摘要
目的探讨血清N末端B型钠尿肽原(NT-proBNP)和心肌肌钙蛋白(hs-TnT)联合定量检测在老年心功能衰竭患者心功能分级(NYHA分级)中的应用价值。方法选取2016年10月～2018年10月心内科住院的慢性心功能衰竭患者1 019例,对照组选取健康体检者96例,心功能衰竭诊断以临床医生依据病史、症状、客观检查等作出的综合判断为金标准。依据美国纽约心脏病协会(NYHA)分级方案将心功能衰竭患者分类为A组(Ⅰ级)和B组(Ⅱ级～Ⅳ级),采用电化学发光法测定其血清中NT-proBNP和hs-TnT的水平,应用方差分析和受试者工作特征曲线(ROC曲线)判断NT-proBNP,hs-TnT的诊断价值及其与NYHA分级的相关性。结果①心功能衰竭组与对照组的血清NT-proBNP,hs-TnT中位数水平分别为275.2 pg/m1,35.3ng/L和79.3 pg/m1,19.2 ng/L,与对照组比较,心功能衰竭组显著高于对照组,差异具有统计学意义(t=3.20,2.543,均P<0.01),而组间年龄和性别无显著差异(P>0.05)。②A组,B组患者人数分别为293例和726例。NT-proBNP和hs-TnT在A组的cutoff值分别为98.3 pg/ml和20.1 ng/L,曲线下面积分别为0.818(95%CI:0.804～0.823)和0.816(95%CI:0.792～0.833),灵敏度分别为64.7%和58.3%,特异度为90.1%和100%,阳性预测值为86%和85%,阴性预测值为67%和59%。B组的cutoff值分别为131.9 pg/ml和28.9 ng/L,曲线下面积分别为0.816(95%CI:0.792～0.833),灵敏度分别为90.4%和91.2%,特异度为90.4%和100%,阳性预测值均为100%,阴性预测值为85%和91%。NT-proBNP联合hs-TnT诊断心功能衰竭的cutoff值分别为133.4 pg/m1,35.3 ng/L,曲线下面积为0.943 (95%CI:0.901～0.951),灵敏度分别为74%和87%,特异度均为100%,阳性预测值均为100%,阴性预测值为86%和72%。B组诊断临界值明显高于在A组,差异有统计学意义(P<0.05)。结论 NT-proBNP及hs-TnT的水平变化与老年心衰患者NYHA分级呈显著正相关(r=0.894,P<0.01),随着分级增加而呈递增趋势,联合检测结果优于单项检测,二者联合检测可为HF患者的诊断及分级严重程度的评估提供依据。
Objective To explore the application value of combined quantitative detection of serum NT-proBNP and hs-TnT in the grading of cardiac function(NYHA)in elderly patients with heart failure.Methods 1 019patients with chronic heart failure hospitalized in the department of cardiology from October 2016to October 2018were selected as control group.96 healthy people were selected as control group.The diagnosis of heart failure was based on the comprehensive judgement made by clinicians according to medical history,symptoms and objective examinations.According to the NYHA grading scheme,patients with heart failure were classified into group A(gradeⅠ)and group B(gradeⅡandⅣ).The serum levels of NT-proBNP and hs-TnT were measured by electrochemiluminescence.The diagnostic value of NT-proBNP and hs-TnT was evaluated by variance analysis and ROC curve.Results①The median levels of NT-proBNP and hs-TnT were 275.2pg/ml,35.3ng/L and 79.3pg/ml,19.2ng/L in the heart failure group and the control group respectively.Compared with the control group,the median levels of NT-proBNP and hs-TnT in the heart failure group were significantly higher than those in the control group(t=13.20,9.543,all P<0.01),but there was no significant difference in age and sex between the two groups(P>0.05).②The number of patients in group A and group B were 293and 726respectively.The cutoff values of NT-proBNP and hs-TnT in group A were 98.3pg/ml and 20.1ng/L,respectively.The area under the curve was 0.818(95%CI:0.804~0.823),0.816(95%CI:0.792~0.833),respectively,sensitivity was 64.7%and 58.3%,respectively,specificity was 90.1%and 100%,respectively,positive predictive value was 86%and 85%,respectively,and negative predictive value was 67%and 59%,respectively.The cutoff values of group B were 131.9pg/ml and 28.9ng/L,respectively,the area under curve was 0.816(95%CI:0.792~0.833),respectively,the sensitivity was 90.4%and 91.2%,respectively,the specificity was 90.4%and 100%,respectively,the positive predictive value was 100%,and the negative predictive value was 85%and 91%.The cutoff values of NT-proBNP combined with hs-TnT in the diagnosis of heart failure were 133.4pg/ml,35.3ng/L,respectively,the area under curve was 0.943(95%CI:0.901~0.951),the sensitivity was 74%and 87%,respectively,the specificity was 100%,respectively,the positive predictive value was 100%,and the negative predictive value was 86%and 72%.The diagnostic threshold of group B was significantly higher than that of group A(P<0.05).Conclusion The changes of NT-proBNP and hs-TnT levels were positively correlated with the NYHA classification of elderly patients with heart failure(r=0.894,P<0.01).With the increase of the classification,the combined detection results were better than the single detection.The combined detection of NT-proBNP and hs-TnT levels could provide a basis for the diagnosis of HF patients and the assessment of the severity of the classification.
作者
杨宏斌
黄巧平
YANG Hong-bin;HUANG Qiao-ping(Department of Clinical Laboratory,Tianshui Traditional Chinese Medicine Hospital,Gansu Tianshui 741000,China;Tianshui 407 Hospital,Gansu Tianshui 741000,China)
出处
《现代检验医学杂志》
CAS
2019年第2期64-67,71,共5页
Journal of Modern Laboratory Medicine
关键词
N末端B型钠尿肽原
高敏心肌肌钙蛋白T
心功能分级
心功能衰竭
N terminal b-type natriuretic peptide
hypersensitive myocardial troponin T
cardiac function classification
heart failure
