Brain-type natriuretic peptide release and seizure activity during vagal nerve stimulation

Vagus nerve stimulation (VNS) has emerged as an effective adjunctive therapy for medically refractory epilepsy when surgery is inadvisable. N-terminal brain-type natriuretic peptide (NT-proBNP) is a potent natriuretic, diuretic, and vasodilatative compound first discovered in the human brain but mainly synthesized in the myocardium. The monitoring of VNS effectiveness in reducing seizure frequency or the detection of possible cardiac adverse effects would be helped by a reliable biochemical marker, which has not been available thus far. We report a four-year-old boy with drug-resistant idiopathic generalized epilepsy whose NT-proBNP levels increased during VNS and seizures.     

卡维地洛对慢性心力衰竭患者心功能和BNP的影响

目的观察卡维地洛对慢性心力衰竭（CHF）患者心功能和BNP的影响。方法90例CHF患者,在常规治疗病情基本稳定的基础上,增加服用卡维地洛,从每次3.125mg开始,bid,缓慢递增。治疗前后分别进行心率、血压、心功能分期评估和血清BNP测定。结果与治疗前相比,治疗6个月后,心率明显下降（P〈0.01）,心功能分级明显改善,血清BNP明显下降（P〈0.01）。66.7%患者服用卡维地洛剂量可达到目标剂量25mg,bid;33.3%患者使用中等剂量12.5mg,bid,维持治疗。结论长期服用卡维地洛能改善心功能,降低血清BNP水平。     

左旋卡尼汀治疗扩张型心肌病36例

目的探讨左旋卡尼汀治疗扩张型心肌病对患者心功能及左室射血分数（LVEF）和脑钠素（BNP）的作用。方法将68例患者随机分为治疗组36例和对照组32例,两组均应用利尿刑、血管紧张素转化酶抑制剂及β-受体阻滞剂治疗,治疗组另外给予左旋卡尼汀治疗14d。观察两组患者临床疗效及治疗前后LVEF和血清BNP变化情况。结果治疗后两组患者心功能均有改善,LVEF均得到提高,BNP水平均降低,治疗组治疗后BNP水平较对照组显著降低（P〈0．05）。结论在常规治疗基础上给予左旋卡尼汀治疗,可以改善扩张型心肌病患者的心功能,显著降低BNP水平。     

氨氯地平对CHF大鼠血浆ET-1和BNP表达的影响

目的探讨氨氯地平对充血性心力衰竭（CHF）大鼠血浆中内皮素-1（ET-1）和B型钠尿肽（BNP）表达的影响。方法SD大鼠随机分为3组：对照组、心衰组、氨氯地平组。CHF组大鼠腹腔注射阿霉素累积剂量达20mg/kgBW制作CHF模型,氨氯地平组大鼠腹腔注射阿霉素同时每天给予氨氯地平10mg/kg。4周后各组大鼠经颈内动脉插管至左心室行血流动力学测定,同时测定大鼠血浆中ET-1和BNP的含量。结果CHF组大鼠左室压力最大上升速率（＋dp/dtmax）和最大下降速率（-dp/dtmax）均显著低于对照组,其血浆内ET-1和BNP均显著高于对照组（P〈0.01）。氨氯地平组±dp/dtmax均显著低于对照组但高于CHF组,其血浆内ET-1和BNP均显著高于对照组低于CHF组（P〈0.01）。结论氨氯地平治疗CHF大鼠的作用机制之一可能是通过保护CHF大鼠左室功能、结构及心肌细胞,间接降低ET-1、BNP表达水平。     

Effects of nocturnal noninvasive mechanical ventilation on heart rate variability of patients with advanced COPD

BACKGROUND: Cardiovascular comorbidities have a negative impact on the health status and prognosis of patients with COPD. We determined whether nocturnal noninvasive (positive) mechanical ventilation (NIMV) can improve heart rate variability (HRV), decrease circulating natriuretic peptide levels, and improve functional performance of patients with very advanced COPD. METHODS: A randomized, double-blind, parallel controlled trial was conducted in 23 participants with stable but advanced COPD. Participants received standard medical therapy plus nocturnal NIMV or standard medical therapy plus sham NIMV for 3 months. RESULTS: After 3 months of NIMV therapy, the 24-h triangular interpolation of N-N intervals increased from 322 to 473 ms (p = 0.034), the 24-h HRV index (HRVI) increased from 21.8 to 29.9 ms (p = 0.035), nocturnal HRVI increased from 6.1 to 8.0 ms (p = 0.026), and the SD of the average N-N interval increased from 37 to 41 ms (p = 0.020). None of these indexes changed significantly in the control group. Additionally, compared with the control group, the pro-atrial natriuretic peptide levels declined significantly in the NIMV group (p = 0.013). CONCLUSIONS: NIMV applied nocturnally over 3 months may improve HRV, reduce circulating natriuretic peptide levels, and enhance the functional performance of patients with advanced but stable COPD. While not definitive due to small sample size, these data suggest that nocturnal NIMV may reduce the impact of cardiac comorbidities in COPD patients.     

Natriuretic peptides

Natriuretic peptides (NPs) are released from the heart in response to pressure and volume overload. B-type natriuretic peptide (BNP) and N-terminal-proBNP have become important diagnostic tools for assessing patients who present acutely with dyspnea. The NP level reflects a compilation of systolic and diastolic function as well as right ventricular and valvular function. Studies suggest that using NPs in the emergency department can reduce the consumption of hospital resources and can lower costs by either eliminating the need for other, more expensive tests or by establishing an alternative diagnosis that does not require hospital stay. Caveats such as body mass index and renal function must be taken into account when analyzing NP levels. Natriuretic peptide levels have important prognostic value in multiple clinical settings, including in patients with stable coronary artery disease and with acute coronary syndromes. In patients with decompensated heart failure due to volume overload, a treatment-induced drop in wedge pressure is often accompanied by a rapid drop in NP levels. Knowing a patient's NP levels might thus assist with hemodynamic assessment and subsequent treatment titration. Monitoring NP levels in the outpatient setting might also improve patient care and outcomes.     

慢性阻塞性肺病患者CRR、CK-MB和BNP水平的改变及临床意义

目的 探讨血清C-反应蛋白(CRP)、磷酸肌酸激酶同工酶(CK-MB)和B型利钠肽(BNP)在慢性阻塞性肺病(COPD)急性发作期和治疗缓解期浓度变化及临床意义.方法 测定90例COPD患者急性发作期、治疗缓解期血清CRP、CK-MB和BNP水平和动脉血氧分压(PaO2),60例健康体检者血清CRP、CK-MB和BNP...