China Academic Journal Electronic Publishing House. All rights reserved.

Transcription

1 NatlMed J China,May 9, 2006, Vol 86, No B B(BNP) ,BNP (LVEF) 40% ( n = 111)> 40%( n = 132) ;(NYHA, n = 110) (NYHA, n = 133) BNP, BNP(29210 ng/l vs 1719 ng/l, P < 01001), LVEF40% LVEF > 40%( ng/l vs ng/l, P < 01001), (57910 ng/l vs 8418 ng/l, P < 01001)BNP(AUC) = LVEF40%(AUC = 01989) (AUC = 01991)(AUC = 01941)AUC,9010 ng/l, LVEF40% 9819% 9811%9815%, 6415% 9410% 9615%5010 ng/l,lvef > 40%8810% 8417%, 7216%7211% BNPLVEF 9010 ng/l LVEF40%; 5010 ng/llvef > 40% ; The clin ica l va lue of B2type na tr iuretic peptide in the d iagnosis of left heart fa ilurezhao Xue2 yan, YAN G Yue2jin, ZHANG J ian, DAN G A i2m in, N I X in2hai, HUANG J ie, KANG Sheng, MA W ei2hua, ZHAO D ong2yun. D epartm ent of Cardiology, Cardiovascular Institute and Fuw ai Hospital, Chinese A cadem y of M edical Sciences and Peking U nion M edical College, B eijing , China Corresponding author: YANG Yue2jin, Em ail: fuw aihospital. org AbstractO bjectiveto evaluate the diagnostic value of B2type natriuretic pep tide (BNP) in the diagnosis of left heart failure (HF) or left ventricular systolic dysfunction. M ethodssamp les of peripheral venous blood were collected from 243 consecutive patients with left HF and 111 normal controls ( control group, CG) to measured BNP level with fluorescence immunoassay method. The patients with left HF were divided into 2 group s: those with the left ventricular ejection fraction (LVEF) 40% ( n = 111) and those with the LVEF > 40% ( n = 132) according to the level of LVEF; or into 2 group s: compensated heart failure group (CHF group, at NYHA grade 2, n = 110) and decompensated heart failure group (DHF group, at NYHA grade 2, n = 133) according to the New York Heart A ssociation (NYHA ) functional class. ResultsThe p lasma level of BNP of the left HF group was ng/l, significantly higher than that of the CG(1719 ng/l, P < ). The p lasma BNP of the group with the LVEF40% was ng/l, significantly than that of the group with the LVEF > 40% (13815 ng/l, P < ). The p lasma BNP of the DHF group was ng/l, significantly higher than that of the of the CHF group (8418 ng/l, P < ). The values of area under the curve (AUC) of receiver operator characteristic curve were all > 0. 9 in the diagnosis of p resence of HF (AUC = ), HF with the LVEF40% (AUC = ), and DHF (AUC = ), and in the differential diagnosis between CHF and DHF (AUC = ). W hen pg/m l was used as cutoff value to diagnose left HF, heart failure with the LVEF40%, and decompensation, the positive p redictive value ( PPV ) were 98. 9%, 98. 1%, and 98. 5% respectively, and the negative p redictive value (NPV) were 64. 5%, 94. 0%, and 96. 5% respectively. W hen pg/m l was used as the cutoff value to diagnose HF with the LVEF > 40% and compensated heart failure, the PPV were 88. 0% and 84. 7%, the NPV were 72. 6% and 72. 1% respectively. ConclusionThe diagnostic value of BNP is : ( ) : , :, YYJ@ fuwaihosp ital. org

