NT-proBNP定量檢測在心力衰竭實驗室診斷中的應用_《中國循證醫學雜志》

作者：

蔡蓓 ¹ , 王蘭蘭 ¹ , 劉瑾 ¹ , 黃德嘉 ² , 劉興斌 ² , 李立新 ¹ , 唐江淘 ¹

1. 四川大學華西醫院實驗醫學科,成都,6100412. 四川大學華西醫院心內科;

關鍵詞：

N末端腦鈉尿肽前體心力衰竭診斷性試驗

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目的　評價血清N末端腦鈉尿肽前體(NT-proBNP)定量檢測對不同程度心力衰竭患者的實驗診斷價值,以及血清NT-proBNP水平與心功能間的相關性.
方法　采用電化學發光檢測儀Elecsys 2010定量檢測,分析不同心功狀態的心力衰竭患者血清NT-proBNP水平.
結果　①血清NT-proBNP診斷心力衰竭的ROC曲線的曲線下面積(AUC)為0.880(P lt;0.01),以155 pg/ml作為界值,其敏感性、特異性均為81%,陽性似然比為4.25,而當NT-proBNP水平 gt;350 pg/ml時,陽性似然比可增至14.32;②心衰患者血清NT-proBNP水平明顯增高,與心功能正常的心臟病患者比較有顯著性差異(P lt;0.05),血清NT-proBNP含量隨著心力衰竭程度加重呈指數增加,NT-proBNP水平和心臟功能狀態的秩相關性系數為0.859(P lt;0.01);③中國漢族人和歐洲人心功分級采用相同標準,但NT-proBNP水平的表達程度不同.
結論　血清NT-proBNP定量檢測是目前評價心力衰竭患者心功能狀態較好的實驗室指標,能夠用于心力衰竭臨床診斷.

引用本文： 蔡蓓,王蘭蘭,劉瑾,黃德嘉,劉興斌,李立新,唐江淘. NT-proBNP定量檢測在心力衰竭實驗室診斷中的應用. 中國循證醫學雜志, 2005, 05(3): 224-228. doi: 復制

1.	［1］Berendes E, Schmidt C, Van Aken H, Hartlage MG, Rothenburger M, Wirtz S, Scheld HH, Brodner G, Walter M. A-type and B-type natriuretic peptides in cardiac surgical procedures[J]. Anesth Analg, 2004; 98(1): 11-19.
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3.	［3］Mueller T, Gegenhuber A, Poelz W, Haltmayer M. Biochemical diagnosis of impaired left ventricular ejection fraction--comparison of the diagnostic accuracy of brain natriuretic peptide (BNP) and amino terminal proBNP (NT-proBNP)[J]. Clin Chem Lab Med, 2004; 42(2): 159-163.
4.	［4］Meune C, Martins E, Fulla Y, Bergmann JF, Devaux JY, Mourad JJ. New biological markers for acute coronary artery disease [J]. J Mal Vasc, 2003; 28(5): 251-257.
5.	［5］Prontera C, Emdin M, Zucchelli GC, Ripoli A, Passino C, Clerico A. Analytical performance and diagnostic accuracy of a fully-automated electrochemiluminescent assay for the N-terminal fragment of the pro-peptide of brain natriuretic peptide in patients with cardiomyopathy: comparison with immunoradiometric assay methods for brain natriuretic peptide and atrial natriuretic peptide[J]. Clin Chem Lab Med, 2004; 42(1): 37-44.
6.	［6］Pfister R, Scholz M, Wielckens K, Erdmann E, Schneider CA. Use of NT-proBNP in routine testing and comparison to BNP[J]. Eur J Heart Fail, 2004; 6(3): 289-293.
7.	［7］Vanderheyden M, Bartunek J, Goethals M. Brain and other natriuretic peptides: molecular aspects[J]. Eur J Heart Fail, 2004; 6(3): 261-268.
8.	［8］Richards AM, Doughty R, Nicholls MG, MacMahon S, Sharpe N, Murphy J, Espiner EA, Frampton C, Yandle TG; Australia-New Zealand Heart Failure Group. Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin: prognostic utility and prediction of benefit from carvedilol in chronic ischemic left ventricular dysfunction. Australia-New Zealand Heart Failure Group[J]. J Am Coll Cardiol, 2001; 37(7): 1 781-1 787.
9.	［9］Wu X, Seino Y, Ogura H, Fukuma N, Katoh T, Takano T. Plasma natriuretic peptide levels and daily physical activity in patients with pacemaker implantation[J]. Jpn Heart J, 2001; 42(4): 471-482.
10.	［10］Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham WT, Wu AH, Clopton P, Steg PG, Westheim A, Knudsen CW, Perez A, Kazanegra R, Herrmann HC, McCullough PA; Breathing Not Properly Multinational Study Investigators. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure[J]. N Engl J Med, 2002; 347(3): 161-167.
11.	［11］McCullough PA, Nowak RM, McCord J, Hollander JE, Herrmann HC, Steg PG, Duc P, Westheim A, Omland T, Knudsen CW, Storrow AB, Abraham WT, Lamba S, Wu AH, Perez A, Clopton P, Krishnaswamy P, Kazanegra R, Maisel AS. B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) Multinational Study[J]. Circulation, 2002; 106(4): 416-422.
12.	［12］Bay M, Kirk V, Parner J, Hassager C, Nielsen H, Krogsgaard K, Trawinski J, Boesgaard S, Aldershvile J. NT-proBNP: a new diagnostic screening tool to differentiate between patients with normal and reduced left ventricular systolic function[J]. Heart, 2003; 89(2): 150-154.
13.	［13］Omland T, Persson A, Ng L, O’Brien R, Karlsson T, Herlitz J, Hartford M, Caidahl K. N-terminal pro-B-type natriuretic peptide and long-term mortality in acute coronary syndromes[J]. Circulation, 2002; 106(23): 2 913-2 918.
14.	［14］Jernberg T, Stridsberg M, Venge P, Lindahl B. N-terminal pro brain natriuretic peptide on admission for early risk stratification of patients with chest pain and no ST-segment elevation[J]. J Am Coll Cardiol, 2002; 40(3): 437-445.

