| Dyspnea is a common clinical symptom. It is also one of common emergency request–treated emergency cases of medical department. If etiological diagnosis is determined correctly and promptly, mortality will be obviously reduced. Otherwise, mortality will be obviously increased. Dyspnea has numerous reasons. Dyspnea is mainly classified under six categories: pulmonary dyspenea,cardiac dyspnea,anaemic dyspnea,central dyspnea,toxic dyspenea,mental dyspnea, of the total, pulmonary dyspenea and cardiac dyspnea are more often reasons, and differentiate diagnosis more difficult. Clinically, according to the results of basic disease of patients,clinical manifestation,mode of episode or relief of dyspnea,laboratory examination and thorax radiography,blood gas analysis and ultrasonic cardiography made comprehend judgement, distinguished pulmonary dyspnea from cardiac dyspnea. However, In practical work, pulmonary dyspenea and cardiac dyspnea not only influence each other, but also mix existence. Especially aged people, Chronic respiratory history and heart disease history usually coexist;It is hard to precisely distinguishing pulmonary dyspnea from cardiac dyspnea or both coexist. Furthermore, restricted by position, patients with serious dyspnea impossiblely do thorax radiography. Although patients can do emergency echocardiography at bedside , extreme dysphoria,respiratory irregularity,position change without intermission will impact directly distinctness and stability of screen image when patients to be examined. All undoubtedly increase degree of difficulty of high-quailty image obtained. Sometimes these even result in misdiagnosis. In addition, there are noticeable dissimilar points in clinical strategy between pulmonary dyspenea and cardiac dyspnea. Incorrect diagnose will result in incorrect treatment. Sometimes severe consequence occurs.Thus a rapid,convenient,specific,more accurately objective index is urgently searched by medical workers to guide dyspnoeic discrimination. This possesses considerably theoretical and practical importance.BNP was named as first being segregated from pig brain. Product of BNP genetic expression ,proBNP is hydrolyzed into ripe BNP and nonbiologic activity Nt-proBNP. The research indicated that there were three kinds of BNPs simultaneously in blood circulation. Whether health persons or cardia failure patients there were three kinds of BNPs simultaneously in blood circulation. Moreover, proBNP is decompose into ripe BNP and Nt-proBNP equally. Before more researches concentrated on biological functions of ripe BNP. The research of nonbiologic activity Nt-proBNP was neglected. Because plasma Nt-proBNP concentrations were influenced less by age,sex,body mass index,renal function and so forth than BNP. Moreover, Nt-proBNP had good stability,long-half-life,high plasma concentration and favourable dependablity with BNP. Thus Nt-proBNP detection was gradually thought highly of clinical application of Disease of the heart and lung at present. We determined plasma Nt-proBNP level with patients of cardiac dyspnea or airway inflammatory disease dyspea by radioimmunoassay. Etiological significance Nt-proBNP level in identification of the two dyspneas was evaluated.The experiment choosed acute dyspnea patients from respiratory department,emergency department,inpatient of general hospital of Da-qing oil field during 2006.4-2006.12 as research subjects. According to patient history,physical sign,ultrasonic cardiogram,thorax radiography and so on, the dyspnea patients were divided into cardiac dyspnea group and airway inflammatory disease group. At the same time 18 healthy persons were choosed from clinic service as normal control. Plasma Nt-proBNP levels were compared among CDG,AIDG,NC by radioimmunoassay.Further correlation tests of plasma Nt-proBNP levels with left ventricle ejection fraction,heart structure index of Ultrasonography of heart were done. Plasma Nt-proBNP levels under different oxygen partial pressure were analyzed in AIDG.Results:Compared with plasma Nt-proBNP concentrations of normal control(22.29±6.02pg/ml), 961.1±324.5pg/ml in CDG and 301.5±138.3pg/ml in AIDG were significantly increased ,p<0.01; there were significant differences between the patients with CDG (961.1±324.5pg/ml )and AIDG (301.5±138.3pg/ml),P<0.01; there was negative correlation between Nt-proBNP concentrations and left ventricular ejection fraction (LVEF)among subjects with dyspea, end-diastolic left ventricular inner diameter correlated positively with plasma Nt-proBNP concentrations ,and left atrial anteroposterior diameter correlated positively with plasma Nt-proBNP concentrations . Plasma Nt-proBNP levels in oxygen partial pressure normal subgroup,mild hypoxemia subgroup,moderate hypoxemia subgroup,severe hypoxemia subgroup gradually rose in AIDG. There was not statistical difference in group comparison.Conclusion:1.Plasma Nt-proBNP concentrations increased significantly in patients with CDG or AIDG compared with those of normal control , moreover, plasma Nt-proBNP concentrations increased more obviously in CDG than in AIDG ,there were significant differences between the patients CDG and AIDG, P<0.01。It suggested plasma Nt-proBNP concentrations had value of differential diagnosis between cardiac dyspnea and airway inflammatory disease dyspea. 2. there was negative correlation between Nt-proBNP concentrations and left ventricular ejection fraction (LVEF)among subjects with dyspea, end-diastolic left ventricular inner diameter correlated positively with plasma Nt-proBNP concentrations ,and left atrial anteroposterior diameter correlated positively with plasma Nt-proBNP concentrations . In a word, Nt-proBNP has been found to be useful as an adjunct to standard clinical evaluation for the differential diagnosis and classification of dyspnoeic patients.Because this marker is considerably higher in patients with cardiac dyspnea. As such, the utility of serum testing for the Nt-proBNP has been recognized and incorporated in consensus documents. Nt-proBNP to become an important routine examination is hopeful for guidelines for the diagnosis of heart failure and evaluation cardiac function. |
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