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目的分析比较围生期心肌病(PPCM)患者血清N端脑钠肽前体(NT-proBNP)、肌钙蛋白I(cTnI)水平变化情况,以了解两者联合检测在PPCM早期诊断及鉴别诊断中的作用。方法采集79例PPCM患者(PPCM组)、同期妊娠生理反应妇女30例(妊娠生理反应组)、健康围生期妇女35例(健康对照组)静脉血,并分离血清。血清NT-proBNP测定采用电化学发光免疫分析(ECLIA)技术;cTnI的定量检测采用酶联免疫吸附(ELISA)法。结果 1)与健康对照组比较,PPCM组及妊娠生理反应组血清NT proBNP对数值均显著增高,差异有统计学意义(P<0.05);PPCM组血清cTnI水平显著高于健康对照组,差异有统计学意义(P<0.01);而妊娠生理反应组与健康对照组比较,血清cTnI水平差异无统计学意义(P>0.05)。2)与健康对照组比较,PPCM早期NYHA I级亚组血清cTnI水平显著增高,差异有统计学意义(P<0.05),而NT-proBNP对数值差异无统计学意义(P>0.05);妊娠生理反应组则正好相反。与健康对照组比较,PPCM早期NYHAⅡ级亚组上述2项指标均显著增高,差异有统计学意义(P<0.05)。3)血清NT-proBNP诊断早期PPCM的敏感性较高,特别是对NYHAⅡ级敏感性达100.0%,但特异性及阴性预测值极低,阳性预测值不足55.0%;而血清cTnI敏感性、特异性、阴性及阳性预测值均大于90.0%,表明血清cTnI水平对PPCM早期的鉴别诊断价值高于NT-proBNP。结论血清NT-proBNP、cTnI联合检测有助于PPCM早期诊断及鉴别诊断。
Objective To compare and analyze the changes of serum NT-proBNP and cTnI in patients with perinatal cardiomyopathy (PPCM) in order to understand the early diagnosis and differential diagnosis of PPCM In the role. Methods Seventy-nine patients with PPCM (PPCM group), 30 women with physiological reaction during pregnancy (physiological reaction group) and 35 healthy women (healthy control group) were collected and serum was collected. Serum NT-proBNP was determined by electrochemiluminescence immunoassay (ECLIA). Quantitative detection of cTnI was performed by enzyme-linked immunosorbent assay (ELISA). Results 1) Compared with the healthy control group, the logarithm of NT proBNP in the PPCM group and the pregnancy physiological response group were significantly increased (P <0.05); the level of cTnI in the PPCM group was significantly higher than that in the healthy control group (P <0.01). However, there was no significant difference in serum cTnI levels between pregnant women and healthy controls (P> 0.05). 2) Compared with the healthy control group, the level of cTnI in NYHA class I subgroup of PPCM was significantly increased (P <0.05), while the NT-proBNP had no significant difference (P> 0.05); pregnancy Physiological response is exactly the opposite. Compared with the healthy control group, the above two indexes of NYHA class Ⅱ subgroup of PPCM were significantly increased, the difference was statistically significant (P <0.05). 3) Serum NT-proBNP is more sensitive to diagnose early stage PPCM, especially to NYHA class II with a sensitivity of 100.0%, but the specificity and negative predictive value are very low, the positive predictive value is less than 55.0%; while serum cTnI sensitivity and specificity The positive, negative and positive predictive values were more than 90.0%, indicating that the serum cTnI level in the early differential diagnosis of PPCM is higher than NT-proBNP. Conclusion Serum NT-proBNP, cTnI combined detection of PPCM early diagnosis and differential diagnosis.