1. ［1］Berendes E, Schmidt C, Van Aken H, Hartlage MG, Rothenburger M, Wirtz S, Scheld HH, Brodner G, Walter M. A-type and B-type natriuretic peptides in cardiac surgical procedures[J]. Anesth Analg, 2004; 98(1): 11-19.
2. ［2］Mair J, Hammerer-Lercher A, Puschendorf B. The impact of cardiac natriuretic peptide determination on the diagnosis and management of heart failure[J]. Clin Chem Lab Med, 2001; 39(7): 571-588.
3. ［3］Mueller T, Gegenhuber A, Poelz W, Haltmayer M. Biochemical diagnosis of impaired left ventricular ejection fraction--comparison of the diagnostic accuracy of brain natriuretic peptide (BNP) and amino terminal proBNP (NT-proBNP)[J]. Clin Chem Lab Med, 2004; 42(2): 159-163.
4. ［4］Meune C, Martins E, Fulla Y, Bergmann JF, Devaux JY, Mourad JJ. New biological markers for acute coronary artery disease [J]. J Mal Vasc, 2003; 28(5): 251-257.
5. ［5］Prontera C, Emdin M, Zucchelli GC, Ripoli A, Passino C, Clerico A. Analytical performance and diagnostic accuracy of a fully-automated electrochemiluminescent assay for the N-terminal fragment of the pro-peptide of brain natriuretic peptide in patients with cardiomyopathy: comparison with immunoradiometric assay methods for brain natriuretic peptide and atrial natriuretic peptide[J]. Clin Chem Lab Med, 2004; 42(1): 37-44.
6. ［6］Pfister R, Scholz M, Wielckens K, Erdmann E, Schneider CA. Use of NT-proBNP in routine testing and comparison to BNP[J]. Eur J Heart Fail, 2004; 6(3): 289-293.
7. ［7］Vanderheyden M, Bartunek J, Goethals M. Brain and other natriuretic peptides: molecular aspects[J]. Eur J Heart Fail, 2004; 6(3): 261-268.
8. ［8］Richards AM, Doughty R, Nicholls MG, MacMahon S, Sharpe N, Murphy J, Espiner EA, Frampton C, Yandle TG; Australia-New Zealand Heart Failure Group. Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin: prognostic utility and prediction of benefit from carvedilol in chronic ischemic left ventricular dysfunction. Australia-New Zealand Heart Failure Group[J]. J Am Coll Cardiol, 2001; 37(7): 1 781-1 787.
9. ［9］Wu X, Seino Y, Ogura H, Fukuma N, Katoh T, Takano T. Plasma natriuretic peptide levels and daily physical activity in patients with pacemaker implantation[J]. Jpn Heart J, 2001; 42(4): 471-482.
10. ［10］Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham WT, Wu AH, Clopton P, Steg PG, Westheim A, Knudsen CW, Perez A, Kazanegra R, Herrmann HC, McCullough PA; Breathing Not Properly Multinational Study Investigators. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure[J]. N Engl J Med, 2002; 347(3): 161-167.
11. ［11］McCullough PA, Nowak RM, McCord J, Hollander JE, Herrmann HC, Steg PG, Duc P, Westheim A, Omland T, Knudsen CW, Storrow AB, Abraham WT, Lamba S, Wu AH, Perez A, Clopton P, Krishnaswamy P, Kazanegra R, Maisel AS. B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) Multinational Study[J]. Circulation, 2002; 106(4): 416-422.
12. ［12］Bay M, Kirk V, Parner J, Hassager C, Nielsen H, Krogsgaard K, Trawinski J, Boesgaard S, Aldershvile J. NT-proBNP: a new diagnostic screening tool to differentiate between patients with normal and reduced left ventricular systolic function[J]. Heart, 2003; 89(2): 150-154.
13. ［13］Omland T, Persson A, Ng L, O’Brien R, Karlsson T, Herlitz J, Hartford M, Caidahl K. N-terminal pro-B-type natriuretic peptide and long-term mortality in acute coronary syndromes[J]. Circulation, 2002; 106(23): 2 913-2 918.
14. ［14］Jernberg T, Stridsberg M, Venge P, Lindahl B. N-terminal pro brain natriuretic peptide on admission for early risk stratification of patients with chest pain and no ST-segment elevation[J]. J Am Coll Cardiol, 2002; 40(3): 437-445.

《中國循證醫學雜志》

NT-proBNP定量檢測在心力衰竭實驗室診斷中的應用

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《中國循證醫學雜志》

NT-proBNP定量檢測在心力衰竭實驗室診斷中的應用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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