n末端b型利钠肽原检测对急性呼吸困难鉴别诊断的临床价值

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1、N末端B型利钠肽原检测对急性呼吸困难鉴别诊断的临床价仲腊春（江苏省灌南县人民医院检验科江苏连云港222500）【摘要】目的：探讨N末端B型利钠肽原（NT-proBNP）检测对急性呼吸困难的鉴别诊断价值。方法：将328例急性呼吸困难患者，根据临床诊断分为急性充血性心力衰竭组（急性心衰组）176例及非心衰组152例,比较两组患者初入院时的NT-proBNP水平，评价其对急性呼吸困难鉴别诊断的价值。结果：急性心衰组及非心衰组NT-proBNP浓度分别为3184.4±1638.3pg/mL和388.6±

2、154.7pg/mL,两组比较差异具有显著性意义（P<0.01）。以NT-proBNP≥1500pg/mL为心力衰竭阳性诊断[1],诊断急性充血性心力衰竭的灵敏度为92.0%,特异性为90.1%,阳性预测值为91.5%,阴性预测值为90.7%,诊断效率达91.2%。结论：急诊常规检测NT-proBNP有利于对急性呼吸困难患者做出快速诊断，有助于鉴别急性呼吸困难是否为急性充血性心力衰竭所致。【关键词】N末端B型利钠肽原；急性呼吸困难；心力衰竭；鉴别诊断【屮图分类号】R446【文献标识码】A【文章编号】1007-8231

3、（2015）11-0017-02DetectionofNterminalBtypenatriureticpeptideontheclinicalvalueofdifferentialdiagnosisofacutedyspneaZhongLachun.GuannanCountypeople’sHospitalofJiangsuProvince.225OO.China【Abstract】ObjectiveStudyondetectionofNterminalBtypenatriureticpeptideontheclinic

4、alvalueofdifferentialdiagnosisofacutedyspnea.Methods328casesofacutedyspneaweredividedinto176caseswithacutecongestiveheartfailureand152caseswithnonheartfailuregroupaccordingtotheclinicaldiagnosis,TheNT-BNPleveloftwogroupsofpatientswerecompared,andthevalueofthediffe

5、rentialdiagnosisofacutedyspneawasevaluated.ResultsNT-BNPconcentrationsinacuteheartfailuregroupandnonheartfailuregroupweresignificantlydifferentbetween3184.4±1638.3pg/mLand388.6±154.7pg/mLtwogroups(P<0.01).NT-proBNP≥1500pg/mLforheartfailurediagnosi

6、s,thesensitivityofdiagnosisofacutecongestiveheartfailurewas92.0%,thespecificitywas90.1%,thepositivepredictivevaluewas91.5%,thenegativepredictivevaluewas90.7%,thediagnosticefficiencywas91.2%.ConclusionRoutinedetectionofNT-proBNPishelpfulformakingrapiddiagnosisofacu

7、tedyspnea,anditcanbehelpfultoidentifyacuterespiratorydifficultiesandwhetheritiscausedbyacutecongestiveheartfailure.【Keywords]NterminalBtypenatriureticpeptide;Acutedyspnea;Heartfailure;Differentialdiagnosis心力衰竭(心衰)是各种心血管疾患的终末阶段，奋很高的发病率及病死率。因此，对于急性心衰患者，早期诊断及吋对症治疗具有非

8、常重要的意义，心衰的临床诊断主要依据临床症状和影像学检査，但这些依据常缺乏特异性，与其它肺部疾病难以区分。N末端B型利钠肽原(NT-proBNP)是在心室壁受牵拉吋心室分泌的一种激素，它以激素原的形式分泌，然后等比例分解成脑尿钠肽(BNP)和NT-proBNP,NT-proBNP代谢速度较BNP慢，浓度