B-型利钠肽、左室射血分数、6分钟步行实验评价心力衰竭患者心功能的临床价值

目的:探讨慢性心力衰竭(CHF)患者通过血浆B-型刺钠肽水平、左室射血分数、6分钟步行实验综合评价心功能的临床价值.方法:采用心力衰竭诊断仪测定心衰患者血浆BNP水平,同时采用NYHA心功能分级和超声心动图评价患者左心功能,记录6分钟步行实验距离,并对结果进行相关性分析.结果:1.CHF组与对照组患者血浆BNP水平比较及其与心功能分级的关系:CHF组各亚组的BNP水平与对照组比较,有显著性差异(P<0.01).CHF组组间两两比较BNP水平,有显著性差异(P<0.01),并随着心功能分级的增加和心功能的恶化,水平逐渐增加,二者呈正相关(r=0.708,P<0.01).2.BNP水平与左室射血分数呈负相关(r=-0.992),与6分钟步行实验距离呈负相关(r=-0.756),左室射血分数与6分钟步行试验距离呈正相关(r=0.989).结论:测定血浆BNP水平,结合NYHA心功能分级、起声心动图左室射血分数、6分钟步行试验有助于对心力衰竭患者的心功能进行综合评估.     

体外循环冠状动脉旁路移植术围手术期血浆脑钠肽的变化及其临床意义

目的观察体外循环冠状动脉旁路移植术（CABG）围手术期血浆脑钠肽（brain natriuretic peptide,BNP）的变化规律。方法2005年7～10月我院收治20例CABG患者,分别于麻醉诱导后,主动脉开放前,开放后20min,进入ICU,术后12h,24h和48h测量血浆BNP浓度,分析围手术期BNP的变化规律,以及BNP与心功能、血流动力学指标及术后血浆肌酸激酶同工酶（CK-MB）、肌钙蛋白（TNT）等的相关关系。结果麻醉诱导后BNP与左心室射血分数（LVEF）呈明显负相关（r=-0.912,P=0.000）,与左心室舒张期末内径（r=0.714,P=0.000）,肺毛细血管楔压（PCWP,r=0.809,P=0.000）,中心静脉压（r=0.787,P=0.000）呈明显正相关。手术前后BNP浓度的差异有统计学意义（F=42.259,P〈0.01）,从主动脉钳开放后逐步上升,并在术后24h达峰值。进入ICU,术后12h,24h的BNP浓度与PCWP呈明显正相关（r=0.602,P=0.005;r=0.554,P=0.011;r=0.631,P=0.003）,与CK-MB浓度呈明显正相关（r=0.528,P=0.017;r=0.638,P=0.002;r=0.882,P=0.000）;但与TNT浓度的相关性不明显。结论冠心病患者术前血浆BNP浓度能正确反映术前的心功能状态;心肌缺血-再灌注损伤是术后BNP大量释放的原因;术后BNP监测能正确及时地反映患者的心功能状态,特别是前负荷状态。     

血浆BNP检测在慢性心力衰竭诊断及预后评估中的意义

目的：探讨血浆 BNP 检测在慢性心衰诊断及预后评估中的临床意义。方法回顾性分析慢性心力衰竭患者100例的临床资料,分析 BNP 水平与心功能分级、左室射血分数、左室舒张末期内径的关系。并根据BNP 水平分为＞400pg/mL 组和≤400pg/mL 组,比较两组患者房颤、陈旧性心肌梗死以及死亡率。结果随着心功能分级的升高,BNP 水平显著升高,LVEF 水平显著下降,LVEDD 显著增加（P ＜0.01）。BNP 与心功能分级和 LVEDD 呈正相关（r=0.921,0.917,P ＜0.01）,与 LVEF 呈负相关（r=-0.960,P ＜0.01）。BNP水平＞400pg/mL 的患者房颤、陈旧性心梗的发生率及死亡率更高（P ＜0.05或＜0.01）。结论血浆 BNP水平检测能够反映慢性心衰患者左心室功能,对患者诊断、预后评估均具有重要的临床意义。     

