Pleural Diseases Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, Institut de Recerca Biomèdica de Lleida, Lleida, Spain.
Curr Opin Pulm Med. 2011 Jul;17(4):215-9. doi: 10.1097/MCP.0b013e3283455cda.
The natriuretic peptides B-type natriuretic peptide (BNP) and NT-proBNP have been incorporated into the existing clinical guidelines for the diagnostic evaluation of heart failure. Recent evidence has provided important information regarding the relative value of each of these peptides to differentiate between pleural effusions caused by heart failure and those attributable to other causes.
In a meta-analysis of 10 studies, which included 1120 patients, pleural fluid levels of NT-proBNP had a pooled sensitivity and specificity of 94%, a positive likelihood ratio of 15.2, and a negative likelihood ratio of 0.06 in identifying heart failure-related effusions. Because pleural fluid and serum natriuretic peptide levels are closely correlated and display similar discriminatory properties, blood tests alone are sufficient. More than 85% of heart failure patients whose pleural fluids meet exudative criteria exhibit high pleural NT-proBNP concentrations. The diagnostic performance of pleural fluid BNP has been reported to be inferior to that of NT-proBNP.
NT-proBNP is an established biomarker of heart failure-associated effusions and the most effective tool for recognizing cardiac effusions that are misclassified as exudates by Light's criteria. If clinicians choose pleural fluid specimens for natriuretic peptide testing, the lower diagnostic accuracy of BNP makes it a poor substitute for NT-proBNP measurements.
利钠肽 B 型利钠肽（BNP）和氨基末端 proBNP（NT-proBNP）已被纳入现有的心力衰竭诊断评估临床指南。最近的证据提供了关于这些肽各自的相对价值的重要信息，有助于区分心力衰竭引起的胸腔积液和其他原因引起的胸腔积液。
在对 10 项研究的荟萃分析中，纳入了 1120 名患者，胸腔积液 NT-proBNP 水平在识别与心力衰竭相关的胸腔积液方面具有 94%的汇总敏感性和特异性、15.2 的阳性似然比和 0.06 的阴性似然比。由于胸腔液和血清利钠肽水平密切相关且具有相似的鉴别特性，因此仅进行血液检查就足够了。超过 85%的胸腔液符合渗出标准的心力衰竭患者表现出高浓度的胸腔 NT-proBNP。已经报道胸腔液 BNP 的诊断性能不如 NT-proBNP。
NT-proBNP 是心力衰竭相关胸腔积液的既定生物标志物，是识别 Light 标准分类为渗出液的心脏积液的最有效工具。如果临床医生选择胸腔液标本进行利钠肽检测，BNP 的诊断准确性较低，使其成为 NT-proBNP 测量的替代方法不佳。
