Hill Stephen A, Booth Ronald A, Santaguida P Lina, Don-Wauchope Andrew, Brown Judy A, Oremus Mark, Ali Usman, Bustamam Amy, Sohel Nazmul, McKelvie Robert, Balion Cynthia, Raina Parminder
Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada.
Heart Fail Rev. 2014 Aug;19(4):421-38. doi: 10.1007/s10741-014-9447-6.
Our purpose was to determine the test performance characteristics of BNP and NT-proBNP in the diagnosis of heart failure for patients presenting to an emergency department or urgent care center. We searched Medline, Embase, AMED, Cochrane, Cochrane Database of Systematic Reviews, and CINAHL for English-language articles published between 1989 and June 2012. Studies were limited to those using FDA-approved assays. We examined test performance at three pre-specified cutpoints (manufacturers' suggested, researchers' optimal, and lowest) and considered the effect of age, gender, ethnicity and renal function. We used the QUADAS-2 tool to examine risk of bias and applicability, and the AHRQ Methods Guide to assess the strength of evidence. Seventy-six articles met our inclusion criteria, 37 examined BNP, 25 examined NT-proBNP, and 14 examined both. Pooled sensitivity and specificity for BNP at the three pre-specified cutpoints were 95, 91, and 95 % (sensitivity) and 55, 80, and 67 % (specificity), respectively. For NT-proBNP, sensitivity and specificity at the same cutpoints were 91, 90, and 96 % (sensitivity) and 67, 74, and 55 % (specificity). Both BNP and NT-proBNP perform well to rule out, but less well to rule in, the diagnosis of heart failure among persons presenting to emergency departments or urgent care centers. Both BNP and NT-proBNP levels are positively associated with age and negatively associated with renal function. However, the effect of these factors with respect to selecting optimal cutpoints is unclear. For BNP, 100 pg/mL appears to be a consensus cutpoint. No clear consensus has emerged for NT-proBNP, but the age-adjusted cutpoints of 450 pg/mL for <50 years, 900 pg/mL for 50-75 years and 1,800 pg/mL for >75 years appear promising and merit greater scrutiny and validation.
我们的目的是确定B型利钠肽（BNP）和N末端B型利钠肽原（NT-proBNP）在急诊科或紧急护理中心就诊患者心力衰竭诊断中的检测性能特征。我们检索了Medline、Embase、AMED、Cochrane、Cochrane系统评价数据库和CINAHL，查找1989年至2012年6月发表的英文文章。研究仅限于使用美国食品药品监督管理局（FDA）批准的检测方法的研究。我们在三个预先设定的切点（制造商建议的、研究人员最佳的和最低的）检查检测性能，并考虑年龄、性别、种族和肾功能的影响。我们使用QUADAS-2工具检查偏倚风险和适用性，并使用美国医疗保健研究与质量局（AHRQ）方法指南评估证据强度。76篇文章符合我们的纳入标准，37篇研究了BNP，25篇研究了NT-proBNP，14篇同时研究了两者。在三个预先设定的切点处，BNP的合并敏感性和特异性分别为95%、91%和95%（敏感性）以及55%、80%和67%（特异性）。对于NT-proBNP，相同切点处的敏感性和特异性分别为91%、90%和96%（敏感性）以及67%、74%和55%（特异性）。在急诊科或紧急护理中心就诊的人群中，BNP和NT-proBNP在排除心力衰竭诊断方面表现良好，但在确诊方面表现较差。BNP和NT-proBNP水平均与年龄呈正相关，与肾功能呈负相关。然而，这些因素对选择最佳切点的影响尚不清楚。对于BNP，100 pg/mL似乎是一个共识切点。对于NT-proBNP尚未形成明确的共识，但年龄校正后的切点，即<50岁为450 pg/mL、50 - 75岁为900 pg/mL、>75岁为1800 pg/mL似乎很有前景，值得进一步深入研究和验证。
