血清NT-proBNP水平在小儿心源性与非心源性呼吸困难诊断鉴别的价值

目的：探究血清B 型利钠肽前体（NT-proBNP）水平在小儿心源性与非心源性呼吸困难诊断鉴别的价值。方法：本研究于 2013 年2月~2015年2 月期间，选择我院收治的急性呼吸困难患儿72 例为研究对象，根据临床诊断将其分为心源性呼吸困难组 （39例）和非心源呼吸困难组（33 例）。采用电化学发光免疫分析法（ECLIA）测量两组患儿血清NT-proBNP 水平，并采用受试者工 作特征曲线（ROC）曲线评估血清NT-proBNP 水平在小儿心源性与非心源性呼吸困难诊断鉴别中的价值。结果：心源性呼吸困难 组患儿血清NT-proBNP水平为(253.23± 39.38)ng/L，明显高于非心源性呼吸困难组患儿血清NT-proBNP水平（76.39± 17.39） ng/L（t=23.882,P<0.05）。小儿血清NT-proBNP 水平诊断心源性呼吸困难和非心源性呼吸困难的曲线下面积为0.914，曲线下面积 的95%的置信区间为（0.861,0.967），当血清NT-proBNP水平为118.34ng/L 时，约登指数取最大值为0.923，敏感度为97.43% （37/39）、特异度为94.87%（32/33）。结论：NT-proBNP 作为一个特异性指标可用于小儿心源性呼吸困难与非心源性呼吸困难的鉴 别诊断。

Clinical Value of NT-proBNP in Differential Diagnosis of Pediatric Cardiac Dyspnea and Non-cardiac Dyspnea

Objective:To explore the clinical value of amino-terminal pro-B-type natriuretic peptide (NT-proBNP) in differential diagnosis of pediatric cardiac dyspnea and non-cardiac dyspnea.Methods:A total of 72 children with acute dyspnea, who were treated in Harbin Children''s Hospital from February 2013 to February 2015, were chosen as the research subjects, were divided into cardiac dyspnea group (n=39) and non-cardiac dyspnea group (n=33) according to the clinical diagnosis results. The levels of NT-proBNP in the two group were detected by electrochemiluminescence immunoassay(ECLIA) method and the clinical value of NT-proBNP in differential diagnosis of pediatric cardiac dyspnea and non-cardiac dyspnea was evaluated by using receiver operating characteristic (ROC) curves.Results:The level of NT-proBNP(253.23± 39.38ng/L ) of cardiac dyspnea group was significantly higher than that(76.39± 17.39ng/L) of non-cardiac dyspnea group (t=23.882, P<0.05).The area under the curve of NT-proBNP in the diagnosis of pediatric cardiac dyspnea and non-cardiac dyspnea was 0.914 and its 95%confidence interval was(0.861, 0.967), the highest Youden''s index was 0.923, sensitivity was 97.43%and specificity was 94.87%when the level of NT-proBNP was 118.34ng/L.Conclusion:As a specific index, NT-proBNP can be used for the differential diagnosis of pediatric cardiac dyspnea and non-cardiac dyspnea.