血浆BNP检测在呼吸困难病因鉴别诊断中的应用价值

摘要

To determine the clinical significance of plasma brain natriuretic peptide (BNP) levels on the differential diagnosis of causes of acute dyspnea and the severity of heart failure. The concentrations of plasma BNP in patients with 64 cases of dyspnea (36 cases with cardiac dyspnea and 28 with pulmonary dyspnea) were detected by Electrochemiluminescence immunoassay. The plasma BNP levels in 120 eases of heart failure patients (Classified into Ⅰ , Ⅱ , Ⅲ, Ⅳ grade in accordance with the reference of the standard New York Heart Association, NYHA) and 30 healthy controls were also detected. The results showed that the plasma BNP levels in cardiac dyspnea group were significantly higher than that in pulmonary dyspnea group (P ＜ 0. 001 ) , and the plasma BNP levels in heart failure group were higher than that of controls (P ＜0. 001 ). The levels of plasma BNP in NYHA Ⅰ group were significantly higher than that of controls (P ＜0.01 ) ,and the level of plasma BNP in Ⅰ ,Ⅱ , Ⅲ, Ⅳ groups gradually increased ( P ＜ 0.01 ). The plasma BNP could be used to distinguish the cardiac and pulmonary dyspnea in patients with acute dyspnea. The detection of plasma BNP might be very useful in the diagnosis of severity and prognosis of heart failure.%探讨血浆脑钠肽(BNP)水平与急性呼吸困难病因鉴别诊断以及心力衰竭严重程度的关系及其临床意义.采用电化学发光免疫法检测64例呼吸困难患者的血浆BNP浓度,最终划分为心源性呼吸困难患者组(36例)、肺源性呼吸困难患者组(28例).比较心源性和肺源性呼吸困难患者的血浆BNP水平;同时测定入院时明确诊断的120例心功能不全 (按照纽约心脏协会NYHA分级Ⅰ、Ⅱ、Ⅲ、Ⅳ级)患者和30名健康对照者的血浆BNP水平,并进行对照分析.心源性呼吸困难组血浆BNP水平较肺源性组显著升高(P<0.001),心功能不全组总体血浆BNP水平明显高于对照组(P<0.01),NYHAⅠ级时血浆BNP明显高于对照组(P<0.01),且Ⅰ、Ⅱ、Ⅲ、Ⅳ级组间血浆BNP依次递增(P<0.01).结果显示,测定急性呼吸困难患者血浆BNP水平可判别病因是心源性或肺源性.随着心功能不全严重程度加重,血浆BNP浓度增加,血浆BNP的浓度变化对心力衰竭的诊断、严重程度和预后评价有重要价值.