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目的探讨血浆N-末端脑利钠肽(NT-proBNP)变化在急性心源性与非心源性呼吸困难患者中诊断和鉴别诊断的临床意义。方法选取2005年10月至2006年6月卫生部北京医院急诊科以呼吸困难为主诉就诊的患者93例,分为心源性呼吸困难组61例,非心源性呼吸困难组32例。其中心源性呼吸困难组按照超声心动图检查结果分为单纯舒张功能不全组25例,单纯收缩功能不全组21例,收缩并舒张功能不全组15例;同时按照纽约心功能分级标准(NYHA)对心功能进行分级。采用酶联免疫吸附法测定各组患者血浆NT-proBNP,用SPSS12.0软件对各组资料进行分析。结果心源性与非心源性呼吸困难组NT-proBNP分别为(3.591±2.943)μg/L和(0.429±0.119)μg/L,差异有显著性意义(P<0.01);心源性呼吸困难组中单纯舒张功能不全、单纯收缩功能不全与收缩合并舒张功能不全患者NT-proBNP为(2.328±1.366)μg/L、(3.966±2.714)μg/L、(5.172±4.203)μg/L,3组间差异有显著性意义(P<0.05);不同NYHA心功能亚组间NT-proBNP差异有显著性(P<0.05);心源性呼吸困难组血浆NT-proBNP与左心室射血分数之间呈中度负相关性(r=-0.599,P<0.01);但与左心室舒张末期内径间无关联(r=0.222,P<0.05)。结论血浆NT-proBNP对心源性呼吸困难和非心源性呼吸困难的诊断和鉴别诊断有实际意义。
Objective To investigate the clinical significance of plasma N-terminal brain natriuretic peptide (NT-proBNP) in the diagnosis and differential diagnosis of acute cardiogenic and non-cardiac dyspnea patients. Methods From October 2005 to June 2006, 93 emergency patients with dyspnea in the emergency department of Beijing Hospital of the Ministry of Health were selected and divided into three groups: 61 cases of cardiogenic dyspnea group and 32 cases of non-cardiac dyspnea group. According to the results of echocardiography, the patients with cardiogenic dyspnea were divided into 25 cases of simple dysfunction group, 21 cases of simple systolic dysfunction group and 15 cases of systolic and diastolic dysfunction group. According to New York Heart Association grading standard (NYHA) Heart function grading. Plasma NT-proBNP levels were measured by enzyme-linked immunosorbent assay (ELISA), and SPSS12.0 software was used to analyze the data of each group. Results NT-proBNP was (3.591 ± 2.943) μg / L and (0.429 ± 0.119) μg / L respectively in cardiogenic and noncardiogenic dyspnea group, with significant difference (P <0.01) NT-proBNP was (2.328 ± 1.366) μg / L, (3.966 ± 2.714) μg / L and (5.172 ± 4.203) μg / L respectively in patients with dysfunction and simple systolic dysfunction and with systolic and diastolic dysfunction. (P <0.05). There was a significant difference in NT-proBNP between different subgroups of NYHA cardiac function (P <0.05). There was significant difference between NT-proBNP and left ventricular ejection fraction (R = -0.599, P <0.01), but no correlation with left ventricular end diastolic diameter (r = 0.222, P <0.05). Conclusion Plasma NT-proBNP has practical significance in the diagnosis and differential diagnosis of cardiogenic dyspnea and noncardiogenic dyspnea.