2 NatlMed J China,May 9, 2006, Vol 86, No117 high for the diagnosis of more severely impaired LVEF and decompensated heart failure with pg/m l as the cutoff value, and if pg/m l is used as the cutoff value, the value is also good for the diagnosis of HF with the LVEF > 40% and compensated heart failure. Key words Heart failure; B rain natriuretic pep tide B(B2type natriuretic pep tide, BNP) ( natriuretic pep tide, NP), [ 1 ], BNP, BNP [ 2 ],BNP [ 3 ],, BNP BNP,BNP 1. : , 14 91, , 255 (7210% ),99(2810% ) 243 (NYHA 35 ) 111 ( 4414% ), ( 2519% ) ( 1619% ) (1218% ),, (LVEF) : LVEF 40%111LVEF > 40%132; (NYHA2) 110 (NYHA2) :,,,BNP, BNP 48 h, X BNP: EDTA,( triage, biosite)bnp 1 ng/l5000 ng/l (0129 pmol/l pmol/l) 3. : gx S gx BNP, BNP, t 2,,q ( receiver operator characteristic curve; ROC ),ROC(AUC), AUC, SPSS :,( P < 01001), ( P < 01001), (LVEF) ( P < 01001), BNP16LVEF40% LVEF > 40%, LVEF40% ( P < 01001),( P < 0105), ( P < 01001), LVEF( P < 01001), BNP(1, 2, P < 01001), ( P < 0105 ), ( P < 01001), LVEF( P < 01001), BNP (2, P < 01001) 2. BNP:BNP 16( P < 01001) NYHA BNP (2, 3, P < 01001), ( P > 0105) NYHA,BNP ( P < ) LVEF40%BNPLVEF > 40% 3( P < ) BNP 7( P < ) 31BNP

3 NatlMed J China,May 9, 2006, Vol 86, No / () 1 () (mm) (mm) LVEF ( % ) BNP 3 ( ng/l) () / [ ] / [ ] 3 : : 3 P < ; 3, 2LVEF > 40%LVEF40% (/) () / (mm) (mm) LVEF ( % ) BNP ( ng/l) () () () () LVEF > 40 % 132 (81 /51) / [ ] LVEF 40% 111 (94 /17) / # # 31 6 # # [ ] 1 # 18 # 44 # 48 # 110 (72 /38) / [ ] (103 /30) / [ ] :LVEF > 40%, 3 P < 0. 05, # P < ;, P < 0. 05; P < NYHABNP BNP ( ng/l ) [ ] [ ] 3 NYHA I [ ] NYHA [ ] 3 NYHA [ ] 3 NYHA [ ] 3 # :, 3 P < ;NYHA, P < 01001; NYHA, P < ;NYHA, # P < : ROC ROC BNP, BNP,;, ROC(AUC) (4, 5) BNP( ) LVEF40% AUC> 019; LVEF > 40% (LVEF > 40%), AUC , ;LVEF > 40%LVEF40%AUC017018, BNP 9010 ng/l LVEF 40%, 9819% ; LVEF40% 4AUCBNP AUC 95% CI P vs < vs LVEF > 40% < vs LVEF40% < LVEF > 40%vs LVEF 40% < vs < vs < vs < BNP ( % ) BNP ( ng/l) vs vs LVEF > 40% vs LVEF40% LVEF > 40%vs LVEF 40% vs vs vs % 9815%, 9410%9615% BNP5010 ng/l LVEF > 40% 8810% 8417%, 7216%7211%

4 NatlMed J China,May 9, 2006, Vol 86, No117 LVEF40%, BNP 50 ng/l, 9710% 98% BNP,BNP BNP BNP 1. BNP :BNP Maisel [ 4 ] BNP37 ng/l 6 ng/l, BNP 572 ng/l 115 ng/l, BNPNYHA Joung [ 5 ], BNP,,2,,2,,, BNP,BNP,, BNP [ 6 ] BNP NYHA McDonagh [ 7 ] BNP,, BNP,, BNP LVEF40% (NYHA)BNP (NYHA ) 7 LVEF 40% BNP LVEF > 40% 3 Ry [ 8 ] NYHA BNP NYHA12, Fonseca [ 9 ] LVEF < 40%BNP LVEF > 40%, LVEF, BNP [ 10 ], BNP,,,mRNA BNP(108),BNP, BNP (NT2p robnp)bnp, BNP LVEF < 40% BNP 2. BNP: AUC,BNP, BNP LVEF40%(AUC = 01989)(AUC = 01991), LVEF > 40%LVEF40% (AUC = ) BNP LVEF, Fonseca [ 9 ] BNP LVEF > 40% LVEF 40%LVEF > 40%LVEF40% BNPLVEF40% (AUC: 9816% 9911% ),LVEF > 40%LVEF40% (AUC: 6313% 6316% ) LVEF40% 9010 ng/l, ; 9010 ng/l, Dao [ 11 ], BNP80 ng/l,98%, 92%, 90%, 98%, ROC 0197 LVEF > 40%,5010 ng/l, 8810% 8417% ; 7216%7211% ; 7914%7619%,,, BNP, 52 [ 12 ], BNP7614 ng/l, 93%,90% ; 1586 BNP [ 13 ], 100 ng/l BNP, 8314% 100 ng/l 9010 ng/l LVEF40% ;5010 ng/l

