Maisel Alan S, Krishnaswamy Padma, Nowak Richard M, McCord James, Hollander Judd E, Duc Philippe, Omland Torbjørn, Storrow Alan B, Abraham William T, Wu Alan H B, Clopton Paul, Steg Philippe G, Westheim Arne, Knudsen Catherine Wold, Perez Alberto, Kazanegra Radmila, Herrmann Howard C, McCullough Peter A
University of California, San Diego, Veterans Affairs Medical Center, San Diego 92161, USA.
N Engl J Med. 2002 Jul 18;347(3):161-7. doi: 10.1056/NEJMoa020233.
B-type natriuretic peptide is released from the cardiac ventricles in response to increased wall tension.
We conducted a prospective study of 1586 patients who came to the emergency department with acute dyspnea and whose B-type natriuretic peptide was measured with a bedside assay. The clinical diagnosis of congestive heart failure was adjudicated by two independent cardiologists, who were blinded to the results of the B-type natriuretic peptide assay.
The final diagnosis was dyspnea due to congestive heart failure in 744 patients (47 percent), dyspnea due to noncardiac causes in 72 patients with a history of left ventricular dysfunction (5 percent), and no finding of congestive heart failure in 770 patients (49 percent). B-type natriuretic peptide levels by themselves were more accurate than any historical or physical findings or laboratory values in identifying congestive heart failure as the cause of dyspnea. The diagnostic accuracy of B-type natriuretic peptide at a cutoff of 100 pg per milliliter was 83.4 percent. The negative predictive value of B-type natriuretic peptide at levels of less than 50 pg per milliliter was 96 percent. In multiple logistic-regression analysis, measurements of B-type natriuretic peptide added significant independent predictive power to other clinical variables in models predicting which patients had congestive heart failure.
Used in conjunction with other clinical information, rapid measurement of B-type natriuretic peptide is useful in establishing or excluding the diagnosis of congestive heart failure in patients with acute dyspnea.
B型利钠肽是心室在壁张力增加时释放的。
我们对1586例因急性呼吸困难前来急诊科就诊且用床旁检测法测定B型利钠肽的患者进行了一项前瞻性研究。充血性心力衰竭的临床诊断由两名独立的心脏病专家判定，他们对B型利钠肽检测结果不知情。
最终诊断为744例患者（47%）因充血性心力衰竭导致呼吸困难，72例有左心室功能障碍病史的患者（5%）因非心脏原因导致呼吸困难，770例患者（49%）未发现充血性心力衰竭。B型利钠肽水平本身在将充血性心力衰竭确定为呼吸困难原因方面比任何既往史、体格检查结果或实验室值都更准确。B型利钠肽在截断值为每毫升100皮克时的诊断准确性为83.4%。B型利钠肽水平低于每毫升50皮克时的阴性预测值为96%。在多因素逻辑回归分析中，在预测哪些患者患有充血性心力衰竭的模型中，B型利钠肽测量值为其他临床变量增加了显著的独立预测能力。
结合其他临床信息，快速测定B型利钠肽有助于对急性呼吸困难患者确立或排除充血性心力衰竭的诊断。
