血BNP在急诊呼吸困难原因鉴别及心力衰竭危险分层中的作用

摘要

目的　探讨B型脑钠肽(BNP)在鉴别急诊呼吸困难病因中的价值及心力衰竭(以下简称心衰)分层中的作用.方法呼吸困难患者共204例,由两位不知BNP测定结果的心内科医师判断诊断,比较心源性呼吸困难、肺源性呼吸困难BNP值,心源性呼吸困难根据心功能(NYHA)分Ⅱ～Ⅳ级,分别测定BNP值和左室射血分数(LVEF),并比较左侧心衰和右侧心衰BNP值.结果心源性呼吸困难BNP值明显高于肺源性呼吸困难.NYHA分级为III、IV级的患者血BNP水平均高于II级患者(P＜0.05或0.01);而NYHA分级为IV级患者的血BNP水平明显高于III级(P＜0.01).NYHA分级为III、IV级患者血LVEF水平均低于II级患者(均P＜0.05);而NYHA分级为IV级患者的血LVEF水平则低于III级(P＜0.05).左侧心衰和右侧心衰BNP值均升高,但左侧心衰BNP升值大于右侧心衰.结论对急诊呼吸困难患者测定BNP可以鉴别心源性呼吸困难和肺源性呼吸困难,BNP含量变化与心功能变化密切相关.%Objective To evaluate the diagnostic value of B- type natriuretic peptide in the patients with dyspean and effection ofrish stratification of B-type natriuretic peptide for patients with congestive heart failure.Methods Plasma BNP were measured with rapid assay in 204 patients with dyspnea.The clinical diagnosis was adjudicated by two cardiologists, who were blinded to the results of the BNP assay.The level of BNP were compared between Cardie dyspnea group and pulmonary dyspnea group. The level of BNP and LVEF were determined in the different NYHA functional class of Cardic dyspnea group.The BNP were compared between patients with left heart failure and patients right heart failure. Results The level of BNP was significantly higher in the Cardie dyspnea group than pulmonary dyspnea group. The level of BNP relates with the NYHA heart function class and LVEF of patient. The BNP increased significantly in patients with left heart failure or with right heart failure.But The variaty value of BNP is different. The increasing level of BNP was significantly higher in the left heart failure group. Conclusion The BNP is very important in distinguishing the reason of dyspnea caused by Cardie disease or pulmonary disease. The variation of BNP levelrelates with the NYHAheart function class of patient.