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目的:探讨血脑利钠肽(BNP)对急性呼吸窘迫综合征(ARDS)及心源性肺水肿(CPE)的诊断价值。方法:34例行右心导管检查(RHC)的严重急性呼吸衰竭患者,测量其BNP浓度、胸片、呼吸机参数及血流动力学参数等数据。并参考肺动脉楔压(PCWP)鉴别诊断ARDS及CPE;统计相应的BNP浓度,获取理想的诊断截点。结果:与CPE组患者相比,ARDS患者具有较高的PEEP以及低的右房压力(RAP)和PCWP,两组比较差异有统计学意义(P=0.012、0.023及0.031)。ARDS患者的BNP显著低于CPE患者(355±168pg/ml和1550±250pg/ml,P=0.001)。BNP与PCWP正相关(r=0.34,P=0.031)。当BNP截点为200pg/ml时,BNP诊断ARDS的特异性为93%,阳性预测值为90%;当BNP截点为1200pg/ml时,BNP诊断CPE的特异性为93%,阳性预测值为78%。结论:BNP结合临床资料能很好地鉴别ICU病房中的ARDS和CPE,具有较高的临床应用价值。
Objective: To investigate the diagnostic value of blood brain natriuretic peptide (BNP) in acute respiratory distress syndrome (ARDS) and cardiogenic pulmonary edema (CPE). Methods: Thirty-four patients with severe acute respiratory failure undergoing right heart catheterization (RHC) were enrolled in this study. Data of BNP concentration, chest radiograph, ventilator parameters and hemodynamic parameters were measured. And reference pulmonary artery wedge pressure (PCWP) differential diagnosis of ARDS and CPE; statistics corresponding BNP concentration, access to the desired diagnostic cut-off point. Results: Patients with ARDS had higher PEEP and lower right atrial pressure (RAP) and PCWP compared with patients in the CPE group. There was significant difference between the two groups (P = 0.012,0.023 and 0.031). BNP was significantly lower in ARDS patients than in CPE patients (355 ± 168 pg / ml and 1550 ± 250 pg / ml, P = 0.001). BNP was positively correlated with PCWP (r = 0.34, P = 0.031). When the BNP cutoff point was 200 pg / ml, the specificity of BNP in the diagnosis of ARDS was 93%, and the positive predictive value was 90%. When BNP cutoff was 1200 pg / ml, the specificity of BNP in diagnosis of CPE was 93%, and the positive predictive value 78%. Conclusion: BNP combined with clinical data can well identify ARDS and CPE in ICU ward, which has high clinical value.