5 NatlMed J China,May 9, 2006, Vol 86, No LVEF > 40%, BNP BNP 50 ng/l, 9710%LVEF40% 9810%, Maisel [ 13 ] BNP (BN P < 50 ng/l ), 96% BNP,BNP [ 14 ] [ 15 ],, 1 Sudoh T, Kangawa K, M inam ino N, et al. A new natriuretic pep tide in porcine brain. Nature, 1988, 332: Mukoyama M, Nakao K, Saito Y, et al. Increased huan brain natriuretic pep tide in congestive heart failure. N Engl J Med, 1990, 323: Morrison KL, Harrison A, Krishnaswany P, et al. V tility of a rap id B2 natriuretic pep tide ( BNP ) assay in differentiating CHF from lung disease in patients p resenting with dyspnea. J Am Coll Cardiol, 2002, 39: Maisel AS, Koon J, Krishnaswamy P, et al. U tility of B2natriuretic pep tide as a rapid, point2of2care test for screening patients undergoing echocardiography to determ ine left ventricular dysfunction. Am Heart J, 2001, 141: Joung BY, Park BE, Kim DS, et al. B2type Natriuretic pep tide p redicts clinical p resentations and ventricular overloading in patients with Heart Failure. YonseiMedical J, 2003, 44: Groenning BA, N ilsson JC, Sondergaard L, et al: Evaluation of impaired left ventricular ejection fraction and increased dimensions by multiple neurohumoral plasma concentrations. European Jourmal of Heart Failure, 2001, 3: McDonagh TA, Robb SD, Murdoch DR, et al. B iochemical detection of left2ventricular systolic dysfunction. Lancet, 1998, 351: Ry SD, Clerico A, Giannessi D, et al. Measurement of brain natriuretic peptide in p lasma samples and cardiac tissue extracts by means of an immunoradiometric assay method. Scand J Clin Lab Invest, 2000, 60: Fonseca C, Sarmento PM, M ineza, et al. Comparative value of BNP and NT2p robnp in diagnosis of heart failure. Rev Port Cardiol, 2004, 23: de Bold AJ, B runeau BG, de Bold MLK. Mechanical and neuroendocrine regulation of the endocrine heart. Cariovasc Res, 1996, 31: Dao Q, Krishnaswarmy P, Kazanegra R, et al. U tility of B2type natriuretic peptide in the diagnosis of congestive heart failure in an urgent2care setting. J Am Coll Cardiol, 2001, 37: Davis M, Espiner E, R ichards G, et al. Plasma brain natriuretic pep tide in assessment of acute dyspnoea. Lancet, 1994, 343: Maisel AS, Krishnaswamy P, Nowak RM, et al. Rap id measurement of B2type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med, 2002, 347: Akiba T, Tachibana K, Togashi K, et al. Plasma human brain natriuretic peptide in chronic renal failure. Clin Nephrol, 1995, 44: S612S La V illa G, R iccardi D, Lazzeri C, et al. B lunted natriuretic response to low2dose brain natriuretic pep tide infusion in nonazotem ic cirrhotic patientswith ascites and avid sodium retention. Hepatology, 1995, 22: (: ) (:) 62, 5000, , ,,:,,,, 32,50, ( 1200,: , , )(15%)