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Bedeutung der Surfactant-Proteine B und D in der Differentialdiagnostik der akuten Dyspnoe

Importance of Surfactant Proteins B and D for the Differential Diagnosis of Acute Dyspnea

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Zusammenfassung

Hintergrund und Ziel:

Grundlage für eine optimale Therapie kardiopulmonaler Erkrankungen ist die frühzeitige Diagnosestellung. Dies beinhaltet die differentialdiagnostische Beurteilung der akuten Dyspnoe. In zahlreichen Studien wurden die natriuretischen Peptide als zusätzliche, aussagekräftige Parameter für die Beurteilung der linksventrikulären Funktion beschrieben. In neueren Studien finden die lungenepithelspezifischen Surfactant-Proteine B (SP-B) und D (SP-D) als diagnostische Parameter Eingang in die weitere Abklärung einer Dyspnoe. Ziel dieser Untersuchung war es, die differentialdiagnostische Wertigkeit von NT-proBNP (N-terminales Spaltprodukt des „brain natriuretic peptide“) und Surfactant-Proteinen bei Patienten mit akuter Dyspnoe zu vergleichen.

Patienten und Methodik:

NT-proBNP, SP-B und SP-D wurden bei 81 Patienten mit akuter Dyspnoe in der Notaufnahme bestimmt und mit klinischen und echokardiographischen Parametern im Rahmen der endgültigen Diagnosestellung korreliert. Hierzu wurden die Patienten nach klinischen und echokardiographischen Parametern in verschiedene Untergruppen entsprechend der Ursache der akuten Dyspnoe eingeteilt.

Ergebnisse:

Patienten mit kardial bedingter akuter Dyspnoe hatten gegenüber Patienten mit nichtkardiopulmonaler Ursache einen signifikant erhöhten NT-proBNP-Spiegel (p = 0,04). Das SP-D zeigte bei Patienten mit kardialer Ursache einer akuten Dyspnoe die signifikant höchsten Plasmaspiegel, ist aber nach Durchführung der Regressionsanalysen von geringerer Bedeutung für die Differentialdiagnose der akuten Dyspnoe als das NT-proBNP. Die SP-B-Plasmaspiegel waren in den einzelnen Untergruppen nicht signifikant verschieden.

Schlussfolgerung:

Das NT-proBNP ist für die Differentialdiagnose der akuten Dyspnoe von Bedeutung. Auch wenn das SP-D ähnliche Plasmaspiegelveränderungen wie das NT-proBNP für die einzelnen Subgruppen aufweist, scheint es insgesamt von geringerer Bedeutung für die Differentialdiagnose zu sein. Das SP-B scheint für die Diagnosestellung einer kardialen oder pulmonalen Ursache bei akuter Dyspnoe ohne Bedeutung zu sein.

Abstract

Background and Purpose:

The basis for an optimal therapy of cardiopulmonary diseases is the assessment of an early diagnosis. This implies an evaluation of possible differential diagnoses of acute dyspnea. In numerous studies, natriuretic peptides were characterized as additional, meaningful parameters for the assessment of left ventricular function. Current studies could demonstrate that surfactant proteins B (SP-B) and D (SP-D) are of importance for the differentiation of patients with acute dyspnea. The aim of this study was to compare the values of NT-proBNP (N-terminal brain natriuretic peptide) and surfactant proteins for the assessment of a final diagnosis in patients with acute dyspnea.

Patients and Methods:

NT-proBNP, SP-B and SP-D were measured in 81 patients with acute dyspnea in the emergency room and were correlated with clinical and echocardiographic parameters with respect to the final diagnosis. For this, patients were classified with respect to clinical and echocardiographic parameters in different subgroups concerning the final diagnosis of acute dyspnea.

Results:

In patients with a cardiac origin of acute dyspnea, plasma levels of NT-proBNP were significantly higher as compared to patients with a noncardiac diagnosis (p = 0.04). SP-D was highest in patients with a cardiac origin of acute dyspnea, but after performing regression analysis it seems to be of less importance for the differential diagnosis of acute dyspnea as compared to NT-proBNP. SP-B plasma levels were not different between the four subgroups.

Conclusion:

NT-proBNP is of importance for the differential diagnosis of acute dyspnea. Although SP-D shows similar changes of plasma levels between the four subgroups, it seems to be of less importance for the differential diagnosis of acute dysnea. SP-B occurs to be of no relevance for the differentiation between cardiac and noncardiac origin of acute dyspnea.

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Authors and Affiliations

  1. Abteilung Innere Medizin – Kardiologie, Philipps-Universität Marburg, Marburg, Germany

    Claus Lüers

  2. Nephrologisches Zentrum Göttingen, Göttingen, Germany

    Gerrit Hagenah

  3. Abteilung Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Göttingen, Germany

    Rolf Wachter, Sibylle Kleta, Jens Schaumberg & Sebastian Riedel

  4. Abteilung Klinische Chemie, Universitätsmedizin Göttingen, Göttingen, Germany

    Lutz Binder

  5. Abteilung Medizinische Statistik, Universitätsmedizin Göttingen, Göttingen, Germany

    Klaus Jung

  6. Klinische Abteilung für Kardiologie, Medizinische Universität Graz, Österreich, Germany

    Albrecht Schmidt & Burkert Pieske

  7. Klinik für Innere Medizin – Kardiologie, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Germany

    Claus Lüers

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  1. Claus Lüers
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Correspondence to Claus Lüers.

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Lüers, C., Hagenah, G., Wachter, R. et al. Bedeutung der Surfactant-Proteine B und D in der Differentialdiagnostik der akuten Dyspnoe. Med Klin 105, 611–618 (2010). https://doi.org/10.1007/s00063-010-1100-0

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  • DOI: https://doi.org/10.1007/s00063-010-1100-0

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