心瓣膜疾病患者围手术期脑钠素浓度的变化

目的 观察心瓣膜置换术患者围手术期血清脑钠素(brain natriuretic peptide, BNP)浓度的变化规律.方法 20例心瓣膜置换术患者按NYHA心功能标准分级,术前进行超声心动图检查,测量左心室射血分数(LVEF),于术前、术后24小时、7天、14天和30天测量血清BNP浓度,分析围手术期BNP浓度变化趋势,术前BNP浓度与心功能、LVEF的关系. 结果心瓣膜疾病患者术后BNP浓度急剧上升,24小时达峰值(P＝0.003);术后7天明显下降,但仍高于术前水平(P＝0.015);术后14天恢复至术前水平,术后30天略低于术前水平.术前心功能NYHA分级与BNP水平呈正相关(r=0.69,P＜0.05),LVEF与BNP浓度无相关关系(r＝0.29,P＞0.05). 结论术前血清BNP浓度能反映心瓣膜置换术患者术前心功能状况,血清BNP浓度越高,心功能越差.术后早期BNP浓度升高,后期呈下降趋势.     

不停跳冠状动脉搭桥术围手术期脑钠肽浓度变化及临床意义

目的测定不停跳冠状动脉搭桥术围手术期血清BNP浓度,研究其变化及临床意义。方法不停跳冠状动脉搭桥患者39例。于术前1d(T1)、术后7h(T2)、1d(T3)、3d(T4)、5d(T5)、7d(T6)测量血清BNP浓度,术前进行NYHA心功能标准分级,超声心动图检查,术后观测肌钙蛋白(TnI)浓度、血管活性药物的应用、呼吸机辅助时间、ICU时间、住院时间、术后并发症。结果冠心病患者BNP平均浓度显著高于正常人群。LVEF与BNP浓度呈负相关关系(r=-0.829,P0.01)。BNP浓度术后7h与术前相比显著增高(P0.05),术后1d达到峰值(P0.01),术后3d开始呈下降趋势,术后7d仍比术前高,但差异无统计学意义(P0.05)。术前BNP浓度≥100pg·ml-1的患者,预后较差。结论BNP浓度能反映冠状动脉搭桥术围手术期患者的心功能状态,心功能越差,BNP浓度越高,较LVEF更准确量化心功能状态。BNP可作为指导冠状动脉搭桥临床治疗及判断预后的一种客观定量指标。     

B型钠尿肽的生物学特征及其研究进展

B型钠尿肽(B-Natriuretic peptide,BNP)又称脑尿钠肽,是由心室分泌的含有32个氨基酸的多肽,是心室对容积扩张及压力负荷的反映.近年来,有关BNP浓度测定与心功能的关系,及于高血压患者左心室肥大的关系,以及对心脏病预后评估作用等方面在国内外已受到越来越密切的关注和重视.BNP是一种心血管肽类激素,大量研究证实,血浆BNP水平与心功能的关系极为密切,能够敏感且特异地反映心室功能紊乱的程度.而且BNP与急性冠状动脉综合征、稳定型冠状动脉粥样硬化性心脏病远期死亡、经皮穿刺冠状动脉介入术后死亡或非致死性心肌梗死、心脏手术后心房纤颤、慢性心力衰竭等均有密切关系,心血管肽类激素重组人脑利钠肽已成为治疗心力衰竭的新药.现就B型钠尿肽的生物学特征及临床应用作以综述.     

开胸手术对胸部恶性肿瘤患者心功能及血浆BNP的影响

目的探讨开胸手术对胸部恶性肿瘤患者心功能及血浆BNP的影响。方法将行开胸手术的48例胸部恶性肿瘤患者采用电化学发光免疫法和心脏彩超多普勒超声诊断仪测定并比较患者手术前后血浆脑钠肽(BNP)、左室射血分数(LVEF)及舒张末期内径(LVEDD)。结果术后7 d患者BNP和LVEDD分别为(106.62±37.24)pg/m L和(58.83±5.11)mm,显著高于术前1 d,LVEF显著低于术前1 d,差异具有统计学意义(P0.05)。结论恶性肿瘤患者开胸术后患者常发生心功能降低现象,血浆BNP可作为衡量心功能变化的早期参考指标。     

