.01).以血浆NT-proBNP水平≥800 pg/ml为判别标准与非充血性心力衰竭鉴别,诊断充血性心力衰竭的敏感性、特异性和准确性分别为83.3%、82.6%和82.9%.结果 充血性心力衰竭是急性呼吸困难的最常见原因;检测血浆NT-proBNP水平有助于充血性心力衰竭的诊断.%Objective To investigate etiology of acute dyspnea and use of N-terminal pro brain natriuretic peptide (NT-proBNP) blood level in differential diagnoais. Methods 211 patients with dyspnea were divided into congestive heart failure (CHF) group and non-congestive heart failure (non-CHF) group through analysis of their clinical data. NT-proBNP blood level was compared between the two groups. Results In 211 patients with dyspnea, incidence of CHF was 45.5％. NT-proBNP blood level in patients with CHF was higher than that in patients with non-CHF [3947.6 pg/ml,(95％ CI, 1421.1 -11378.3 pg/ml) and 412.4 pg/ml,(95％ CI, 41.2 ～1123.2 pg/ml), respectively] (P ＜0. 01 ). When NT-proBNP blood level ≥ 800 pg/ml was adopted as the guideline of differenfiating CHF from non-CHF, its sensitivity, specificity, and accuracy were 83.3％, 82. 6％, and 82. 9％, respectively. Conclusions CHF is a major cause of dyspnea. Rapid testing of plasma NT-proBNP may help differentiate CHF from other diseases such as pulmonary diseases.