摘要目的 探讨心力衰竭(心衰)标志物N末端B型利钠肽原(NT-proBNP)与B型利钠肽(BNP)检测结果对心衰评价的潜在干扰因素,为临床医生正确选择分析物与合理分析检验结果提供依据.方法 采用美国临床与实验室标准化协会(CLSI)颁布的EP15-A2文件验证NT-proBNP与BNP常用检测仪器"电化学发光免疫检测系统罗氏Cobas E601"和"化学发光免疫检测系统西门子ADVIA Centaur"对NT-proBNP与BNP检测的精密度和准确度,评价由于仪器本身原因造成的检测结果偏离.对患者标本在不同标本采集管和不同放置时间的检测结果进行对比分析,并采用EP7-A2文件探讨内源性干扰物(溶血、黄疸和脂血)对标本NT-proBNP与BNP检测的干扰,评价由于标本不合格造成的检测结果偏离.在保证仪器运行及标本采集均符合要求的情况下,对203例单纯心衰与急性脑梗死合并心衰患者的NT-proBNP与BNP进行检测,探讨由于患者本身伴有其他疾病造成的检测结果干扰.结果 Cobas E601与ADVIA Centaur对NT-proBNP与BNP检测均具有良好的重复性,总不精密度分别小于2.9%与3.5%,与定值校准品的偏差分别小于2.38%与3.91%,符合临床检测要求.NT-proBNP与BNP的最适标本类型分别为血清和EDTA抗凝血浆,二者可室温稳定保存至少120 min;血红蛋白(2g/L)、直接胆红素(428μmol/L)、乳糜(2000 FIU)不会对NT-proBNP和BNP的检测造成影响.相对于单纯心衰患者,急性脑梗死患者NT-proBNP水平会明显抬高(P=0.003),而BNP仅在急性脑梗死合并Ⅲ级心衰患者体内明显升高(P＜0.01).结论 NT-proBNP与BNP的检测仪器性能应符合临床要求,虽然检测仪器具有较强的抗干扰能力,但合理选择标本类型仍然是正确获得检测结果的关键.在评价合并有其他疾病的心衰时,应客观分析NT-proBNP与BNP的诊断价值.

abstractsObjective To find the potential interference factors for the detection of NT-proBNP and BNP in patients with chronic heart failure. Methods EP15-A2 issued by Clinical and Laboratory Standards Institute (CLSI) was employed to compare the precision and accuracy of commercial NT-proBNP and BNP analyzer electrochemiluminescence immunoassay system Cobas E601 and chemiluminescence system ADVIA Centaur. Moreover, NT-proBNP and BNP were detected in different time interval and in different interfered sampling conditions (haematolysis, choloplania, lipemia). NT-proBNP and BNP of 203 patients with heart failure or heart failure complicated with acute cerebral infarction were analyzed to find the deviation caused by patients' endogenous factors. Results The precision and accuracy were comparable for NT-proBNP and BNP detection using Cobas E601 and ADVIA Centaur (total-CV below 2. 9% and 3.5%, the deviation from definite value below 2. 38% and 3.91% ). The most suitable sample type for NT-proBNP and BNP detection was serum and EDTA- anticoagulant plasma. The detection results of NT-proBNP and BNP were comparable for at least 120 min post sampling and not affected by Hb(2 g/L), DB(428 μmol/L) and chyle(2000FIU). NT-proBNP was significantly higher in heart failure patients complicated with cerebral infarction( P =0. 003) than in heart failure patients. BNP was significantly higher in heart failure grade Ⅲ patients complicated with cerebral infarction ( P ＜ 0. 01 ). Conclusions Cobas E601 and ADVIA Centaur supplied satisfactory detection of NT-proBNP and BNP in patients with chronic heart failure with strong anti-interference capacity. The diagnostic value of NT-proBNP and BNP for chronic heart failure should be analyzed objectively in the presence of complicating diseases.