Wieczorek Stacey J, Wu Alan H B, Christenson Robert, Krishnaswamy Padma, Gottlieb Stephen, Rosano Thomas, Hager David, Gardetto Nancy, Chiu Albert, Bailly Kathryn R, Maisel Alan
Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, Conn, USA.
Am Heart J. 2002 Nov;144(5):834-9. doi: 10.1067/mhj.2002.125623.
B-Type natriuretic peptide (BNP), a protein released from the left ventricle in response to volume expansion and pressure overload, has emerged as the first whole blood marker for the identification of individuals with congestive heart failure (CHF).
The purpose of this study was to assess the performance of a point-of-care assay to diagnose and evaluate the severity of CHF on the basis of the New York Heart Association (NYHA) classification system.
Through a prospective, multicenter trial, whole blood samples were collected from a total of 1050 inpatients, outpatients, and healthy control patients. Participants were divided into subgroups for BNP analysis: patients without cardiovascular CHF (n = 473), patients with hypertension and no cardiovascular disease (n = 168), NYHA class I CHF (n = 73), class II CHF (n = 135), class III CHF (n = 141), and class IV CHF (n = 60).
Circulating BNP concentrations determined from the bedside assay increased with CHF severity, as determined by the NYHA classification system, but were only statistically significant (P <.001) between individuals with and without CHF. Individuals without CHF had a median BNP concentration of 9.29 pg/mL. Median BNP values, with their corresponding interquartile ranges, for NYHA classification I through IV were 83.1 pg/mL (49.4-137 pg/mL), 235 pg/mL (137-391 pg/mL), 459 pg/mL (200-871 pg/mL), and 1119 pg/mL (728->1300 pg/mL), respectively. With the use of a decision threshold of 100 pg/mL, the assay demonstrated 82% sensitivity and 99% specificity for distinguishing control patients and patients with CHF.
BNP concentrations obtained from whole blood samples are useful in the diagnosis of CHF and staging the severity of the disease.
B型利钠肽（BNP）是一种在容量扩张和压力超负荷时从左心室释放的蛋白质，已成为识别充血性心力衰竭（CHF）患者的首个全血标志物。
本研究旨在评估一种即时检验方法根据纽约心脏协会（NYHA）分类系统诊断和评估CHF严重程度的性能。
通过一项前瞻性多中心试验，从总共1050名住院患者、门诊患者和健康对照患者中采集全血样本。参与者被分为亚组进行BNP分析：无心血管CHF患者（n = 473）、高血压且无心血管疾病患者（n = 168）、NYHA I级CHF患者（n = 73）、II级CHF患者（n = 135）、III级CHF患者（n = 141）和IV级CHF患者（n = 60）。
根据NYHA分类系统确定，床边检测法测得的循环BNP浓度随CHF严重程度增加，但仅在有CHF和无CHF个体之间具有统计学意义（P <.001）。无CHF个体的BNP浓度中位数为9.29 pg/mL。NYHA I级至IV级的BNP值中位数及其相应的四分位间距分别为83.1 pg/mL（49.4 - 137 pg/mL）、235 pg/mL（137 - 391 pg/mL）、459 pg/mL（200 - 871 pg/mL）和ll19 pg/mL（728 -> 1300 pg/mL）。使用100 pg/mL的判定阈值，该检测方法在区分对照患者和CHF患者时显示出82%的灵敏度和99%的特异性。
从全血样本中获得的BNP浓度有助于CHF的诊断和疾病严重程度分期。