慢性肾脏病非透析患者脑钠素与动脉粥样硬化及心功能的关系

目的 研究脑钠素（BNP）与慢性肾脏病（CKD）非透析患者动脉粥样硬化及心功能不全的关系。 方法 采用双抗夹心免疫荧光法检测203例CKD非透析患者与16例高血压患者对照组全血BNP水平，分析其与颈动脉超声结果、心脏彩超结果及既往心血管疾病史的关系。 结果 CKD非透析患者BNP水平与对照组相比显著升高[M（范围）：54.40(15.10～ 173.00) ng/L比9.35(7.35～15.00) ng/L，P < 0.01]。Spearman相关分析显示CKD患者BNP与颈动脉内膜中层厚度（IMT）、左室心肌重量指数（LVMI）等呈正相关。存在颈动脉斑块、左室肥厚或既往发生过心血管事件的患者血BNP水平显著增高。多元回归分析显示LVMI、既往心血管事件均是影响BNP水平的独立因素。 结论 CKD非透析患者BNP水平和动脉粥样硬化性疾病、左室肥厚及心功能不全相关，提示BNP水平可作为一项评价CKD非透析患者心功能及动脉粥样硬化的敏感生物学指标。     

脑利钠肽在冠心病心功能评价中的应用

目的研究脑利钠肽在冠心病心功能评价中的应用。方法选择2009年10月～2010年3月在上海中山医院住院的100例确诊为冠心病心功能不全患者为实验组。所有入选实验组心功能均按美国纽约心脏病协会（NYHA）分级标准进行分级,冠脉造影证实冠心病,心脏彩超提示左室射血分数（LVEF）〈50%。所有患者入院后均行肝肾功能检查、心电图、胸片（必要时行胸部CT检查）、心脏彩超,排除肝肾疾病、肺部疾病及其他心脏病所致心功能不全。选择100例同期入住心内科的冠心病心功能正常的患者为对照组,心脏超声LVEF正常,心室无明显扩大。通过检测两组血浆NT-proBNP浓度评价冠心病患者心功能情况。结果冠心病心功能不全患者的血浆BNP浓度明显偏高,且患者心功能越差,NYHA分级越高,LVEF值越低,BNP浓度越高。经治疗后随着患者心功能及LVEF的改善,NT-proBNP浓度渐下降。结论通过监测NT-proBNP可客观地反映心功能情况,与目前临床上通过心超LVEF值判断心功能情况有等同意义。     

脑钠肽在急性肾衰竭鉴别诊断中的价值

脑钠肽(BNP),又称B型钠尿肽,是心室肌细胞合成分泌的多肽类神经激素,广泛应用于心功能不全的诊断、治疗和预后评价.我们检测不同原因急性肾衰竭少尿期和恢复期的BNP水平,探讨其在急性肾衰竭鉴别诊断中的意义.     

Changes in type B natriuretic peptide (BNP) concentrations during cardiac valve replacement

Objective: The aim of our study was to investigate the ability of BNP levels to reveal the immediate post-surgery cardiac function improvement. We measured the perioperative variations in BNP concentrations in patients scheduled for cardiac surgery with cardiopulmonary bypass (CPB), chronic mitral regurgitation, valvular aortic stenosis, or myocardial ischaemia. Methods: Three groups were included: patients with coronary artery bypass graft (CABG, group I, n=14), aortic (AVR, group II, n=14) or mitral (MVR, group III, n=7) valve replacement. BNP assay was performed at the induction of anesthesia, immediately after the CPB, at the arrival in the intensive care unit, 4 h, 8 h and 12 h after the arrival in ICU. Results and conclusion: The occurring variation in BNP levels after the operation is an increase whatever the corrective surgery, underlying the relative lack of specificity of BNP with regard to the cardiac pathology. Besides iatrogenic cardioplegia one can supposes that cardiac surgery involves other major stimuli such as anesthesia, sternotomia, hemodynamics, post-operative that could influence in a non specific way BNP levels.     

Effect of acute brain death on release of atrium and B-type natriuretic peptides in an animal model

