Shaikh Kaleemullah, Ahmad Mansoor
Department of Cardiology, Liaquat National Hospital, Karachi.
J Coll Physicians Surg Pak. 2011 Oct;21(10):584-8. doi: 10.2011/JCPSP.584588.
To determine the diagnostic significance of plasma NT-proBNP estimation in patients presenting with acute dyspnea in Emergency Department.
An observational, cross sectional study.
From January to June 2008 at Liaquat National Hospital, Karachi.
In this study, 100 patients were selected with purposive non-probability sampling who had presented to the emergency department with acute dyspnea. Plasma NT-proBNP levels, chest X-ray and transthoracic echocardiography were performed at the time of admission. NT-proBNP levels were assessed by commercial tests. The clinical diagnosis of congestive heart failure, patient's hospital course and discharge diagnosis were cross-tabulated with NT-proBNP levels. The chi-square test for categorical data and Student's t-test for numerical data was applied at 0.05 level of significance to compare patients with and without heart failure (HF). Further comparative analysis between age groups was done by one way ANOVA test.
The mean NT-proBNP level among the 79 subjects with a final diagnosis of heart failure was 10918 compared with 461 pg/ml in those without heart failure (p=0.001). The diagnostic accuracy of NT-proBNP at a cutoff of 300 pg/milliliter (ml) was 100 percent. An optimal strategy to identify acute HF was to use age-related cut-points of 450 and 900 pg/ml for ages < 50 and > 50 years, which yielded 100% sensitivity and 86% specificity for acute HF. An age-independent cut-point of 300 pg/ml had 100% negative predictive value to exclude acute HF.
NT-proBNP is useful in establishing or excluding the diagnosis of congestive heart failure in patients with acute dyspnea.
确定急诊科急性呼吸困难患者血浆N末端脑钠肽前体（NT-proBNP）测定的诊断意义。
一项观察性横断面研究。
2008年1月至6月于卡拉奇利亚卡特国家医院。
本研究采用目的非概率抽样法选取100例因急性呼吸困难就诊于急诊科的患者。入院时检测血浆NT-proBNP水平、胸部X线及经胸超声心动图。NT-proBNP水平通过商业检测进行评估。将充血性心力衰竭的临床诊断、患者的住院病程及出院诊断与NT-proBNP水平进行交叉制表。采用卡方检验分析分类数据，采用学生t检验分析数值数据，以0.05的显著性水平比较有心力衰竭（HF）和无心力衰竭的患者。通过单因素方差分析对年龄组进行进一步的比较分析。
最终诊断为心力衰竭的79例患者的平均NT-proBNP水平为10918 pg/ml，而无心力衰竭患者为461 pg/ml（p = 0.001）。NT-proBNP在300 pg/毫升（ml）临界值时的诊断准确率为100%。识别急性HF的最佳策略是对于年龄<50岁和>50岁的患者分别采用450和900 pg/ml的年龄相关临界值，其对急性HF的敏感性为100%，特异性为86%。300 pg/ml的年龄独立临界值对排除急性HF具有100%的阴性预测价值。
NT-proBNP有助于对急性呼吸困难患者建立或排除充血性心力衰竭的诊断。
