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目的 探讨血浆N 末端心房利钠肽 (Nt proANP)及N 末端脑利钠肽 (Nt proBNP)对充血性心力衰竭 (CHF)的早期诊断和呼吸困难鉴别诊断的临床意义。方法 选择 2 0 0 1年 12月～ 2 0 0 2年 4月在北京协和医院门诊、急诊及住院的患者 111例 ,其中有呼吸困难表现的CHF患者 (LVEF≤4 5 % ) 5 0例 ,有呼吸困难表现的非CHF患者 2 1例 ,正常对照组 4 0例。超声心动图测定LVEF ;ELISA法测定血浆Nt proANP和Nt proBNP浓度。 结果 CHF组的血浆Nt proANP、Nt proBNP浓度比对照组有显著的提高 [分别为 (114 9 7± 5 2 7 7)比 (194 8± 93 2 )pmol/L和 (70 2 4± 30 0 9)比(187 7± 5 3 5 ) pmol/L ,P <0 0 0 1];有呼吸困难的CHF组比呼吸困难非CHF组的Nt proANP、Nt proBNP浓度有显著的提高 [分别为 (114 9 7± 5 2 7 7)比 (30 5 6± 12 4 1) pmol/L和 (70 2 4± 30 0 9)比 (2 4 4 8± 5 5 3) pmol/L ,P <0 0 0 1]。取正常对照组利钠肽类物质 (NPs)浓度的 x +1 96s为正常上限值 ,Nt proANP诊断CHF的敏感性为 90 % ,特异性为 90 % ;Nt proBNP诊断CHF的敏感性为94 % ,特异性为 95 %。在CHF组内 ,血浆Nt proBNP浓度在心功能不同分级之间均有显著差异。Nt proANP和Nt proBNP浓度与LVEF均呈显著负相关 (r =- 0
Objective To investigate the clinical significance of Nt proANP and Nt proBNP in the differential diagnosis of early diagnosis and dyspnea of congestive heart failure (CHF). Methods A total of 111 outpatients, emergency department and hospitalized patients in Peking Union Medical College Hospital from December 2001 to April 2002 were selected, including 50 patients with dyspnea in CHF (LVEF ≤ 45%), There were 21 non-CHF patients with dyspnea and 40 healthy controls. Echocardiography was used to measure LVEF. Plasma concentrations of Nt proANP and Nt proBNP were measured by ELISA. Results The concentrations of plasma Nt proANP and Nt proBNP in CHF group were significantly higher than those in control group [(114 9 7 ± 5 2 7 7) vs 194 8 ± 93 2 pmol / L and (70 24 ± 30 0 9) than that of (187 7 ± 5 3 5) pmol / L, P <0 0 01]. The concentrations of Nt proANP and Nt proBNP in CHF patients with dyspnea were significantly higher than those in non-CHF patients with dyspnea [ 114 9 7 ± 5 2 7 7) than that of (30 5 6 ± 12 4 1) pmol / L and (70 2 4 ± 30 0 9) (2 4 48 ± 5 5 3) pmol / L respectively 0 0 1]. The normal control group of natriuretic peptide (NPs) concentration of x +1 96s for the upper limit of normal, Nt proANP diagnosis of CHF was 90%, specificity of 90%; Nt proBNP diagnosis of CHF was 94 %, Specificity of 95%. Within the CHF group, there was a significant difference in plasma Nt proBNP concentrations between different grading of cardiac function. There was a significant negative correlation between Nt proANP and Nt proBNP concentrations and LVEF (r = - 0