INTRODUCTION: Atrium and B-type natriuretic peptides (ANP and BNP) and big endothelin (ET)-1 are markers for severity of heart failure and may be used in the quality assessment of donor hearts. Elevated cardiac troponins predict early graft failure after heart transplantation. This study evaluated the effects of acute brain death (BD) on the release of ANP, BNP, big ET-1, and cardiac troponins in an animal model. MATERIALS AND METHODS: Pigs were randomized into a BD group (n=5) and a control group (n=5). In the first group, acute BD was induced, and anesthesia was stopped. In the control animals, a sham operation was performed, and anesthesia was continued. Parameters were measured at baseline and for 13 hours postoperatively. RESULTS: After acute BD, there were significant hemodynamic changes. In the control group, the BNP level was higher than in the BD group and decreased over time (P =0.016). There was no significant change in BNP release in the BD group up to 13 hours (P =0.1). ANP release remained stable over time in the control group (P =0.35) but decreased in the BD group (P =0.043). The big ET-1 levels were not different between groups. Cardiac troponin I was elevated in the BD group 5 hours after BD (P< 0.05) but remained under 1.5 mg/L throughout the study. CONCLUSION: Acute BD did not lead to an increase of BNP and ANP levels. Moreover, intact brain function seems to augment the release of natriuretic peptides from the myocardium. Further clinical evaluation of prognostic values of natriuretic peptides for the assessment of donor hearts is necessary. Cardiac troponins are a useful additional tool in the evaluation of donor hearts.     

Role of B-type natriuretic peptide and effect of nesiritide after total cardiac replacement with the AbioCor total artificial heart.

Endogenous B-type natriuretic peptide (BNP) is thought to be produced in the cardiac ventricles. After sub-total cardiectomy and implantation of a total artificial heart (TAH), the abrupt withdrawal of BNP impairs renal function despite normal hemodynamic variables. We hypothesized that abrupt withdrawal of endogenous BNP may impair renal function and volume homeostasis and BNP may have a direct renal influence unrelated to its cardiovascular effect. Nesiritide infusion should be supplemented in the interim and weaned slowly until BNP levels normalize, which suggests that BNP is produced in tissues other than the cardiac ventricles.     

Continuous intra- and postoperative thoracic epidural analgesia attenuates brain natriuretic peptide release after major abdominal surgery

We investigated whether blocking afferent nociceptive inputs by continuous intra- and postoperative thoracic epidural analgesia (TEA) would decrease plasma concentrations of brain natriuretic peptide (BNP) in patients who were at risk for, or had, coronary artery disease. Twenty-eight patients undergoing major abdominal surgery received either general anesthesia supplemented with a continuous thoracic epidural infusion of 1.25 mg/mL bupivacaine and 1 microg/mL sufentanil (n = 14; TEA) or general anesthesia followed by IV patient-controlled analgesia (n = 14; IV PCA). Visual analog scale pain scores, hemodynamics, plasma catecholamines, cardiac troponin T, atrial natriuretic peptide (ANP), and BNP were serially measured preoperatively, 90 min after skin incision, at arrival in the intensive care unit, and in the morning of the first, second, and third postoperative day. Dynamic visual analog scale scores were significantly less in the TEA group. TEA reduced the postoperative heart rate without affecting other hemodynamic variables. Plasma epinephrine increased perioperatively in both groups but was significantly lower in the TEA group. Baseline ANP and BNP concentrations were similar between groups (TEA 3.4 +/- 1.8 and 27.0 +/- 12.3 pg/mL; IV PCA 3.1 +/- 2.0 and 25.9 +/- 13.0 pg/mL, respectively). ANP and BNP increased perioperatively in both groups, with significantly lower postoperative BNP levels in TEA patients (TEA 92.1 +/- 31.9 pg/mL; IV PCA 161.2 +/- 44.7 pg/mL). No such difference was observed in plasma ANP concentrations. Plasma cardiac troponin T concentrations were within normal limits in both groups at all times. We conclude that continuous perioperative TEA using local anesthetics and opioids attenuated the release of BNP in patients undergoing major abdominal surgery who were at risk for, or had, coronary artery disease.     

左心辅助循环后心肌功能恢复的预测研究

目的研究急性缺血性左心功能不全时左心辅助装置(LVAD)对左心功能的影响，筛选合适的心肌功能预后指标。方法将15只健康成年犬随机分为对照组(A)、心衰组(B)、辅助组(C)，仅对C组进行左心辅助。监测6h内3组实验犬的血流动力学指标及血浆心钠素(ANP)、脑钠素(BNP)、心肌肌钙蛋白Ⅰ(cTnⅠ)水平变化情况。结果辅助组实验犬各项血流动力学指标明显改善，ANP、BNP、cTnⅠ降至正常水平，心肌超微结构基本恢复正常。通过相关性分析，血浆。BNP水平不受血流动力学变化影响。结论血浆BNP更适于作为预测心肌功能恢复的预后指标。     

Comparison of plasma levels of mature adrenomedullin and natriuretic peptide as markers of cardiac function in hemodialysis patients with coronary artery disease

