NT-PRO BNP NATRİÜRETİK PEPTİT:KALP YETMEZLİĞİNE BAĞLI PLEVRAL EFFÜZYONDA YENİ TANI ARACI

Öz

Amaç: Transüdatif ve eksüdatif sıvıları özellikle diüretik kullanan kalp yetmezliği olan hastalarda birbirinden ayırt etmek bazen zor olmaktadır. Bu çalışmanın amacı kalp yetmezliğine bağlı plevral effüzyonları kalp yetmezliği olmayan plevral effüzyonlardan ayırmada plevral sıvı NT-pro BNP'nin tanısal değerini araştırmaktır. Materyal ve method: Plevral effüzyonu olan 126 hasta çalışmaya alındı. Plevral sıvı ve serum örnekleri eş zamanlı laboratuvara gönderildi. Biyokimyasal analiz, bakteriyel ve mantar kültürü, mycobacterium tuberculosis için yayma ve kültür ve sitolojik inceleme yapıldı. Bulgular: Kalp yetmezliğine bağlı plevral effüzyonlarda NT-proBNP değeri diğer plevral effüzyon nedenlerine göre istatistiksel olarak yüksek saptandı (p (r: 0.91, p <0.001). Kalp yetmezliğine bağlı plevral effüzyonları kalp yetmezliğine bağlı olmayan plevral effüzyonlardan ayırmada plevral sıvı NTproBNP cut off değeri 5133 pg/ml’de duyarlık %51,8, özgüllük %98,9 (p:0,000), tanı doğruluğu da %84,1 idi. (r: 0.91, p <0.001). Kalp yetmezliğine bağlı plevral effüzyonları kalp yetmezliğine bağlı olmayan plevral effüzyonlardan ayırmada plevral sıvı NTproBNP cut off değeri 5133 pg/ml’de duyarlık %51,8, özgüllük %98,9 (p:0,000), tanı doğruluğu da %84,1 idi.

Anahtar Kelimeler

• NT-pro BNP, plevral sıvı, kalp yetmezliği

NT-PRO BRAIN NATRIURETIC PEPTIDE:NEW DIAGNOSTIC TOOL FOR HEART FAILURE RELATED PLEURAL EFFUSION

Öz

Aim: Definite diagnosis of transudative or exudative pleural fluids often presents a diagnostic dilemma. The aim of this study was to evaluate whether amino-terminal pro-brain natriuretic peptide (NT-proBNP) levels in pleural fluid has a diagnostic value for discriminating heart-failure related pleural effusions from non-heart-failure effusions. Methods: One hundred twenty six subjects with pleural effusions were included. Samples of pleural fluid and serum were obtained simultaneously from each subject. Biochemical analysis, bacterial and fungal culture, acid-fast bacilli smear, culture and cytology were performed on the pleural fluid. Results: Subjects with heart-failure-related pleural effusion had significantly higher pleural NT-proBNP levels than other subjects (P < 0.000). Pleural and serum NT-proBNP measures were closely correlated. An NT-proBNP cut off value of > 5133 pg/mL in pleural fluid had a sensitivity of 51.8%, a specificity of 98.9%, respectively (P=0.000, diagnostic accuracy 84.1%) for discriminating transudates caused by heart failure from exudates. Conclusions: Pleural fluid NT-proBNP measurement in the routine diagnostic panel may be useful in differentiation of heart-failure-related pleural effusions and exudative pleural fluids with reasonable accuracy, especially in heart-failure patients treated with diuretics.

Anahtar Kelimeler

• NT-proBNP, pleural effusion, heart failure

Kaynakça

1. 1. Light RW, Macgregor MI, Luchsinger PC,Ball WC Jr. Pleuraleffusions: the diagnosticseparation of transudates and exudates. AnnIntern Med 1972; 77(4): 507-13.
2. 2. Han CH, Choi JE, Chung JH. Clinical utility of pleuralfluid NT-probrainnatriureticpeptide (NTproBNP) in patients with pleuraleffusions. InternMed 2008; 47(19): 1669-74.
3. 3. Romero-Candeira S, Herna´ndez L, RomeroBrufao S, Orts D, Ferna´ndezC, Martín C. Is it meaningful to usebiochemicalparameters to discriminate between transudative and exudativepleuraleffusions? Chest 2002; 122(5): 1524-9.
4. 4. Tomcsa´nyi J, Nagy E, Somlo´i M, Moldvay J, Bezzegh A, Bo´zsik B, Strausz J. NTbrainnatriureticpeptide levels in pleuralfluid distinguish between pleuraltransudates and exudates. Eur J Hear tFail 2004; 6(6): 753-6.
5. 5. Porcel JM, Martínez-Alonso M, CaoG, Bielsa S, Sopena A, EsquerdaA. Biomarkers of heart failure in pleuralfluid. Chest 2009; 136(3): 671- 7.
6. 6. Kolditz M, Halank M, Schiemanck CS, Schmeisser A, Ho¨ffken G. High diagnostic accuracy of NT-proBNP for cardiac origin of pleural effusions. EurRespir J 2006; 28(1): 144- 50.
7. 7. Porcel JM, Vives M, Cao G, Esquerda A, Rubio M, Rivas MC.Measurement of pro-brain natriuretic peptide in pleural fluidfor the diagnosis of pleural effusions due to heart failure. Am J Med 2004; 116(6): 417-20.
8. 8. Gegenhuber A, Mueller T, Dieplinger B, Lenz K, Poelz W, HaltmayerM. Plasma B-type natriuretic peptide in patients with pleuraleffusions: preliminaryobservations. Chest 2005; 128(2): 1003-9

9. 9. Porcel JM. The use of probrain natriuretic peptide in pleural fluid fort he diagnosis of pleural effusions resulting from heart failure. CurrOpin Pulm Med 2005; 11(4): 329-333.
10. 10. Altug Cincin ,Yasin Abul M, Beste Ozben M, Azra Tanrikulu, Nurhayat Topaloglu, Gulsevil Ozgul , Sait Karakurt, and Ahmet Oktay. Pleural Fluid Amino-Terminal Brain Natriuretic Peptide in Patients With Pleural Effusions. respıratory care, february 2013; 58: 313.
11. 11. Romero-Candeira S, Fernandez C, Martin C, Sanchez-Paya J, Hernandez L. Influence of diuretics on the concentration of proteins and other components of pleural transudates in patients with heart failure. Am J Med 2009; 110: 681-6.
12. 12. Rehman SU, Januzzi JL Jr. Natriuretic peptide testing in clinical medicine. Cardiol Rev 2008; 16(5): 240-249