梅蕊,张茜,薛忠文
MEI Rui,ZHANG Qian,XUE Zhongwen

• 1:中国核工业北京四O一医院急诊科
• 2:首都医科大学附属北京朝阳医院心脏中心
• 3:北京市房山区良乡医院心内科

摘要(Abstract)：

目的:探讨两种血浆N-末端脑钠肽前体(Nt-proBnp)检测方法对心源性或肺源性急性呼吸困难的鉴别诊断价值。方法:200例急性呼吸困难患者分为心源性组(心源性急性呼吸困难,n=107)和肺源性组(肺源性急性呼吸困难,n=93),50例同期体检健康者作为对照组,分别采用干式免疫层析法、双抗体夹心法检测3组受试者入院或体检时血浆Nt-proBnp水平;比较2组急性呼吸困难患者入院时的左心室射血分数(LVEF)及血浆Nt-proBnp水平,同时观察心源性呼吸困难患者NYHA心功能分级与血浆Nt-proBnp水平的关系。结果:2种方法检测的血浆Nt-proBnp结果显示,3组被检者各组内比较,差异无统计学意义(P>0.05);2组急性呼吸困难患者血浆Nt-proBnp水平明显高于对照组(P<0.05),心源性组显著高于肺源性组(P<0.05);入院时,心源性组患者LEVF水平较肺源性组患者明显降低(P<0.05),心源性组急性呼吸困难患者血浆Nt-proBnp>550 ng/L的比例明显高于肺源性组(P<0.05),而Nt-proBnp<120 ng/L的比例明显低于肺源性组(P<0.05);随着心功能等级的升高(Ⅰ级~Ⅳ级),心源性急性呼吸困难患者血浆Nt-proBnp水平呈升高趋势,差异有统计学意义(P<0.05)。结论:2种血浆Nt-proBnp检测方法均能有效鉴别心源性或肺源性呼吸困难,血浆Nt-proBnp水平与左心室功能改变、心功能分级密切有关。
Objective: To explore the clinical value of plasma Nt-proBnp detection in different types of acute respiratory dyspnea. Methods: 200 patients with acute dyspnea were divided into the cardiogenic group( with cardiac acute dyspnea,n = 107) and the pulmonary group( with pulmonary acute dyspnea,n = 93),and 50 healthy subjects were collected as the control group. Nt-proBNP levels of plasma and left ventricular ejection fraction( LVEF) of the 3 groups were compared. The nt-probnp level of patients with different cardiac functions was assessed. The distribution of Nt-proBNP concentration was analyzed. Results: The plasma concentration of Nt-proBnp in patients with cardiogenic acute dyspnea was significantly higher than that in patients with lung diseases( P < 0. 05). Patients with a history of myocardial infarction were more likely to suffer from cardiogenic acute dyspnea( P < 0. 05).The level of Nt-proBnp in patients with cardiogenic acute dyspnea was significantly higher than that in patients with pulmonary artery( P < 0. 05). The level of Nt-proBNP was negatively correlated with left ventricular ejection fraction( LVEF). The difference of Nt-proBNP levels in pateients with variedheart function of cardiogenic dyspnea were significant( P < 0. 05). When Nt-proBnp > 550 pg/m L,the number of patients in the cardiogenic group was significantly larger than that in the patients with pulmonary heart failure( P < 0. 05). When Nt-proBNP < 120 pg/m L,the number of patients with cardiogenic dyspnea was significantly smaller than that in patients with pulmonary heart failure( P < 0. 05).Conclusion: Plasma Nt-proBNP analysis can effectively identify cardiogenic and pulmonary dyspnea.

关键词(KeyWords)： 呼吸困难,急性;呼吸困难,阵发性;N-末端脑钠肽前体;左心室射血分数;实验室
respiratory dyspnea,acute;respiratory dyspnea,paroxysmal;N-terminal pro-B-type natriuretic peptide;left ventricular ejection fraction;laboratory

Abstract:

Keywords:

基金项目(Foundation): 首都卫生发展科研专项项目(首发2014-4-7071)

作者(Author): 梅蕊,张茜,薛忠文
MEI Rui,ZHANG Qian,XUE Zhongwen

DOI: 10.19367/j.cnki.1000-2707.2018.07.021

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