血浆脑钠素水平在病毒性心肌炎患者中的临床意义

目的 探讨血浆脑钠素(BNP)水平在病毒性心肌炎(VMC)患者中的临床意义及预后.方法 测定48例病毒性心肌炎患者及40例非心肌炎患者BNP浓度及射血分数(EF),随访2年,观察两组患者,分析血浆BNP与心肌炎的相关性以及BNP对病毒性心肌炎患者预后的影响.结果 VMC组血浆BNP、EF值与对照组比较显著高于对照组(P＜0.01,P＜0.05).VMC组BNP显著升高患者死亡率高.结论 VMC患者中血浆BNP水平升高,BNP显著升高患者预后差.     

重组人脑利钠肽用于重症急性心肌炎伴 心力衰竭患者治疗的临床研究

目的 研究重组人脑利钠肽应用于重症急性心肌炎伴心力衰竭患者在临床治疗的效果。方法 选取我院2014年1月~2017年6月收治的98例急性心肌炎合并心力衰竭患者,并随机均分为实验组和对照组,每组49例。对照组行常规的抗心力衰竭治疗,实验组在对照组的基础上行静脉泵入重组人脑利钠肽。72 h后测定两组患者用药前后血清N末端脑钠肽前体水平、左室射血分数和Supper-Score的评分。结果 72 h后两组患者N末端脑钠肽前提水平均:用药前>对照组>实验组,左室射血分数:实验组>对照组>用药前,差异存在统计学意义（P<0.05）,两组患者用药前N末端脑钠肽前体水平、左室射血分数的差异,无统计学意义（P>0.05）。结论 重组人脑利钠肽应用于重症急性心肌炎伴心力衰竭患者的疗效显著,可推广应用。     

1例重症病毒性心肌炎的护理

重症病毒性心肌炎在临床上发病较少,但其严重的并发症导致死亡率极高,本例患者通过多学科、多专业的联合抢救与护理,患者的疾病成功治愈。     

椒蒿提取物对病毒性心肌炎心肌保护作用的研究

椒蒿为菊科植物 ,民间常作为野菜采食 ,中药认为有抗风寒作用。本文所用的椒蒿提取物含茴香脑 5 6 %。用提取物对病毒性心肌炎的动物模型进行了研究 ,旨在探讨其心肌保护作用。柯萨奇B3 病毒 (CVB3 )Nancy株 ,在Vero细胞上增殖后 ,TCID50 为 10 9;BALB/c雄性小鼠 4～ 6周龄 ,体重 12± 2g,16 0只。分为 6组 ,A组 :为正常对照组 ,取10只小鼠 ,腹腔注射 0 1ml不含病毒的Eagle′sMEM液。其余 15 0只小鼠随机等分为 5组 ,每组 30只 ,分别腹腔接种0 .1ml病毒液 ,建立病毒性心肌炎 (VMC)模型。B组 :病毒模型对照组 ;C组 :黄芪治疗组 ;…     

利尿钠肽在诊断心力衰竭中的应用价值

探讨利尿钠肽的水平对心力衰竭（心衰）早期诊断的应用价值。采用放免法、ELISA法检测了129例心衰患者血浆中的心房利尿钠肽（ANP）、脑利尿钠肽（BNP）、N末端脑钠肽前体蛋白（NT-proBNP）水平,并与30例健康对照者进行了比较分析。结果显示,心衰患者血浆中的ANP、BNP、NT-proBNP显著高于健康对照组,且均随着NYHA分级的升高而逐渐增加,其含量在NYHA Ⅳ级时到达最高,心衰患者的血浆ANP、NT-proBNP水平与LVEF呈明显负相关。检测血浆中的ANP、BNP、NT-proBNP含量简便、快捷,可用于心衰诊断及NYHA分级判断。     

树突状细胞在病毒性心肌炎中的作用及其可能的机制

病毒性心肌炎的发病机制尚不完全清楚,病毒感染后引起的免疫损伤作用可能是其重要机制之一.树突状细胞是功能强大的专职抗原提呈细胞,连接固有免疫反应和适应性免疫反应,居于免疫反应的中心地位.树突状细胞在病毒性心肌炎中的作用及其机制目前还没有相关报道.本文就病毒性心肌炎的免疫学发病机制以及树突状细胞的生物学特性和其在病毒性心肌炎免疫学发病中的作用作一综述,旨在为心肌炎的治疗提供新方向.     

