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目的:探讨血浆氮-末端脑钠肽前体(NT-proBNP)水平检测在左室射血分数正常的心力衰竭(HF-NEF)诊断中的应用价值。方法:测定88例左室射血分数正常的原发性高血压(EH)患者与20例健康者的血浆NT-proBNP水平。比较不同舒张功能障碍程度患者血浆NT-proBNP水平变化;观察血浆NT-proBNP水平与EH患者NYHA心功能分级的关系。结果:血浆NT-proBNP水平与EH患者舒张功能障碍程度和NYHA心功能分级相关,血浆NT-proBNP水平随舒张功能障碍程度加重及NYHA心功能分级增加而升高。应用ROC曲线分析确定诊断HFNEF的血浆NT-proBNP最佳截断值为286ng/L,以此截断值诊断HFNEF的敏感性为90.5%,特异性为97.0%,阳性预测值为80.0%,阴性预测值为97.1%。结论:血浆NT-proBNP水平与EH患者左室舒张功能障碍程度及临床心功能状态相关;当血浆NT-proBNP水平≥286ng/L时,诊断HFNEF的敏感性、特异性、阳性预测值、阴性预测值均较高。
Objective: To investigate the value of plasma NT-proBNP level in the diagnosis of heart failure with normal left ventricular ejection fraction (HF-NEF). Methods: Plasma NT-proBNP levels were measured in 88 patients with essential hypertension (EH) with normal left ventricular ejection fraction and 20 healthy controls. The plasma levels of NT-proBNP in patients with different degree of diastolic dysfunction were compared. The relationship between plasma NT-proBNP level and NYHA functional class in patients with EH was observed. Results: The plasma levels of NT-proBNP correlated with the degree of diastolic dysfunction and NYHA functional class in patients with EH. The plasma NT-proBNP level increased with the increase of diastolic dysfunction and the NYHA class. The best cutoff value of plasma NT-proBNP for diagnosis of HFNEF was 286 ng / L by ROC curve analysis. The cutoff value of HFNEF was 90.5%, the specificity was 97.0%, the positive predictive value was 80.0%, the negative predictive value 97.1%. Conclusion: The level of NT-proBNP in plasma is related to the degree of left ventricular diastolic dysfunction and clinical cardiac function in patients with EH. The sensitivity, specificity, positive predictive value and negative predictive value of HFNEF in patients with NT-proBNP≥286ng / L Values are higher.