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目的探讨胸腔积液中性肽链内切酶(neprilysin,NEP)浓度变化及其对心衰所致胸腔积液的诊断价值。方法 88例胸腔积液住院患者纳入研究,根据病因分为心衰组胸腔积液25例,类肺炎组胸腔积液21例,结核组胸腔积液21例及肿瘤组胸腔积液21例,酶联免疫吸附法测定胸腔积液NEP浓度。结果 (1)心衰组NEP浓度显著低于其他组(P<0.001),类肺炎组和肿瘤组NEP浓度无显著差异(P>0.05),均显著低于结核组(P<0.001)。(2)胸腔积液中NEP浓度和血清脑钠肽(brain natriuretic peptide,BNP)含量呈负相关(r=-0.570,P<0.001)。(3)ROC曲线显示NEP浓度271 pg/mL为临界值诊断心衰所致胸腔积液灵敏度为76%,特异度为92.06%。胸腔积液NEP联合血清BNP诊断心衰所致胸腔积液灵敏度为98.1%,特异度为98.4%。结论心衰所致胸腔积液中NEP分泌降低,对诊断心衰有一定参考价值;胸腔积液NEP联合血清BNP可提高心衰诊断的灵敏度和特异度。
Objective To investigate the changes of neprilysin (NEP) concentration in pleural effusion and its diagnostic value for pleural effusion caused by heart failure. Methods 88 cases of pleural effusion inpatients were included in the study. According to the cause, 25 cases were divided into heart failure group, 21 cases of pleural effusion of pneumonia group, 21 cases of tuberculosis pleural effusion and 21 cases of tumor group pleural effusion. Determination of NEP in Pleural Effusion by. Results (1) The concentration of NEP in heart failure group was significantly lower than that in other groups (P <0.001). There was no significant difference in NEP concentration between pneumonia group and tumor group (P> 0.05). (2) The concentration of NEP in pleural effusion was negatively correlated with the content of serum brain natriuretic peptide (r = -0.570, P <0.001). (3) ROC curve showed 271 pg / mL NEP concentration as the critical value in the diagnosis of heart failure caused by pleural effusion with a sensitivity of 76% and a specificity of 92.06%. Pleural effusion NEP combined with serum BNP diagnosis of heart failure-induced pleural effusion sensitivity was 98.1%, specificity was 98.4%. Conclusions The decrease of NEP secretion in pleural effusion caused by heart failure has some reference value for the diagnosis of heart failure. Pleural effusion NEP combined with serum BNP can improve the sensitivity and specificity of heart failure diagnosis.