Zhao S-Q, Hu Y-M, Li Q, Liu X-R, Wang M, Zhang W-Y, Wu T, Nie X-L, Zhao N, Wang L-R
Department of Cardiology, Second People's Hospital of Chengdu, Chengdu, China.
Int J Clin Pract. 2008 Feb;62(2):214-20. doi: 10.1111/j.1742-1241.2007.01591.x. Epub 2007 Dec 11.
B-type natriuretic peptide (BNP) is a cardiac neurohormone secreted from the cardiac ventricles in response to pressure overload.
To evaluate the optimal cutoff point of plasma BNP in diagnosing congestive heart failure (CHF).
We conducted a prospective study of 195 patients who were hospitalised with dyspnoea. Pulmonary capillary wedge pressure (PCWP) was measured with a Swan-Ganz catheterisation and plasma BNP level was obtained by a rapid immunofluorescence assay in all patients. PCWP >12 mmHg was chosen as the golden standard for left ventricular dysfunction in this study. The subjects were divided into two groups by the criteria, one group with dyspnoea caused by CHF (n=134) and the other caused by lung diseases (n=61).
(1) BNP cutoff point of 100 pg/ml had a sensitivity of 94.34%, a specificity of 92.13% and an accuracy of 93.33% for differentiating CHF from pulmonary dyspnoea. (2) By multiple logistic-regression analysis, measurements of BNP added significantly independent predictive power to other clinical variables in models predicting which patients had CHF.
A value of 100 pg/ml or more for a rapid BNP assay may be the most accurate independent predictor of the presence or absence of CHF.
B型利钠肽（BNP）是一种由心室分泌的心脏神经激素，其分泌是对压力超负荷的反应。
评估血浆BNP在诊断充血性心力衰竭（CHF）中的最佳截断点。
我们对195例因呼吸困难住院的患者进行了一项前瞻性研究。所有患者均通过Swan-Ganz导管插入术测量肺毛细血管楔压（PCWP），并通过快速免疫荧光测定法获得血浆BNP水平。本研究中，PCWP>12 mmHg被选为左心室功能不全的金标准。根据该标准将受试者分为两组，一组为CHF所致呼吸困难患者（n = 134），另一组为肺部疾病所致呼吸困难患者（n = 61）。
（1）BNP截断点为100 pg/ml时，鉴别CHF与肺源性呼吸困难的灵敏度为94.34%，特异度为92.13%，准确度为93.33%。（2）通过多因素逻辑回归分析，在预测哪些患者患有CHF的模型中，BNP测量值为其他临床变量增加了显著的独立预测能力。
快速BNP检测值≥100 pg/ml可能是CHF存在与否最准确的独立预测指标。
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