探讨NT-proBNP对心力衰竭致胸腔积液的诊断意义

发布时间：2018-03-11 19:08

本文选题：胸腔积液　切入点：心力衰竭　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:胸腔积液是一种常见临床疾病,任何导致胸膜腔内液体形成过快或吸收过缓的疾病都可产生胸腔积液。NT-proBNP是一种血管活性多肽,心力衰竭时心室壁因压力负荷增大受到物理牵拉由脑钠肽(B-type natriuretic peptide,BNP)裂解产生,可直接由血浆透过血管壁进入胸膜腔,使胸腔积液中NT-proBNP含量增高,本文旨在研究其在诊断心衰性胸腔积液中的诊断价值,以期望能够找到敏感性高,特异性强,准确性高的有效分子诊断标记物。方法:选取2014年11月至2015年10月因胸腔积液就诊我院的住院患者,根据患者的临床病理特点及相关检查化验结果,将患者分为心力衰竭性胸腔积液组和非心力衰竭性胸腔积液组。应用胶体金免疫层析法检测心力衰竭性胸腔积液患者和非心力衰竭性胸腔积液患者血浆和胸腔积液中的NT-proBNP含量,通过SPSS17.0统计软件进行统计分析。结果:心衰患者血浆和胸腔积液中NT-proBNP平均含量分别为13725pg/ml和12309pg/ml,显著高于非心衰患者血浆和胸腔积液中NT-proBNP平均含量,分别为1094pg/ml和974pg/ml,其差异有显著的统计学意义(P0.001)。胸腔积液患者血浆中NT-proBNP含量和胸腔积液中NT-proBNP含量呈明显的线性正相关,Spearman等级相关系数为0.961。血浆和胸腔积液中NT-proBNP含量的ROC曲线下面积均为0.97,以血浆中NT-proBNP含量大于4000ng/L为诊断界值时,其在诊断心力衰竭时的敏感性、特异性、阳性似然比、阴性似然比及准确性分别为89%(73%-96%)、92%(82%-96%)、82%(65%-94%)、94%(87%-97%)和90%(83%-94%),以胸腔积液中NT-proBNP含量大于4000ng/L为诊断界值时,其在诊断心力衰竭时的敏感性、特异性、阳性似然比、阴性似然比及准确性分别为91%(74%-97%)、92%(83%-97%)、81%(66%-93%)、96%(86%-99%)、91%(84%-96%)。结论:胸腔积液和血浆中NT-proBNP在心力衰竭患者中明显高于非心力衰竭患者。胸腔积液中的NT-proBNP含量与血浆中的NT-proBNP含量呈明显正相关。胸腔积液中NT-proBNP判断心力衰竭所致胸腔积液敏感性高,特异性强,准确性高。
[Abstract]:Objective: pleural effusion is a common clinical disease. Any disease that causes pleural fluid to form too fast or slow to absorb can produce pleural effusion. NT-proBNP is a vasoactive polypeptide. In congestive heart failure, the ventricular wall is physically pulled by physical pull from the brain natriuretic peptide B-type natriuretic peptideBNPs, which can enter the pleural cavity directly through the blood vessel wall from the plasma and increase the content of NT-proBNP in the pleural effusion. The purpose of this study was to study its diagnostic value in the diagnosis of pleural effusion due to heart failure, in order to find a highly sensitive and specific pleural effusion. Methods: from November 2014 to October 2015, the inpatients with pleural effusion were selected according to the clinicopathological characteristics of the patients and the results of relevant examinations and laboratory tests. Patients were divided into heart failure pleural effusion group and non-heart failure pleural effusion group. The plasma and pleural effusion levels of NT-proBNP in patients with congestive heart failure pleural effusion and non-heart failure pleural effusion were measured by colloidal gold immunochromatography. Results: the average contents of NT-proBNP in plasma and pleural effusion were 13725pg / ml and 12309pg / ml, respectively, which were significantly higher than those in plasma and pleural effusion of patients with heart failure. The difference was statistically significant (P 0.001). There was a significant linear positive correlation between the NT-proBNP content in plasma and NT-proBNP content in pleural effusion. The NT-proBNP content in plasma and pleural effusion was 0.961.The positive correlation coefficient was 0.961.The positive correlation coefficient was 0.961.There was a significant linear correlation between the NT-proBNP content in plasma and pleural effusion, and the correlation coefficient of NT-proBNP in pleural effusion was 0.961.There was a significant linear positive correlation between the content of NT-proBNP in plasma and pleural effusion. The areas under the ROC curve were 0.97. When the plasma NT-proBNP content was greater than 4000ng / L as the diagnostic threshold, Its sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and accuracy in the diagnosis of heart failure are 89, respectively. The sensitivity, specificity, specificity and specificity of NT-proBNP in pleural fluid when it is greater than 4000ng / L in diagnosing heart failure. Positive likelihood ratio, The negative likelihood ratio and accuracy were 91C / 74-97g and 922T, respectively. The NT-proBNP content in pleural effusion and plasma was significantly higher in patients with heart failure than that in non-heart failure patients. The content of NT-proBNP in pleural effusion was positively correlated with the NT-proBNP content in plasma, and it was significantly correlated with the content of NT-proBNP in plasma of patients with congestive heart failure, and there was a significant positive correlation between NT-proBNP content in pleural effusion and the content of NT-proBNP in plasma. [WT5HZ] [WT5 "HZ] [WT5" HZ] [WT5BZ] [WT5BZ] [WT5BZ] [WT5BZ] [WT5 "HZ]. The sensitivity of NT-proBNP in pleural effusion due to heart failure was high. The specificity is strong and the accuracy is high.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.6;R561.3

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