CAJ | 학술논문

目的：评价脑钠肽（ BNP）、N末端脑钠肽原（ NT－proBNP）对心力衰竭（ HF）的诊断价值。方法检索2010－01－01～2014－08－31在国内外公开发表的关于评价 BNP、NT －proBNP对HF的诊断价值的中英文文献，按照Cochrane Handbook推荐的诊断试验的纳入标准筛选文献。采用Meta分析软件对纳入文献汇总分析，获得汇总敏感度、特异度、阳性似然比、阴性似然比和诊断优势比及其95％CI，并绘制汇总受试者工作特征（ SROC）曲线、森林图。结果共纳入36篇文献。 Meta分析结果显示，BNP、NT－proBNP的合并敏感度分别为[0．91，95％CI （0．89，0．92）]、[0．86，95％CI （0．85，0．88）]；合并特异度分别为[0．88，95％CI （0．85，0．91）]、[0．92，95％CI （0．90，0．93）]；阳性似然比分别为[5．24，95％CI （4．20，6．54）]、[8．46，95％CI （6．80，10．52）]；阴性似然比分别为[0．16，95％CI （0．13，0．20）]、[0．18，95％CI （0．15，0．22）]；诊断优势比分别为[45．09，95％CI （26．22，77．55）]、[76．34，95％CI （39．15，148．87）]；SROC曲线下面积（AUC）分别为（AUC 0．9350，Q＝0．8712）、（AUC 0．9574，Q ＝0．9008）。结论 BNP、NT －proBNP检测是一种比较好的评价HF的无创性检查方法，BNP的敏感度高于NT－proBNP，NT－proBNP的特异度、似然比和诊断优势比高于BNP；若能联合BNP、NT－proBNP检测，对早期HF具有较高的诊断价值，但上述结论仍需要更多大样本、高质量的临床试验加以验证。
목적：평개뇌납태（ BNP）、N말단뇌납태원（ NT－proBNP）대심력쇠갈（ HF）적진단개치。방법검색2010－01－01～2014－08－31재국내외공개발표적관우평개 BNP、NT －proBNP대HF적진단개치적중영문문헌，안조Cochrane Handbook추천적진단시험적납입표준사선문헌。채용Meta분석연건대납입문헌회총분석，획득회총민감도、특이도、양성사연비、음성사연비화진단우세비급기95％CI，병회제회총수시자공작특정（ SROC）곡선、삼림도。결과공납입36편문헌。 Meta분석결과현시，BNP、NT－proBNP적합병민감도분별위[0．91，95％CI （0．89，0．92）]、[0．86，95％CI （0．85，0．88）]；합병특이도분별위[0．88，95％CI （0．85，0．91）]、[0．92，95％CI （0．90，0．93）]；양성사연비분별위[5．24，95％CI （4．20，6．54）]、[8．46，95％CI （6．80，10．52）]；음성사연비분별위[0．16，95％CI （0．13，0．20）]、[0．18，95％CI （0．15，0．22）]；진단우세비분별위[45．09，95％CI （26．22，77．55）]、[76．34，95％CI （39．15，148．87）]；SROC곡선하면적（AUC）분별위（AUC 0．9350，Q＝0．8712）、（AUC 0．9574，Q ＝0．9008）。결론 BNP、NT －proBNP검측시일충비교호적평개HF적무창성검사방법，BNP적민감도고우NT－proBNP，NT－proBNP적특이도、사연비화진단우세비고우BNP；약능연합BNP、NT－proBNP검측，대조기HF구유교고적진단개치，단상술결론잉수요경다대양본、고질량적림상시험가이험증。
Objective To systematically review the value of B -type natriuretic peptide (BNP) or N-terminal pro -brain natriuretic peptide ( NT-proBNP) in diagnosis of heart failure. Methods We searched literatures on randomized control trials of BNP or NT-proBNP in diagnosis of heart failure published at home and abroad from January 1st 2010 to August 31st 2014.The quality of inclusive literatures was assessed by methods from Cochrane Handbook.Valid data were analyzed by Meta-analysis Software in summary to obtain the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and the corresponding 95%CI.Summary receiver operating characteristic ( SROC) curve was performed and the area under the curve was calculated. Results We got 36 trials totally.Combined BNP and NT-proBNP for the diagnosis heart failure, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and the corresponding 95%CI were [0.91,95%CI (0.89,0.92)] and [0.86,95%CI (0.85,0.88)], [0.88,95%CI (0.85,0.91)] and [0.92,95%CI (0.90,0.93)], [5.24,95%CI (4.20,6.54)] and [8.46,95%CI (6.80,10.52)], [0.16,95%CI (0.13,0.20)] and [0.18,95%CI (0.15, 0.22)] and [45.09,95%CI (26.22,77.55)] and [76.34,95%CI (39.15,148.87)].BNP for the diagnosis of heart failure, the area under SROC curve was 0.9350 and Q index was 0.8712.NT -proBNP for the diagnosis of heart failure, the area under SROC curve was 0.9574 and Q index was 0.9008.Conclusion The BNP and NT -proBNP test is a highly accurate method without invasive examination to diagnose heart failure.The pooled sensitivity of BNP is higher than the NT-proBNP's. The pooled specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of NT-proBNP are higher than the BNP's.If we could detect the BNP and NT-proBNP at the same time, the diagnosis of early heart failure would have been more accurate.But these conclusions still need more large and high-quality clinical trials to verify.