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目的:评价血浆脑钠肽(BNP)对于鉴别心源性呼吸困难和非心源性呼吸困难的临床价值。方法:入选心源性呼吸困难患者68例,其中NYHAⅡ级患者20例,NYHAⅢ级患者30例,NYHAⅣ级患者18例;非心源性呼吸困难患者22例。24 h内检测血浆BNP水平,空腹血醛固酮、肾素、血管紧张素水平,48 h内心脏超声测量左心室舒张末期内径(LVEDD)、左室射血分数(LVEF),以及6 min步行距离等。结果:心源性呼吸困难患者血浆BNP水平、LVEDD明显高于非心源性呼吸困难患者。血浆BNP水平与LVEF及6 min步行距离呈显著负相关(r=-0.63,P<0.001;r=-0.70,P<0.001),与LVEDD、血醛固酮、肾素、血管紧张素水平呈显著正相关(r=0.61,P<0.001;r=0.37,P<0.001;r=0.48,P<0.001;r=0.27,P=0.01);Logistic回归分析显示,LVEDD、BNP、LVEF对心功能具有显著影响[OR=7.90,95%CI(5.74,10.52),P=0.01;OR=3.02,95%CI(1.69,5.06),P=0.02;OR=1.80,95%CI(1.20,2.55),P=0.01]。结论:血浆BNP水平可以作为鉴别心源性呼吸困难和非心源性呼吸困难的一个有价值的临床指标。
Objective: To evaluate the clinical value of plasma brain natriuretic peptide (BNP) in differentiating cardiogenic dyspnea and noncardiogenic dyspnea. Methods: A total of 68 patients with cardiogenic dyspnea were enrolled, including 20 NYHA class Ⅱ patients, 30 NYHA class Ⅲ patients and 18 NYHA class Ⅳ patients and 22 non-cardiac dyspnea patients. Plasma levels of BNP, fasting serum aldosterone, renin, angiotensin level, left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and distance of 6 min walking within 48 h . Results: Plasma BNP level and LVEDD in patients with cardiogenic dyspnea were significantly higher than those in non-cardiac dyspnea patients. Plasma BNP levels were significantly negatively correlated with LVEF and walking distance at 6 min (r = -0.63, P <0.001; r = -0.70, P <0.001), and positively correlated with LVEDD, serum aldosterone, renin and angiotensin (R = 0.61, P <0.001; r = 0.37, P <0.001; r = 0.48, P <0.001; r = 0.27, P = 0.01). Logistic regression analysis showed that LVEDD, BNP and LVEF were significantly correlated with cardiac function OR = 3.02, 95% CI (1.69, 5.06), P = 0.02; OR = 1.80, 95% CI (1.20, 2.55), P = 0.01]. Conclusions: Plasma BNP levels may be a valuable clinical marker for differential diagnosis of cardiogenic dyspnea and noncardiogenic dyspnea.