Knudsen Cathrine Wold, Westheim Arne, Omland Torbjørn
Hjertemedisinsk avdeling, Ullevål universitetssykehus, 0407 Oslo.
Tidsskr Nor Laegeforen. 2003 Aug 14;123(15):2045-8.
B-type natriuretic peptide (BNP) is increased in left ventricular dysfunction and congestive heart failure e. The aim of the study was to determine the diagnostic accuracy of BNP and the degree to which BNP adds to clinical judgement in the diagnosis of heart failure.
The BNP Multinational Study was a seven-centre prospective study of 1586 patients presenting to emergency departments with acute dyspnoea who had BNP levels measured with a rapid, point-of-care device on arrival. 1538 (97%) had pre-test probability of congestive heart failure determined from 0-100% by the attending physician in the emergency department who was blinded to the BNP levels. The final diagnosis was adjudicated by two independent cardiologists, also blinded to BNP results, who reviewed all clinical data and standardised congestive heart failure scores.
The final diagnosis was congestive heart failure in 722 (47%) patients. Pre-test probability of this condition > or = 80% as determined by the attending physician had a sensitivity of 49% and specificity of 96 % for correct diagnosis. BNP > or = 100 pg/ml had a sensitivity of 90% and a specificity of 73% for correct diagnosis. In determining the correct diagnosis (congestive heart failure or not), adding BNP to clinical judgement would have enhanced diagnostic accuracy from 74% to 81%.
Measurement of BNP adds to the clinical information in the diagnosis of congestive heart failure in patients presenting with acute dyspnoea.
B型利钠肽（BNP）在左心室功能不全和充血性心力衰竭时升高。本研究的目的是确定BNP的诊断准确性以及BNP在心力衰竭诊断中对临床判断的补充程度。
BNP多国研究是一项在7个中心进行的前瞻性研究，共纳入1586例因急性呼吸困难就诊于急诊科的患者，患者到达时使用快速床旁检测设备测定BNP水平。1538例（97%）患者的充血性心力衰竭预测试概率由急诊科主治医师根据0 - 100%进行判定，该主治医师对BNP水平不知情。最终诊断由两名独立的心脏病专家裁定，他们也对BNP结果不知情，他们审查了所有临床数据并对充血性心力衰竭评分进行了标准化。
最终诊断为充血性心力衰竭的患者有722例（47%）。主治医师判定该疾病的预测试概率≥80%时，正确诊断的敏感性为49%，特异性为96%。BNP≥100 pg/ml时，正确诊断的敏感性为90%，特异性为73%。在确定正确诊断（是否为充血性心力衰竭）时，将BNP添加到临床判断中可使诊断准确性从74%提高到81%。
对于因急性呼吸困难就诊的患者，测定BNP可增加充血性心力衰竭诊断中的临床信息。