BACKGROUND: It has been suggested that, like ANP and BNP, high plasma levels of mature adrenomedullin (mAM) indirectly reflect the severity of heart failure or renal failure. However, the relationship between mAM levels and hemodynamics and cardiac function has not been examined in hemodialysis (HD) patients with coronary artery disease (CAD). The best marker, among mAM, ANP and BNP, for left-ventricular function in those patients is also unclear. PATIENTS AND METHODS: Plasma levels of mAM, total AM (tAM), ANP and BNP were determined before HD in chronic HD patients with CAD (group 1; n = 17) and were compared with those of HD patients without cardiac disease (group 2; n = 22). We examined their relationship to hemodynamics and cardiac function in group 1 using data obtained by cardiac catheterization. RESULTS: Plasma levels of ANP and BNP were significantly higher in group 1 than in group 2, but there was no significant difference in plasma levels of mAM and tAM between the two patient groups. Plasma levels of both mAM and tAM significantly correlated with right atrial pressure (RAP), and only plasma tAM levels correlated with pulmonary artery pressure (PAP) and pulmonary artery wedge pressure (PAWP). However, no correlations were found between levels of the two forms of AM and ejection fraction (EF). In contrast, plasma ANP and BNP levels significantly correlated with both PAP and PAWP, and also with EF, although they did not correlate with RAP. The correlation of PAP and PAWP with ANP and BNP levels was closer than that with tAM levels. The most significant correlation was between BNP levels and EF (r = -0.756, p < 0.0001). CONCLUSIONS: Our results suggest that the mAM level may be less useful than natriuretic peptide levels as a marker of cardiac function in HD patients with CAD, and that the BNP level might be the best indicator of left-ventricular function. In addition, cardiac disease such as CAD may have a minor impact on mAM levels compared to renal failure.     

Brain natriuretic peptide and right heart dysfunction after heart transplantation

Heart transplantation (HT) should normalize cardiac endocrine function, but brain natriuretic peptide (BNP) levels remain elevated after HT, even in the absence of left ventricular hemodynamic disturbance or allograft rejection. Right ventricle (RV) abnormalities are common in HT recipients (HTx), as a result of engraftment process, tricuspid insufficiency, and/or repeated inflammation due to iterative endomyocardial biopsies. RV function follow‐up is vital for patient management as RV dysfunction is a recognized cause of in‐hospital death and is responsible for a worse prognosis. Interestingly, few and controversial data are available concerning the relationship between plasma BNP levels and RV functional impairment in HTx. This suggests that infra‐clinical modifications, such as subtle immune system disorders or hypoxic conditions, might influence BNP expression. Nevertheless, due to other altered circulating molecular forms of BNP, a lack of specificity of BNP assays is described in heart failure patients. This phenomenon could exist in HT population and could explain elevated BNP plasmatic levels despite a normal RV function. In clinical practice, intra‐individual change in BNP over time, rather than absolute BNP values, might be more helpful in detecting right cardiac dysfunction in HTx.     

Cerebral salt wasting and elevated brain natriuretic peptide levels after traumatic brain injury: 2 case reports

BACKGROUND: Historically, hyponatremia in patients with varying brain diseases was termed cerebral salt wasting. Hyponatremia secondary to CSW was reported to be a distinct entity from SIADH, with the distinguishing feature of decreased extracellular fluid volume. Brain natriuretic peptide, a peptide with natriuretic, vasorelaxant, and aldosterone-inhibiting properties, was recently implicated in aneurysmal SAH patients with CSW. Here, we describe 2 cases of CSW in TBI patients with elevated BNP levels. This phenomenon has not been previously described. CASE DESCRIPTION: Two patients with TBI and hyponatremia were subject to analysis. Central lines were placed to assess volume status. Levels of BNP were measured at the onset of hypertonic saline infusion. Electrocardiogram and cardiac enzyme studies were performed to assess cardiac function. Serial imaging was performed to assess the extent of brain injury. CONCLUSIONS: These patients with TBI had findings consistent with CSW with elevated BNP levels in the setting of normal cardiac function. In both cases, a high BNP level was observed after declining plasma Na levels despite aggressive hypertonic saline infusion. High BNP levels may be associated with CSW. Further studies are necessary to establish a causative role for BNP in TBI-induced CSW.