[血浆N末端B型利钠肽原在诊断既往心肌梗死患者心力衰竭中的价值]

[Value of plasma NT-proBNP for diagnosing heart failure in patients with previous myocardial infarction].

作者信息

Wei Bing-qi, Zhang Jian, Yang Yue-jin, Lü Rong, Zhang Yu-hui, Zhou Qiong, Gao Run-lin

机构信息

Chinese Academy of Medical Sciences, Beijing, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2012 Jan;40(1):34-8.

PMID:22490631

Abstract

OBJECTIVE

The study aimed to evaluate the value of plasma NT-proBNP in diagnosing heart failure in patients with previous myocardial infarction.

METHODS

Plasma concentration of NT-proBNP was measured in patients with previous myocardial infarction by ELISA method at admission. Patients were divided into non heart failure group (NYHA class I) and heart failure group (NYHA class II-IV). The NT-proBNP levels were compared between NYHA class I, II, III and IV, and between heart failure group and non heart failure group. ROC analyses were performed to evaluate the diagnosing value of plasma NT-proBNP for heart failure and to identify the optimal cut-off point for diagnosing heart failure patients.

RESULTS

Total 586 patients [aged from 25 - 83 (58 ± 11) years, 80% male] with previous myocardial infarction were enrolled in his study (n = 374 of NYHA class I, n = 99 of NYHA classes II, n = 82 of NYHA class III, n = 31 of NYHA class IV). Plasma NT-proBNP levels in these four NYHA classes were 484.7 (381.6, 647.8) pmol/L, 907.6 (516.6, 1290.3) pmol/L, 1420.2 (879.5, 2336.2) pmol/L, 2442.6 (1695.4, 3670.7) pmol/L, respectively (P < 0.01). The plasma NT-proBNP level in heart failure group was significantly higher than in non heart failure group [1148.2 (707.9, 2145.3) pmol/L vs. 484.7 (381.6, 647.8) pmol/L, P < 0.01]. Plasma NT-proBNP level in patients with age ≥ 60 years was significantly higher than patients with age < 60 years [702.3 (472.4, 1208.5) pmol/L vs. 526.6 (392.1, 855.6) pmol/L, P < 0.01]. ROC analysis showed that the area under the curve (AUC) for diagnosing heart failure was 0.844 (95%CI: 0.809 - 0.880, P < 0.01), the optimal plasma NT-proBNP cut-off point for diagnosing heart failure was 700 pmol/L with a sensitivity of 75.9%, a specificity of 79.9%, an accuracy of 78.3%, a positive predictive value of 67.9% and a negative predictive value of 85.3%. The optimal plasma NT-proBNP cut-off point was 600 pmol/L for patients ≥ 60 years old and 800 pmol/L for patients < 60 years old.

CONCLUSION

Plasma NT-proBNP level is a valuable parameter for diagnosing heart failure in patients with previous myocardial infarction.

摘要

目的

本研究旨在评估血浆N末端B型利钠肽原（NT-proBNP）在诊断既往心肌梗死患者心力衰竭中的价值。

方法

采用酶联免疫吸附测定（ELISA）法测定既往心肌梗死患者入院时血浆NT-proBNP浓度。将患者分为非心力衰竭组（纽约心脏协会心功能分级I级）和心力衰竭组（纽约心脏协会心功能分级II-IV级）。比较纽约心脏协会心功能分级I、II、III和IV级患者之间以及心力衰竭组和非心力衰竭组之间的NT-proBNP水平。进行ROC分析以评估血浆NT-proBNP对心力衰竭的诊断价值，并确定诊断心力衰竭患者的最佳截断点。

结果

本研究共纳入586例既往心肌梗死患者[年龄25 - 83（58±11）岁，80%为男性]（纽约心脏协会心功能分级I级374例，II级99例，III级82例，IV级31例）。这四个纽约心脏协会心功能分级患者的血浆NT-proBNP水平分别为484.7（381.6，647.8）pmol/L、907.6（516.6，1290.3）pmol/L、1420.2（879.5，2336.2）pmol/L、2442.6（1695.4，3670.7）pmol/L（P<0.01）。心力衰竭组的血浆NT-proBNP水平显著高于非心力衰竭组[1148.2（707.9，2145.3）pmol/L对484.7（381.6，647.8）pmol/L，P<0.01]。年龄≥60岁患者的血浆NT-proBNP水平显著高于年龄<60岁的患者[702.3（472.4，1208.5）pmol/L对526.6（392.1，855.6）pmol/L，P<0.01]。ROC分析显示，诊断心力衰竭的曲线下面积（AUC）为0.844（95%CI：0.809 - 0.880，P<0.01），诊断心力衰竭的最佳血浆NT-proBNP截断点为700 pmol/L，敏感性为75.9%，特异性为79.9%，准确性为78.3%，阳性预测值为67.9%，阴性预测值为85.3%。年龄≥60岁患者的最佳血浆NT-proBNP截断点为600 pmol/L，年龄<60岁患者为800 pmol/L。