摘要
目的比较分析氨基末端B型利钠肽原（NT-proBNP）与B型利钠肽（BNP）检测对合并脑梗死心力衰竭（HF）患者的诊断性能。方法采用临床与实验室标准化协会（CLSI）颁布的EPl5-A2文件验证NT-proBNP与BNP常用检测仪器“电化学发光免疫检测系统RocheCobasE601”和“化学发光免疫检测系统SIEMENSADVIACentaur”对NT—proBNP与BNP检测的精密度和准确度，保证仪器条件符合实验要求。收集不同程度慢性HF患者、脑出血患者、急性脑梗死患者、脑梗死伴HF患者及正常人群外周血共363例，分别采用罗氏Cobase601和BayerCentaur对样本NT—proBNP和BNP进行检测，观察NT—proBNP与BNP检测结果的变化趋势，并采用ROC曲线比较NT．proBNP与BNP对慢性HF及合并有脑梗死HF的诊断性能。结果CobasE601与ADVIACentaur对NT—proBNP与BNP检测均具有良好的重复性，总不精密度小于3．5％，与定值校准品的偏差小于3．91％，符合临床检测要求。比较发现，NT—proBNP与BNP不会在正常人和脑出血患者样本中表达升高。而在慢性HF患者、急性脑梗死患者及脑梗死伴HF患者样本中均明显升高（P〈0．01），升高程度与HF的严重程度有关。脑梗死伴Ⅰ度至Ⅲ度HF患者NT—proBNP升高幅度较同级慢性HF患者更为明显（P〈0．05），而BNP水平在两组中Ⅰ度和Ⅱ度HF患者中无明显变化，而在脑梗死伴Ⅲ度HF时，明显升高于慢性Ⅲ度HF患者。NT—proBNP与BNP对慢性HF患者均具有很好的诊断性能，ROC曲线下面积大于93％；而在脑梗死合并HF患者中，受脑梗死疾病影响，NT—proBNP与BNP诊断性能均有所下降，但BNP诊断曲线面积明显大于NT—proBNP（P〈0．05）。结论在脑梗死合并HF患者的诊断中，BNP较NT—proBNP能更好地反映HF的严重程度。
Objective To compare the capabilities of NT-proBNP and BNP in diagnosis of heart failure when complicated with acute cerebral infarction. Methods EP15-A2 document, was employed to verify the precision and accuracy of NT-proBNP and BNP assays on chemiluminescence analyzer Cobas E601 and ADVIA Centaur respectively for 363 samples from patients with chronic heart failure, cerebral hemorrhage and acute cerebral infarction, cerebral infarction complicated with heart failure and normal controls were collected and analyzed by Cobas E601 and ADVIA Centaur, and then determined the changing trends of NT-proBNP and BNP. Moreover, ROC curve was employed in diagnostic value comparison of NT- proBNP and BNP in heart failure groups. Results Cobas E601 and ADVIA Centaur showed good repeatability and accuracy in the detection of NT-proBNP and BNP that both total non-precision were below 3.5% and the deviations to calibrator were below 3.91%. The level of NT-proBNP an BNP didn＇t elevate in normal people and cerebral hemorrhage patients. However, they significant elevated in heart failure, acute cerebral infarction and cerebral infarction complicated with heart failure patients （ P 〈 0. 01 ）. Their levels were heart failure grade dependent. The levels of NT-proBNP in cerebral infarction complicated with grade I to UI heart failure patients were significantly higher than those in chronic heart failure patients, with same heart failure（ P 〈 0. 05 ）. However, compared to chronic heart failure patients, the level of BNP in cerebral infarction complicated with heart failure patients didn＇t elevate significantly until grade 111 heart failure happened. Areas under the ROC curve （AUCs） of NT-proBNP and BNP were both above 93% in the diagnosis of chronic heart failure. But for patients who suffered cerebral infarction complicated with heart failure, the diagnostic value of NT-proBNP and BNP were decreased due to cerebral infarction interference. However, the ROC area of BNP was larger than that of NT-proBNP（P 〈 0. 05 ）. Conclusion In the diagnosis of cerebral infarction complicated with heart failure, BNP could be a better choice to determine the degree of heart failure.
出处
《中华检验医学杂志》
CAS
CSCD
北大核心
2012年第10期890-893,共4页
Chinese Journal of Laboratory Medicine
关键词
脑梗死
HF
利钠肽
脑
Brain infarction
Heart failure
Natriuretic peptide, brain
