Fuat Ahmet, Murphy Jeremy J, Hungin A Pali S, Curry Jane, Mehrzad Ali A, Hetherington Andrew, Johnston Jennifer I, Smellie W Stuart A, Duffy Victoria, Cawley Patricia
Department of Medicine, Darlington Memorial Hospital, Centre for Integrated Health Care Research, University of Durham, Darlington Primary Care Trust.
Br J Gen Pract. 2006 May;56(526):327-33.
National guidelines suggest the use of natriuretic peptides in suspected heart failure but there have been no studies comparing assays in primary care.
To test and compare the diagnostic accuracy and utility of B-type natriuretic peptide (BNP) and N-terminal B-type natriuretic peptide (NT proBNP) in diagnosing heart failure due to left ventricular systolic dysfunction in patients with suspected heart failure referred by GPs to one-stop diagnostic clinics.
Community cohort, prospective, diagnostic accuracy study.
One-stop diagnostic clinics in Darlington Memorial and Bishop Auckland General Hospitals and general practices in South Durham.
Two hundred and ninety-seven consecutive patients with symptoms and signs suggestive of heart failure referred from general practice.
The study measured sensitivity, specificity, positive and negative predictive values (PPV, NPV), and area under receiver operating characteristic curve for BNP (near patient assay) and NT proBNP (laboratory assay) in diagnosis of heart failure due to left ventricular systolic dysfunction. The NPV of both assays was determined as a potential method of reducing the number of referrals for echocardiography.
One hundred and fourteen of the 297 patients had left ventricular systolic dysfunction (38%). At the manufacturer's recommended cut-off of 100 pg/ml BNP gave a NPV of 82%. BNP performed better at a cut-off of 40 pg/ml with a NPV of 88%. At a cut-off of 150 pg/ml, NT proBNP gave a NPV of 92%. Using cut-offs of 40 pg/ml and 150 pg/ml for BNP and NT pro-BNP, respectively, could have prevented 24% and 25% of referrals to the clinic, respectively.
In this setting, NT pro-BNP performed marginally better than BNP, and would be easier to use practically in primary care. A satisfactory cut-off has been identified, which needs validating in general practice. NT pro-BNP could be used to select referrals to a heart failure clinic or for echocardiography. This process needs testing in real-life general practice.
国家指南建议在疑似心力衰竭时使用利钠肽，但尚无在初级保健中比较检测方法的研究。
测试并比较B型利钠肽（BNP）和N末端B型利钠肽原（NT proBNP）在诊断由全科医生转诊至一站式诊断诊所的疑似心力衰竭患者左心室收缩功能障碍所致心力衰竭时的诊断准确性和实用性。
社区队列、前瞻性诊断准确性研究。
达灵顿纪念医院和奥克兰主教总医院的一站式诊断诊所以及南达勒姆的全科诊所。
297例连续从全科诊所转诊而来、有提示心力衰竭症状和体征的患者。
本研究测量了BNP（即时检测）和NT proBNP（实验室检测）诊断左心室收缩功能障碍所致心力衰竭的敏感性、特异性、阳性和阴性预测值（PPV、NPV）以及受试者工作特征曲线下面积。确定两种检测方法的NPV作为减少超声心动图转诊数量的潜在方法。
297例患者中有114例存在左心室收缩功能障碍（38%）。按照制造商推荐的100 pg/ml的临界值，BNP的NPV为82%。BNP在40 pg/ml的临界值时表现更好，NPV为88%。NT proBNP在150 pg/ml的临界值时，NPV为92%。分别使用40 pg/ml和150 pg/ml的临界值用于BNP和NT proBNP，可分别避免24%和25%的患者转诊至诊所。
在本研究环境中，NT proBNP的表现略优于BNP，且在初级保健中实际应用会更简便。已确定了一个令人满意的临界值，需要在全科医疗中进行验证。NT proBNP可用于选择转诊至心力衰竭诊所或进行超声心动图检查的患者。这一过程需要在实际的全科医疗中进行测试。
