Lüers Claus, Hagenah Gerrit, Wachter Rolf, Kleta Sibylle, Schaumberg Jens, Riedel Sebastian, Binder Lutz, Jung Klaus, Schmidt Albrecht, Pieske Burkert
Abteilung Innere Medizin - Kardiologie, Philipps-Universität Marburg, Marburg, Germany.
Med Klin (Munich). 2010 Sep;105(9):611-8. doi: 10.1007/s00063-010-1100-0. Epub 2010 Sep 28.
The basis for an optimal therapy of cardiopulmonary diseases is the assessment of an early diagnosis. This implies an evaluation of possible differential diagnoses of acute dyspnea. In numerous studies, natriuretic peptides were characterized as additional, meaningful parameters for the assessment of left ventricular function. Current studies could demonstrate that surfactant proteins B (SP-B) and D (SP-D) are of importance for the differentiation of patients with acute dyspnea. The aim of this study was to compare the values of NT-proBNP (N-terminal brain natriuretic peptide) and surfactant proteins for the assessment of a final diagnosis in patients with acute dyspnea.
NT-proBNP, SP-B and SP-D were measured in 81 patients with acute dyspnea in the emergency room and were correlated with clinical and echocardiographic parameters with respect to the final diagnosis. For this, patients were classified with respect to clinical and echocardiographic parameters in different subgroups concerning the final diagnosis of acute dyspnea.
In patients with a cardiac origin of acute dyspnea, plasma levels of NT-proBNP were significantly higher as compared to patients with a noncardiac diagnosis (p = 0.04). SP-D was highest in patients with a cardiac origin of acute dyspnea, but after performing regression analysis it seems to be of less importance for the differential diagnosis of acute dyspnea as compared to NT-proBNP. SP-B plasma levels were not different between the four subgroups.
NT-proBNP is of importance for the differential diagnosis of acute dyspnea. Although SP-D shows similar changes of plasma levels between the four subgroups, it seems to be of less importance for the differential diagnosis of acute dysnea. SP-B occurs to be of no relevance for the differentiation between cardiac and noncardiac origin of acute dyspnea.
心肺疾病最佳治疗的基础是早期诊断评估。这意味着要对急性呼吸困难的可能鉴别诊断进行评估。在众多研究中，利钠肽被确定为评估左心室功能的额外重要参数。当前研究表明，表面活性蛋白B（SP - B）和D（SP - D）对于急性呼吸困难患者的鉴别诊断具有重要意义。本研究的目的是比较NT - proBNP（N末端脑利钠肽）和表面活性蛋白在评估急性呼吸困难患者最终诊断中的价值。
对81例急诊室急性呼吸困难患者测定NT - proBNP、SP - B和SP - D，并将其与最终诊断的临床和超声心动图参数进行关联。为此目的，根据临床和超声心动图参数将患者就急性呼吸困难的最终诊断分为不同亚组。
急性呼吸困难源于心脏的患者，其血浆NT - proBNP水平显著高于非心脏诊断患者（p = 0.04）。SP - D在急性呼吸困难源于心脏的患者中最高，但进行回归分析后发现，与NT - proBNP相比，其对急性呼吸困难鉴别诊断的重要性似乎较低。四个亚组之间的SP - B血浆水平无差异。
NT - proBNP对急性呼吸困难的鉴别诊断具有重要意义。尽管SP - D在四个亚组之间的血浆水平有类似变化，但其对急性呼吸困难鉴别诊断的重要性似乎较低。SP - B在急性呼吸困难的心脏源性与非心脏源性鉴别中似乎无关。
