Yang Shuangshuang, Li Linbin, Cao Ju, Yu Hongsong, Xu Huajian
Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China.
J Clin Lab Anal. 2015 Jan;29(1):37-42. doi: 10.1002/jcla.21724. Epub 2014 Mar 28.
Serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) is considered as an effective predictor for patients with heart failure (HF), while a strong body of evidence has found its utility in inflammatory diseases. It is difficult to differentiate HF and HF coexisting with other inflammations by measuring NT-proBNP. The aim of this study was to estimate the differential diagnostic performance of serum NT-proBNP in hospitalized HF patients with pneumonia. A prospective study was launched. Sixty nine HF patients, 51 HF patients complicated with pneumonia, and 38 patients with pneumonia were enrolled. Serum NT-proBNP levels were measured on Roche Elecsys. X-ray and the European Society of Cardiology (ESC) diagnostic principles were adopted to identify patients with pneumonia and HF, respectively. The diagnostic performance of NT-proBNP was assessed by ROC. Serum NT-proBNP [7,039(1,008-24,672) pg/ml] in patients of HF complicated with pneumonia was significantly higher than that in those of patients with single HF [3,147(616-24,062) pg/ml] or single pneumonia [911(98-3,812) pg/ml] (P < 0.0001). No correlation was found between the level of NT-proBNP and hospital stay. The area under ROC curve (AUC) of NT-proBNP for distinguishing patients of HF with pneumonia was 0.8082. At the level of 4,691 pg/ml, the optimal cutoff value, 74.5% sensitivity and 81.8% specificity of NT-proBNP were predicted. Evaluation of serum NT-proBNP is conducive for clinicians to identify patients of HF with pneumonia, but its poor efficacy in monitoring the curative therapy in this entire cohort is not recommended.
血清N末端B型利钠肽原（NT-proBNP）被认为是心力衰竭（HF）患者的有效预测指标，同时大量证据表明其在炎症性疾病中也有应用价值。通过测量NT-proBNP来区分HF以及合并其他炎症的HF存在困难。本研究旨在评估血清NT-proBNP在住院的合并肺炎的HF患者中的鉴别诊断性能。开展了一项前瞻性研究。纳入了69例HF患者、51例合并肺炎的HF患者以及38例肺炎患者。使用罗氏电化学发光免疫分析仪测定血清NT-proBNP水平。分别采用X线和欧洲心脏病学会（ESC）诊断标准来识别肺炎和HF患者。通过ROC曲线评估NT-proBNP的诊断性能。合并肺炎的HF患者的血清NT-proBNP[7,039（1,008 - 24,672）pg/ml]显著高于单纯HF患者[3,147（616 - 24,062）pg/ml]或单纯肺炎患者[911（98 - 3,812）pg/ml]（P < 0.0001）。未发现NT-proBNP水平与住院时间之间存在相关性。NT-proBNP区分合并肺炎的HF患者的ROC曲线下面积（AUC）为0.8082。在4,691 pg/ml的水平，即最佳截断值时，预测NT-proBNP的敏感性为74.5%，特异性为81.8%。评估血清NT-proBNP有助于临床医生识别合并肺炎的HF患者，但不建议其在监测整个队列的治疗效果方面应用，因为其效果不佳。
