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目的探讨血浆N-末端B型利钠肽原(NT-proBNP)水平的检测对呼吸困难的鉴别诊断价值。方法对92例因呼吸困难入院的患者和20例健康成年人(对照组)行血浆NT-proBNP检测,并作超声心动图检查确定左室射血分数(LVEF)。92例患者中有呼吸困难无充血性心力衰竭(CHF)为肺源性呼吸困难组(Ⅰ组),20例;呼吸困难由慢性阻塞性肺部疾病与肺心病心力衰竭共同引起者为心肺源性呼吸困难组(Ⅱ组),21例;诊断为CHF引起的呼吸困难为心源性呼吸困难组(Ⅲ组),51例。结果心源性呼吸困难患者的NT-proBNP明显高于心肺源性呼吸困难、肺源性呼吸困难及对照组,而LVEF值低于后3组,差异有统计学意义(P均<0.01);NT-proBNP浓度与LVEF值呈负相关(r=-0.71,P<0.05)。结论检测呼吸困难患者的NT-proBNP,联合超声心动图检测可鉴别呼吸困难的病因,对于心源性和非心源性呼吸困难的早期诊断和鉴别诊断有重要的意义。
Objective To investigate the value of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the differential diagnosis of dyspnea. Methods Thirty-two patients admitted to hospital due to dyspnea and 20 healthy adults (control group) underwent NT-proBNP and echocardiography to determine left ventricular ejection fraction (LVEF). Among the 92 patients, those with dyspnea without congestive heart failure (CHF) were those with pulmonary-derived dyspnea (group Ⅰ), 20 patients. Dyspnea was caused by chronic obstructive pulmonary disease and heart failure due to cor pulmonale. 21 cases of dyspnea group (group Ⅱ), and 53 cases of dyspnea caused by CHF as cardiogenic dyspnea group (group Ⅲ). Results The NT-proBNP in patients with cardiogenic dyspnea was significantly higher than that in cardiopulmonary respiration, pulmonary dyspnea and control group, but the LVEF was lower than the latter three groups (all P <0.01). NT-proBNP concentration was negatively correlated with LVEF (r = -0.71, P <0.05). Conclusion The detection of NT-proBNP in patients with dyspnea, combined with echocardiography can identify the etiology of dyspnea, which is of great significance for the early diagnosis and differential diagnosis of cardiogenic and noncardiogenic dyspnea.