B型利鈉利尿胜肽對於心臟衰竭診斷能力的評估

An Assessment of the Heart Failure Diagnostic Capability of B-type Natriuretic Peptides Diuresis

目的：以心臟衰竭在台灣的發生率不斷增加，而且在臨床上的診斷往往不易與其他疾病區別。而心室心肌所分泌的B型利鈉利尿胜肽（BNP）因為能反映心臟功能的狀態，因此目前已廣泛用於心臟衰竭的診斷。因此本研究之目的在瞭解BNP與其他相關生物標誌在心臟衰竭診斷能力上的差異。方法：本研究係自2012年1月至6月止，針對因呼吸困難而至本院就診之患者，總計172名，檢測BNP、Troponin I、CK-M B、Myoglobin等心臟生物標誌。另外也檢測腎臟生物標誌BUN、Creatinine，以及肝臟生物標誌SGOT，比較其在心臟衰竭診斷上的能力。結果：研究結果顯示，BNP相較其他生物指標在敏感性、陰性預測值與陰性相似比上有最最佳的表現（sensitivity:0.74，NPV:0.83，LR-:0.37），另外在勝算比也較其他生物指標為高（odds ratio: 7.03）。結論：由於BNP相較其他生物指標在心臟衰竭方面具有良好的診斷能力，因此在臨床上，若是以BNP搭配病史、症狀與超音波等檢驗，更能準確的診斷心臟衰竭。

Purposes: The incidence of heart failure in Taiwan is increasing, and it is often hard to distinguish it from other diseases by clinical diagnosis alone. The ventricular secretion of BNP (B-Type Natriuretic Peptides Diuresis) can reflect the state of cardiac function, so it has been widely applied for the diagnosis of heart failure. The aim of this study was to understand the differences in heart failure diagnostic capability between BNP and other relevant biomarkers. Methods: Heart biomarkers including BNP, Troponin I, CK-MB, and myoglobin were collected from 172 clinically suspected heart failure patients. Kidney biomarkers including BUN and Creatinine, and the liver biomarker SGOT were also collected to compare with the capability of diagnosing heart failure. Results: Compared to other heart biomarkers, BNP had the best performance in sensitivity, negative predictive value and negative likelihood ratio (sensitivity: 0.74, NPV: 0.83, LR-: 0.37), and a higher odds ratio (odds ratio: 7.03). Conclusion: BNP had a better heart failure diagnostic capability than other biomarkers. Coupled with history, symptoms, and ultrasound tests, it can provide a more accurate diagnosis of heart failure in clinical practice.