CAJ | 학술논문

目的探讨氨基端前腩钠肽(NT-proBNP)在不同年龄段评价心功能的界值选择.方法 48例心功能不全(NYHA Ⅰ-Ⅳ)患者来自复旦大学附属中山医院急诊科.入选标准:有器质性心脏疾病基础;心功能(NYI-IA)Ⅰ-Ⅳ级.所有患者均排除急性冠脉综合征、持续性房颤、肺气肿、肺栓塞、慢性肾功能不全、贫血、甲状腺功能异常以及肿瘤患者.按年龄是否超过75岁分两组,高龄组(n=18)和非高龄组(n=30),并按NYHA标准进行心功能分级.测定患者血NT-proBNP,分析高龄组和非高龄组心功能分级与NT-proBNP之间的关系,分析利用心功能分级参考值作为鉴别急性心源性呼吸困难界值的可行性.计量数据以均数±标准差表示.两组间差异的显著性分析用t检验,多组间差异的显著性分析用方差分析.P＜0.05具有统计学意义.数据分析使用统计软件SPSS11.0.结果研究对象的NT-proBNP与心功能分级、左心室射血分数(LVEF)关系密切.非高年龄组的NT-proBNP值较高龄组高,在心功能Ⅱ、Ⅳ级水平,两组NT-proBNP相比,差异具有统计学意义[(407±277)vs.(1358±967),P＜0.05;(727±1342)vs.(9031±2363),P＜0.01].在心功能Ⅲ级水平,尽管高龄组的NT-proBNP值更高,但组间没有显著性差异(P=0.067).NT-proBNP检测严重症状性心衰(NYHAⅢ-Ⅳ级)的受试者工作特性曲线下面积为0.958,界值525 pg/ml,敏感性100%,特异性76%;界值1911pg/ml,敏感性73%,特异性96%.高龄患者NT-proBNP检测严重症状性心衰(NYHA Ⅲ-Ⅳ级)的受试者工作特性曲线下面积为0.922,界值849 pg/ml,敏感性100%,特异性57%;界值2990 pg/ml,敏感性81%,特异性100%.结论心功能分级的NT-proBNP参考值存在年龄组间差异.笔者建议对高龄患者选择更高的NT-proBNP参考值评价心功能状况,选择更高的界值鉴别急性心源性呼吸困难.
목적 탐토안기단전남납태(NT-proBNP)재불동년령단평개심공능적계치선택.방법 48례심공능불전(NYHA Ⅰ-Ⅳ)환자래자복단대학부속중산의원급진과.입선표준:유기질성심장질병기출;심공능(NYI-IA)Ⅰ-Ⅳ급.소유환자균배제급성관맥종합정、지속성방전、폐기종、폐전새、만성신공능불전、빈혈、갑상선공능이상이급종류환자.안년령시부초과75세분량조,고령조(n=18)화비고령조(n=30),병안NYHA표준진행심공능분급.측정환자혈NT-proBNP,분석고령조화비고령조심공능분급여NT-proBNP지간적관계,분석이용심공능분급삼고치작위감별급성심원성호흡곤난계치적가행성.계량수거이균수±표준차표시.량조간차이적현저성분석용t검험,다조간차이적현저성분석용방차분석.P＜0.05구유통계학의의.수거분석사용통계연건SPSS11.0.결과 연구대상적NT-proBNP여심공능분급、좌심실사혈분수(LVEF)관계밀절.비고년령조적NT-proBNP치교고령조고,재심공능Ⅱ、Ⅳ급수평,량조NT-proBNP상비,차이구유통계학의의[(407±277)vs.(1358±967),P＜0.05;(727±1342)vs.(9031±2363),P＜0.01].재심공능Ⅲ급수평,진관고령조적NT-proBNP치경고,단조간몰유현저성차이(P=0.067).NT-proBNP검측엄중증상성심쇠(NYHAⅢ-Ⅳ급)적수시자공작특성곡선하면적위0.958,계치525 pg/ml,민감성100%,특이성76%;계치1911pg/ml,민감성73%,특이성96%.고령환자NT-proBNP검측엄중증상성심쇠(NYHA Ⅲ-Ⅳ급)적수시자공작특성곡선하면적위0.922,계치849 pg/ml,민감성100%,특이성57%;계치2990 pg/ml,민감성81%,특이성100%.결론 심공능분급적NT-proBNP삼고치존재년령조간차이.필자건의대고령환자선택경고적NT-proBNP삼고치평개심공능상황,선택경고적계치감별급성심원성호흡곤난.
Objective To investigate the cut-off value of N-terminal portion of pro-brain nairiuretic peptid (NT-proBNP)for detecting various degrees of heart failure(HF)at different ages.Method Totally 48 patients with cardiac dysfunction(NYHA Ⅰ-Ⅳ)were from Department of Emergency Nedicine of Zhongshan Hospital Fudan University.The inclusion criteria inclued:organic heart disease,cardiac dysfunction(NYHA Ⅰ-Ⅳ).The exclusion criteria included:acute coronary syndrome,continuous atrial fibrillation,pulmonary emphysema,lung embolism,chronic renal insufficiency,anaemia,abnormal function of glandula thyreoidea,and tumor.The NT- proBNP was studied in order to find out the relevance of NT-proBNP to the classification of HF among patients aged over75 years old(age≥75 years)and patients aged below 75 years old(age＜75 years).Moreover,the NT- proBNP values were used to differentiate acute cardiogenic dyspnea.The data were expressed as(x±s)and ana- lyzed using analysis of variance and Student's t test with SPSS 11.0.A P value less than 0.05 indicated statistical significance.Results The analysis of NT-proBNP levels showed the leveis of it were associated with the grades of cardiac function and left ventricular ejection fraction(LVEF).NT-proBNP levels in patients aged over 75 years were higher than those in patients aged below 75 years.When patients wele of NYI-IA Ⅱ grade and NYHA Ⅳ grade,the levels of NT-proBNP showed signitieant differences between two sorts of patients(407±277 vs.1358± 967 P＜0.05;3727±1342 vs.9031±2363,P＜0.01).The cut-off value of NT-proBNP determined in 48 patients was at 525 pg/ml(AUC=0.958,sensitivity 100%,specificity 76%),at 1911 pg/ml(sensitivity 73%, specificity 96%)in patients with NYHA Ⅱgrade,which were used to identify severe symptomatic heart failure.The cut-off value of NT-proBNP determined in patients aged over 75 yeats was 849pg/ml(AUC=0.922,sensitivity 100%,s pecificity 57%),at 2990 pg/ml(semitivity 81%,specificity 100%)in patients with NYHA Ⅳ grade.Cobckysions NT-proBNP levels are associated with grades of cardiac functions limit of 75 years.It suggests that higher NT-proBNP value in patients aged over 75 years should be considered to evaluate caidiac function and identify acute cardiac dyspnea.