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目的:检测NT-proBNP浓度在呼吸困难鉴别诊断中的临床价值以及研究其对心衰病情严重程度的反应,以便为临床提供科学的并有价值的精准实验项目和方法。方法:收集2014年1月—2016年9月,因呼吸困难为主诉,在我院门急诊就诊或转院高淳区人民医院后,经诊断明确的患者158例。以弗雷明汉评分标准,胸X光片和心脏彩超以及治疗效果等诊断为心源性呼吸困难的组共108例,其中包括纽约心脏病协会提出的分类,心功能Ⅱ级共42例,心功能Ⅲ级共36例,心功能Ⅳ级共30例。依照病史和其他实验室检查未发现异常,而且没有心脏病肺淤血、扩大,心脏彩超基本正常等来判断非心源性呼吸困难组共47例。和我院健康体检合格的正常职工35例NT-proBNP浓度水平。结果:非心源性与心源性呼吸困难组、正常对照组血清NT-proBNP浓度水平比较,非心源性呼吸困难组血清氨基末端-B型利钠肽前体浓度水平显著低于心源性呼吸困难组(p<0.01),而心源性呼吸困难心功能三级间心衰患者的血浆血清氨基末端-B型利钠肽前体浓度水平也存在有显著差异。而且两组都是显著高于对照组(p<0.01),差异具有统计学意义。结论:NT-proBNP,一项新的心脏功能监测指标,可以精准地区分心源性与肺源性呼吸困难,同时也作为心衰病情的严重指标和治疗观察。很大程度上缩减了疑似患者的确诊时间,降低了医疗费用,很大程度上提高了急性呼吸困难患者的诊断与治疗水平。可以作为较好的初查、诊断及预后指标。
Objective: To detect the clinical value of NT-proBNP in the differential diagnosis of dyspnea and to study its response to the severity of heart failure in order to provide scientific and valuable clinical experimental projects and methods. Methods: From January 2014 to September 2016, 158 patients were diagnosed as patients with dyspnea as the chief complaint and hospitalized in our outpatient and emergency department or transferred to Gaochun District People’s Hospital. A total of 108 cases were diagnosed as cardiogenic dyspnea with Framingham score, chest X-ray and echocardiography, as well as the therapeutic effect. Among them, there were 42 cases classified by New York Heart Association, grade Ⅱ of heart function, A total of 36 cases of cardiac function Ⅲ grade, heart function Ⅳ a total of 30 cases. In accordance with the history and other laboratory tests found no abnormalities, and there is no heart disease lung congestion, enlargement, the basic normal of the heart color Doppler ultrasound to determine the non-cardiogenic dyspnea group a total of 47 cases. NT-proBNP levels were measured in 35 normal workers who passed the physical examination in our hospital. Results: Compared with the serum NT-proBNP levels in non-cardiac and cardiogenic dyspnea group and normal control group, the concentration of serum amino-terminal pro-B-type natriuretic peptide in non-cardiac dyspnea group was significantly lower than that in cardiac source Dyspnea group (p <0.01), while there was also a significant difference in plasma concentrations of amino-terminal pro-B-type natriuretic peptide between patients with cardiogenic dyspnea and cardiac dysfunction. And both groups were significantly higher than the control group (p <0.01), the difference was statistically significant. Conclusion: NT-proBNP, a new indicator of cardiac function, can accurately distinguish between cardiogenic and pulmonary-derived dyspnea, and also as a serious indicator and treatment of heart failure. To a large extent reduce the time of diagnosis of suspected patients, reducing medical costs, largely to improve the diagnosis and treatment of patients with acute dyspnea. Can be used as a good initial check, diagnosis and prognostic indicators.