Brain natriuretic peptide and N-terminal brain natriuretic peptide in the diagnosis of heart failure in patients with acute shortness of breath
Brain natriuretic peptide and N-terminal brain natriuretic peptide in the diagnosis of heart failure in patients with acute shortness of breath
复制标题
DOI：
10.1016/s0735-1097(03)00787-3
复制
发表时间：
2003-08-20
影响因子：
24
通讯作者：
Richards, AM
中科院分区：
文献类型：
--
作者：
Lainchbury, JG;Campbell, E;Richards, AM
本研究旨在比较血浆脑利钠肽（BHP）和N-末端脑利钠肽（N-BHP）在诊断急性呼吸困难患者心力衰竭（HF）中的效用。背景血浆BNP在急诊科鉴别HF与其他呼吸困难原因中是有用的。BNP的N-末端组分具有较长的半衰期，在HF中血浆N-BNP的增加是proportionalgreat.METHODS我们研究了205例（平均年龄70 +/- 14岁）急性呼吸困难急诊科。使用即时检测和两种当地开发的放射免疫测定法分析脑钠肽。使用当地开发的放射免疫测定法和市售测定法测量N-末端BNP。HF的最终诊断由两名心脏病学家判定。结果HF患者（n = 70）的所有测定的两种激素的平均水平较高（p < 0.001）。所有测定的结果密切相关（r值在0.902和0.969之间）。患有左心室（LV）功能障碍或左侧瓣膜疾病但无HF的受试者的BNP和N-BNP水平居中（低于HF受试者，高于无HF且无LV功能障碍或左侧瓣膜疾病的受试者）（所有受试者p < 0.01）。使用最佳临界值，诊断HF的特异性范围为70%至89%（N-BNP测定的最高值）。敏感性范围在80%和94%之间（床旁BNP检测最高）。结论BNP或N-BNP的测量是有用的，在急性呼吸困难的HF诊断。市售检测试剂盒与经过充分验证的实验室检测试剂盒相比具有优势。灵敏度和特异性的差异可能会影响这种情况下的检测选择。(C)2003年由美国心脏病学会基金会。
OBJECTIVES This study sought to compare the utility of measurement of plasma brain natriuretic peptide (BHP) and N-terminal brain natriuretic peptide (N-BHP) in the diagnosis of heart failure (HF) in patients with acute dyspnea.BACKGROUND Plasma BNP is useful in differentiating HF from other causes of dyspnea in the emergency department. The N-terminal component of BNP has a longer half-life, and in HF increases in plasma N-BNP are proportionately greater.METHODS We studied 205 patients (average age 70 +/- 14 years) presenting to the emergency department with acute dyspnea. Brain natriuretic peptide was analyzed using a point-of-care test and two locally developed radioimmunoassays. N-terminal BNP was measured using a locally developed radioimmunoassay and a commercially available assay. Final diagnosis of HF was adjudicated by two cardiologists.RESULTS Patients with HF (n = 70) had higher mean levels of both hormones by all assays (p < 0.001 for all). Results with all assays correlated closely (r values between 0.902 and 0.969). Subjects with left ventricular (LV) dysfunction or left-sided valvular disease but no HF had intermediate levels of BNP and N-BNP (lower than subjects with HF, and higher than subjects without HF with no LV dysfunction or left-sided valvular disease) (p < 0.01 for all). Using optimum cut-offs, specificity for the diagnosis of HF ranged between 70% and 89% (highest for the N-BNP assays). Sensitivity ranged between 80% and 94% (highest for the point-of-care BNP assay).CONCLUSIONS Measurement of BNP or N-BNP is useful in the diagnosis of HF in acute dyspnea. Commercially available assays compare favorably with well-validated laboratory assays. Differences in sensitivity and specificity may influence the assay choice in this setting. (C) 2003 by the American College of Cardiology Foundation.