NT-proBNP、cTnI、H-FABP对呼吸困难鉴别诊断及预后判断的价值

中国临床药理学与治疗学 ›› 2015, Vol. 20 ›› Issue (5): 562-566.

NT-proBNP、cTnI、H-FABP对呼吸困难鉴别诊断及预后判断的价值

李祥东, 王安才

皖南医学院第一附属医院弋矶山医院老年医学科,芜湖241001,安徽

收稿日期:2015-01-19 修回日期:2015-03-26 发布日期:2015-06-11
通讯作者: 王安才,男,主任医师,教授,研究方向:高血压病与冠心病的基础与临床。E-mail: yjswac@sina.com
作者简介:李祥东,主治医师,助教,研究方向:高血压病与冠心病的基础与临床。Tel: 13955337248 E-mail: lxdvvc@163.com

Differential diagnostic and prognostic values of measurements of N-terminal pro-brain natriuretic peptide, cardiac troponin I and heart-type fatty acid binding protein in patients with dyspnea

LI Xiang-dong, WANG An-cai

Department of Geriatric Medicine,the First Affiliated Hospital of Wannan Medical College,Wuhu 241001,An Hui,China

Received:2015-01-19 Revised:2015-03-26 Published:2015-06-11

摘要/Abstract

摘要： 目的: 探讨氨基末端B型脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、肌钙蛋白I(cardiac troponin I, cTnI)、心型脂肪酸结合蛋白(heart-type fatty acid-binding protein,H-FABP)对呼吸困难患者的鉴别诊断以及预后判断的价值。方法: 选择80名[其中男55例,女25例;平均年龄(53.5±7.8 )岁]呼吸困难患者作为试验组和健康体检者20名[其中男14例,女6例,平均年龄(52.6±6.9) 岁]作为对照组,测定其血清NT-proBNP、cTnI、H-FABP浓度,根据出院诊断将呼吸困难患者分为慢性收缩性心力衰竭(CHF)组和非慢性收缩性心力衰竭(NCHF)组,按纽约心脏病学会(NYHA)标准将CHF组又分为心功能Ⅱ、Ⅲ、Ⅳ级三个亚组。分别观察五组NT-proBNP、cTnI、H-FABP的水平并进行比较。随访观察患者心脏事件再发生的情况。结果: 血清NT-proBNP、cTnI、H-FABP浓度在CHF各亚组均高于对照组和NCHF组(P<0.05),且心功能越差其浓度越高(P<0.05),而对照组和NCHF组之间差异无统计学意义(P>0.05)。NT-proBNP、cTnI、H-FABP联合检测诊断CHF的敏感性为93.6%、阴性预测值为 95.6%,高于NT-proBNP、cTnI、H-FABP任何一项单独检测,差异有统计学意义(P<0.05)。随访患者发生心脏事件组血清NT-proBNP、cTnI和H-FABP出院时浓度明显高于未发生心脏事件组(P<0.01)。结论: 联合检测NT-proBNP、cTnI和H-FABP对于诊断CHF和判断其病情严重程度及预后具有重要的意义,对于鉴别CHF和NCHF引起的呼吸困难有很高的临床价值。

关键词: 呼吸困难, 氨基末端B型脑钠肽前体, 肌钙蛋白I, 心型脂肪酸结合蛋白

Abstract: AIM: To explore the differential diagnostic and prognostic values of measurements of N-terminal pro-brain natriuretic peptide(NT-proBNP), cardiac troponin I(cTnI)and heart-type fatty acid-binding protein(H-FABP) in patients with dyspnea.METHODS: Choice 80 patients [55 males and 25 females; mean age (53.5±7.8) years] with dyspnea as test group and 20 healthy persons [14 males and 6 females; mean age (52.6±6.9) years] as control group, and the serum concentrations of NT-proBNP, cTnI and H-FABP were detected, patients with dyspnea were divided into one group of chronic systolic heart failure (CHF) and the other group of non chronic systolic heart failure (NCHF) according to the hospital discharge diagnosis, the CHF group was divided into three subgroups of cardiac function II, III, IV according to the New York Heart Association (NYHA) standard. NT-proBNP, cTnI and H-FABP levels were observed and compared in the five groups. Patients were followed up to be observed the recurrence of cardiac events.RESULTS: The concentration of NT-proBNP, cTnI, H-FABP in the CHF group were higher than those in the control group and NCHF group (P<0.05), the cardiac function was worse with the increase of concentration (P<0.05), while there was no significant difference between the control and NCHF group (P>0.05). The sensitivity of NT-proBNP, cTnI, H-FABP three combined detection in the diagnosis of CHF was 93.6%, and the negative predictive value was 95.6%,which was higher than that of NT-proBNP, cTnI, H-FABP of any single detection, the difference was statistically significant (P<0.05). In the follow-up patients of the cardiac events group, serum NT-proBNP, cTnI and H-FABP concentrations at hospital discharge were markedly higher than those in the non-cardiac events group (P<0.01).CONCLUSION: There is important significance on diagnosis, prognosis and judging the severity for the detection of NT-proBNP, cTnI and H-FABP in patients with CHF.The levels of NT-proBNP, cTnI and H-FABP can possibly be used clinically in differentiating dyspnea of CHF from NCHF.

Key words: dyspnea, N-terminal pro-brain natriuretic peptide, cardiac troponin I, heart-type fatty acid binding protein

中图分类号:

R541.6

李祥东, 王安才. NT-proBNP、cTnI、H-FABP对呼吸困难鉴别诊断及预后判断的价值[J]. 中国临床药理学与治疗学, 2015, 20(5): 562-566.

LI Xiang-dong, WANG An-cai. Differential diagnostic and prognostic values of measurements of N-terminal pro-brain natriuretic peptide, cardiac troponin I and heart-type fatty acid binding protein in patients with dyspnea[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2015, 20(5): 562-566.

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