Gegenhuber Alfons, Mueller Thomas, Dieplinger Benjamin, Lenz Kurt, Poelz Werner, Haltmayer Meinhard
Department of Internal Medicine, Konventhospital Barmherzige Brueder, Seilerstaette 2, 4021 Linz, Austria.
Chest. 2005 Aug;128(2):1003-9. doi: 10.1378/chest.128.2.1003.
To address the value of plasma B-type natriuretic peptide (BNP) concentrations as a diagnostic tool for determining the cardiac etiology of pleural effusions, and to determine possible differences of plasma BNP concentrations before and after pleurocentesis in patients with congestive heart failure (CHF).
Observational study.
Tertiary care hospital.
Consecutive series of 64 patients with indications for diagnostic pleurocentesis. The final diagnosis of the underlying disease was assessed by clinical criteria. Seven patients were excluded due to pleural effusions of equivocal origin or due to obvious hemothorax secondary to trauma.
Pleurocentesis attempting to drain effusions dry. Plasma BNP concentrations were measured directly before pleurocentesis and 24 h after the intervention. During these 24 h, the dosages of patients' medications were held constant.
In distinguishing between patients with pleural effusions caused by CHF (n = 31) and patients with pleural effusions attributable to other causes (n = 26), the area under the curve was 0.974 (SE, 0.021; 95% confidence interval, 0.892 to 0.997) for plasma BNP. A BNP cutoff concentration of 2,201 ng/L had a sensitivity of 77% and a specificity of 100% in the diagnosis of CHF. The median plasma BNP concentrations in patients with pleural effusions caused by CHF (n = 31) did not change within 24 h after pleurocentesis compared with the concentrations obtained before the procedure (before pleurocentesis, 3,227 ng/L; 24 h after pleurocentesis, 2,759 ng/L; p = 0.189), despite a median removal of 1,100 mL pleural fluid.
Plasma BNP concentrations of patients with pleural effusions of unknown origin may be an aid in the diagnosis of CHF as the underlying cause. If plasma BNP is used as a surrogate marker of global cardiac function, there is no indication of hemodynamic improvement caused by pleurocentesis alone in patients with CHF and pleural effusions.
探讨血浆B型利钠肽（BNP）浓度作为诊断胸腔积液心脏病因的诊断工具的价值，并确定充血性心力衰竭（CHF）患者胸腔穿刺术前、后血浆BNP浓度的可能差异。
观察性研究。
三级护理医院。
连续64例有诊断性胸腔穿刺指征的患者。根据临床标准评估基础疾病的最终诊断。7例患者因胸腔积液病因不明或因创伤继发明显血胸而被排除。
胸腔穿刺术试图将胸腔积液抽干。在胸腔穿刺术前及干预后24小时直接测定血浆BNP浓度。在这24小时内，患者的药物剂量保持不变。
在区分CHF所致胸腔积液患者（n = 31）和其他原因所致胸腔积液患者（n = 26）时，血浆BNP的曲线下面积为0.974（标准误，0.021；95%置信区间，0.892至0.997）。BNP临界浓度为2201 ng/L时，诊断CHF的敏感性为77%，特异性为100%。CHF所致胸腔积液患者（n = 31）的血浆BNP浓度中位数在胸腔穿刺术后24小时内与穿刺术前相比无变化（穿刺术前，3227 ng/L；穿刺术后24小时，2759 ng/L；p = 0.189），尽管胸腔积液中位数引流量为1100 mL。
不明原因胸腔积液患者的血浆BNP浓度可能有助于诊断CHF作为潜在病因。如果将血浆BNP用作整体心功能的替代标志物，对于CHF合并胸腔积液患者，没有迹象表明单纯胸腔穿刺术能改善血流动力学。
