快速检测氨基末端-脑钠肽前体在急诊老年呼吸困难患者中的应用价值

N-terminal pro-B-type natriuretic peptide detection for elderly emergency patients with dyspnea

摘要:

目的 探讨快速检测氨基末端-脑钠肽前体（NT-proBNP）在急诊老年呼吸困难患者中的临床应用价值。方法 根据病因将202例老年急性呼吸困难患者分为单纯肺源性呼吸困难组（A组）; 单纯心源性呼吸困难组（B组）; 混合性呼吸困难组（肺源性＋心源性, C组）。床旁快速检测NT-proBNP水平, 并行超声心动图检查, 测量左心室射血分数（LVEF）。比较各组间NT-proBNP水平的差异及B, C两组中NT-proBNP水平与NYHA心功能分级和LVEF的相关性。结果 A组NT-proBNP水平明显低于B, C两组[（197.5±64.3）vs（1873.9±857.1）和（1952.4±914.8）ng/L, P＜0.01]。B, C两组NT-proBNP水平差异无显著统计学意义（P＞0.05）, 说明有心源性呼吸困难的患者NT-proBNP水平明显高于单纯肺源性呼吸困难患者。心功能Ⅱ级、Ⅲ级、Ⅳ级患者中, NT-proBNP水平依次升高, 说明患者NT-proBNP水平越高, 心功能分级越高[分别（562.37±102.45）,（2736.72±81.67）,（5873.19±127.73）ng/L, P＜0.01]。Person直线相关分析发现, NT-proBNP水平与LVEF呈负相关（r =－0.689, P＜0.01）, 提示NT-proBNP水平越高, LVEF值越低, 心功能越差。结论 NT-proBNP水平检测在判断老年肺源性与心源性呼吸困难方面具有较好的临床鉴别诊断价值, 其水平高低与心力衰竭严重程度密切相关。

Abstract:

Objective To evaluate the clinical value of N-terminal pro-brain natriuretic peptide (NT-proBNP) detection in elderly patients with acute dyspnea. Methods Based on the etiology, 202 elderly patients with acute dyspnea were divided into three groups: simple pulmonary disease(PD) group(A), simple congestive heart failure(CHF) group (B), and CHF and PD combination group (C). NT-proBNP levels, echocardiogram, left ventricular ejection fraction (LVEF), and New York Heart Association (NYHA) classification were assessed in all subjects. NT-proBNP levels were compared between different groups. Correlations of NT-proBNP levels with NYHA classification and LVEF in group B and C were analyzed. Results NT-proBNP level was significantly lower in group A than in group B and C [(197.5±64.3) vs (1873.9±857.1) and (1952.4±914.8)ng/L, P＜0.01], and was not significantly different between group B and C (P＞0.05). This indicated that NT-proBNP level was significantly higher in patients with cardiac dyspnea than those with pulmonary dyspnea. NT-proBNP level increased gradually in patients with NYHA Ⅱ, Ⅲ and Ⅳ heart function [(562.37±102.4), (2736.72±81.67), (5873.19±127.73) ng/L respectively, P＜0.01], indicating that higher level of NT-proBNP in patients with higher heart functional class. Person linear correlation analysis showed that NT-proBNP level was negatively correlated with LVEF (r= ?0.689, P＜0.01), indicating that higher NT-proBNP level corresponds with lower LVEF and poorer heart function. Conclusion NT-proBNP plays a key role in differential diagnosis of cardiac and pulmonary dyspnea in elderly patients and its level is closely related with the severity of heart failure.