脑钠尿肽作为起搏器植入心力衰竭患者筛选指标的临床意义

周 缨; 陈宗建

脑钠尿肽作为起搏器植入心力衰竭患者筛选指标的临床意义

周缨,
陈宗建

Brain natriuretic peptide as a screening tool for heart failure in a pacemaker population

摘要

摘要: 目的:评价血浆脑钠尿肽（BNP）作为永久性心脏起搏器植入术后心力衰竭的衡量指标的临床意义。方法：入选行常规植入永久心脏起搏器的患者52例，年齡18～92（70±11）岁。记录患者的诊疗史和检查，心脏超声及收集血液样本，检测BNP。结果： 52例患者中（DDD 12例，VVI 38例，其他 2例）有19例测量左室射血分数（LVEF≤40%）和有心力衰竭症状（纽约心力衰竭分级Ⅱ、Ⅲ或Ⅳ级）。在取诊断界点为BNP≥425 pmol/L时，所有心力衰竭的患者中BNP作为筛选工具有着95%的灵敏度和57%的特异度。这在应用DDD型起搏器时为灵敏度71%，特度87%，而在应用VVI型起搏器为灵敏度90%，特异度69%。结论: BNP作为一种监测指标对于心脏起搏器植入患者心力衰竭的评定是适合而且有帮助的。

Abstract: AIM:To assess brain natriuretic peptide (BNP) as a screening tool for heart failure in patients with a permanent pacemaker. METHODS: Consecutive patients undergoing a routine permanent pacemaker assessment were enrolled. Patients underwent medical history and examination, echocardiogram and blood sampling for BNP. Analysis was performed in 52 patients (12 DDD, 38 VVI, 2 others; mean age 70±11 years, range: 18-92 years). RESULTS: Nineteen subjects (37%) had heart failure as defined by left ventricular ejection fraction (LVEF) ≤40% and symptoms of heart failure (NYHA class II, III, or IV). At 425 pmol/L, the sensitivity and specificity of screening with BNP were, respectively, 95% and 57% for detecting heart failure in patients under study ［area under the curve (AUC) 0.906, 95% CI 0.860-0.953］. Sensitivity and the specificity were, respectively, 71% and 87% in cases of DDD type pacemakers and were, respectively, 90% and 69% in cases of VVI type pacemakers. CONCLUSION: BNP as an indicator for monitoring patients with cardiac pacemaker implantation is suitable and helpful for assessment of heart failure.

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