【摘要】 目的　评估快速B型钠尿肽 (BNP)测定在老年人呼吸困难诊断及充血性心力衰竭(CHF)近期预后判断的意义。　方法　根据最后诊断将 2 92例老年呼吸困难患者分为 4组 :CHF组( 14 6例 )、肺病组 ( 75例 )、CHF +肺病组 ( 5 2例 )和非CHF +非肺病组 ( 19例 ) ,采用干式快速免疫荧光法定量测定全部患者的血浆BNP浓度。　结果　CHF组BNP水平为 ( 736± 381)ng/L ;肺病组为 ( 6 2± 37)ng/L ;CHF +肺病组为 ( 5 14± 32 7)ng/L ;非CHF +非肺病组为 ( 6 1± 2 9)ng/L。肺病组的BNP水平与非CHF +非肺病组差异无显著性 (P >0 0 5 ) ,其余各组间差异有显著性 (P <0 0 1)。心功能Ⅱ～Ⅳ级〔纽约心脏学会 (NYHA)分级〕的BNP水平分别为 ( 374± 2 2 1)ng/L、( 6 34± 336 )ng/L、( 96 4± 32 1)ng/L ,组间差异有显著性 (P <0 0 1)。BNP值等于 110ng/L为界值时预测CHF的准确性最强。经短期观察发现 ,CHF组 14 6例中有 2 1例发生心血管事件 ,其BNP水平显著高于无心血管事件患者〔( 110 9± 4 31)ng/L和 ( 6 73± 336 )ng/L ,P <0 0 1)〕。　 结论　快速测定血浆BNP有助于鉴别老年人呼吸困难病因 ,是一种判断CHF预后的客观性指标更多还原

【Abstract】 Objective To assess whether a rapid assay for B type natriuretic peptide(BNP) levels can differentiate cardiac from other causes of dyspnea in the elderly, and its short term prognostic value for congestive heart failure (CHF). Methods Plasma BNP were measured with a rapid fluorescence immunoassay in 292 elderly patients presenting to the hospital with dyspnea. The clinical diagnosis was adjudicated by one respiratory physician and two cardiololgists, who were blinded to the results of the BNP assay. The final diagnosis was as follows: the dyspnea was caused by CHF, or pulmonary disease (PD), or both CHF and PD, or other problems except CHF or PD. Results It was found that there were 146 patients with dyspnea in CHF group, and 75 patients with dyspnea in PD group among the 292 patients; there was no findings of CHF or PD in 19 patients, while 52 patients’ symptoms were caused by combination of CHF and PD. Their BNP levels was (736±381) ng/L, (62±37)ng/L, (61±29)ng/L, (514±327)ng/L, respectively. The BNP levels of CHF group were significantly higher than those of other groups(P<0 01). Plasma BNP levels increased significantly accordingly to different New York Hcart Association(NYHA) functional classes 〔class Ⅱ: (374±221)ng/L, class Ⅲ: (634±336)ng/L, classⅣ: (964±321)ng/L, P<0 01〕. The BNP cutoff point judged to be optimal for making the diagnosis of CHF was 110 ng/L by short period observation, 21 out of 146 patients with CHF developed cardiovascular events, whose BNP levels were significantly higher than other patients〔(1109±431)ng/L vs (673±336)ng/L, P<0 01〕. Conclusions Rapid testing of BNP can help differentiate etiology of dyspnea in the elderly, and plasma BNP is a useful prognostic biomarker in CHF.更多还原