CAJ | 학술논문

目的探讨尿液BNP水平对慢性心力衰竭的诊断价值。方法采用微粒酶免疫测定法检测83例慢性心力衰竭患者（NYHAⅠ ～Ⅳ级）和30名健康对照者的尿液和血浆BNP浓度，同时采用NYHA标准对心功能进行分级，并用超声心动图检查评定患者心功能。结果慢性心力衰竭组尿液BNP水平为[90.0(38.3～209.5)]ng/L，血浆BNP水平为[680.0(289.7 ～ 1543.5)]ng/L，明显高于健康对照组的[17.0（13.0 ～33.0）]ng/L和[84.5(56.0～158.0)]ng/L，差异均有统计学意义（U值分别为207.5、71.0，P均＜0.01）。随心功能NYHA分级的增高，尿液BNP水平逐渐升高。尿液BNP水平与血浆BNP水平呈正相关(r=0.842,P＜0.01)，与NYHA分级呈正相关(r =0.742，P＜0.01)，与LVEF呈负相关（r=-0.801，P＜0.01）。LVEF＜ 40％患者的尿液BNP水平为[143.0(85.0 ～258.0)]ng/L，LVEF≥40％患者的尿液BNP水平为[31.5(17.3～38.8)]ng/L，差异有统计学意义(U=80.0,P＜0.01)。以36.5 ng/L为临界值时，尿液BNP诊断慢性心力衰竭的敏感度为84％，特异度为80％。结论尿液BNP对慢性心力衰竭的诊断有重要意义，与血浆BNP具有相似的诊断价值。
목적 탐토뇨액BNP수평대만성심력쇠갈적진단개치。방법채용미립매면역측정법검측83례만성심력쇠갈환자（NYHAⅠ ～Ⅳ급）화30명건강대조자적뇨액화혈장BNP농도，동시채용NYHA표준대심공능진행분급，병용초성심동도검사평정환자심공능。결과만성심력쇠갈조뇨액BNP수평위[90.0(38.3～209.5)]ng/L，혈장BNP수평위[680.0(289.7 ～ 1543.5)]ng/L，명현고우건강대조조적[17.0（13.0 ～33.0）]ng/L화[84.5(56.0～158.0)]ng/L，차이균유통계학의의（U치분별위207.5、71.0，P균＜0.01）。수심공능NYHA분급적증고，뇨액BNP수평축점승고。뇨액BNP수평여혈장BNP수평정정상관(r=0.842,P＜0.01)，여NYHA분급정정상관(r =0.742，P＜0.01)，여LVEF정부상관（r=-0.801，P＜0.01）。LVEF＜ 40％환자적뇨액BNP수평위[143.0(85.0 ～258.0)]ng/L，LVEF≥40％환자적뇨액BNP수평위[31.5(17.3～38.8)]ng/L，차이유통계학의의(U=80.0,P＜0.01)。이36.5 ng/L위림계치시，뇨액BNP진단만성심력쇠갈적민감도위84％，특이도위80％。결론 뇨액BNP대만성심력쇠갈적진단유중요의의，여혈장BNP구유상사적진단개치。
Objective To investigate the value of urinary BNP for diagnosis of chronic heart failure (CHF). Methods The levels of Urinary BNP and plasma BNP were measured by microparticle enzyme immunoassay (MEIA) in 83 patients with CHF and 30 control subjects. The heart function was classified according to the NYHA criteria. Left ventricular ejection fractions (LVEF) were measured by echocardiology. Results The level of urinary BNP in patients with CHF was[90. 0(38. 3 -209. 5 )]ng/L and the level of plasma BNP was[680. 0 ( 289. 7 - 1543.5)]ng/L, both of them were much higher than those in healthy subjects,[17. 0 ( 13.0 - 33. 0)]ng/L and[84. 5 ( 56. 0 - 158.0 )]ng/L, respectively (P＜0. 01 ). The concentrations of urinary BNP increased gradually with more severe symptoms ( NYHA cl ass Ⅰ -ⅣV ). The level of urinary BNP was positively correlated with NYHA class ( r = 0. 742, P ＜ 0. 01 )and the level of plasma BNP (r =0. 842,P ＜0. 01 ) while negatively related with LVEF (r = -0. 801 ,P ＜0. 01 ). The level of urinary BNP in patients with LVEF ＜ 40％ was[143.0 ( 85. 0 - 258.0)]ng/L , which was much higher than that in patients with LVEF≥40％ ,[31.5( 17.3 -38. 8)]ng/L, (P ＜0. 01 ). At a decision threshold of 36. 5 ng/L, the urine BNP assay demonstrated a clinical sensitivity and specificity of 84％ and 80％ ,respectively. In this study,the area under the curve(AUC) was 0. 905. Conclusion Urinary BNP is a new candidate marker for the diagnosis of CHF,it provides a similar accuracy with plasma BNP.