大蒜新素治疗小鼠巨细胞病毒性心肌炎作用研究

目的探讨大蒜新素对小鼠巨细胞病毒(MCMV)性心肌炎治疗作用及其抗CMV机制. 方法 60只BALB/c小鼠随机分成大蒜新素治疗组(20只)、安慰剂组(20只)和正常对照组(20只).大蒜新素治疗组接种MCMV K181后24 h开始用大蒜新素一般剂量(25 mg/kg)腹腔注射,每天1次,共14 d;安慰剂组和正常对照组仅用等量生理盐水.各组分别于治疗后第3、5、7、14天各处死5只小鼠,观察小鼠心肌组织病理损害;用双抗体夹心ELISA法检测小鼠心肌组织细胞因子IFN-γ表达水平;用RT-PCR方法检测小鼠脾核转录因子T-bet mRNA表达强度. 结果 MCMV感染下调小鼠T-bet mRNA和TH1类细胞因子IFN-γ的表达(P＜0.01);大蒜新素能诱导MCMV性心肌炎模型小鼠转录因子T-bet mRNA和细胞因子IFN-γ的表达显著增加(P＜0.01),并显著改善MCMV感染小鼠心肌组织病理损害(P＜0.05). 结论大蒜新素通过上调转录因子T-bet mRNA表达进而促进TH1类细胞因子IFN-γ分泌,诱导和促进TH1优势应答反应,增强机体特异性细胞免疫功能而发挥抗MCMV作用.     

脑钠肽在心力衰竭和急性冠脉综合征中的临床应用

脑钠肽是一种具有多种生理活性的多肽.可以评判左心功能,预测急性冠脉综合征(ACS)及经皮冠状动脉介入治疗(PCI)术后患者的预后.此外,对心力衰竭和急性心梗治疗(AMI)也有显著疗效.     

脑钠肽在心力衰竭和急性冠脉综合征中的临床应用

脑钠肽是一种具有多种生理活性的多肽。可以评判左心功能,预测急性冠脉综合征（ACS）及经皮冠状动脉介入治疗（PCI）术后患者的预后。此外,对心力衰竭和急性心梗治疗（AMI）也有显著疗效。     

急性重症病毒性心肌炎的临床特点与治疗

目的 探讨酷似急性心肌梗死的急性重症病毒性心肌炎患者的临床特点和治疗方法,以提高急性重症病毒性心肌炎的早期诊断率和治愈率.方法 选取2010年6月至2012年6月佛山市禅城区中心医院收治的酷似急性心肌梗死的急性重症病毒性心肌炎患者36例与急性心肌梗死患者40例,收集患者临床信息进行对比分析;并评价急性重症病毒性心肌炎的治疗效果.结果 急性重症病毒性心肌炎和急性心肌梗死患者在感染史、发热、胸痛、阿-斯综合症发生率以及CK峰值、CK-MB峰值、房室传导阻滞、异常Q波上存在差异,具有统计学意义(P＜0.05).治疗后,患者心功能得到显著提高,差异具有统计学意义(P＜0.05).结论 酷似急性心肌梗死的急性重症病毒性心肌炎可通过心电图表现、心肌酶检查结果与急性心肌梗死进行鉴别.早诊断、早治疗有助于提高疗效.     

急性心肌缺氧对乳鼠心肌细胞脑钠尿肽表达的影响及其作用机制

目的: 观察急性缺氧损伤对乳鼠心肌细胞脑钠尿肽(BNP)表达水平的影响并探讨其可能作用机制。方法: 原代乳鼠心肌细胞缺氧、无糖、无血清培养以模拟心肌缺血损伤,利用CCK-8法测细胞存活率、ELISA法测白细胞介素-6(IL-6)和BNP的表达;以IL-6直接干预体外培养的心肌细胞, 采用RT-PCR、Western blotting和ELISA方法观察BNP、转化生长因子β₁(TGF-β₁)、Smad2 mRNA的转录和蛋白的表达。结果: 缺氧显著上调IL-6和BNP的表达,且两者呈线性正相关;IL-6直接干预可剂量和时间依赖性地上调心肌细胞BNP的mRNA和蛋白表达水平,同时TGF-β₁和Smad2的表达水平亦增加;而针对TGF-β₁的中和抗体能够部分地抑制由IL-6引起的BNP表达增加。结论: 急性心肌缺氧可直接上调BNP的表达水平,这种调节效应与TGF-β₁/Smad2信号通路上调有关。     

脑利钠肽水平联合肺动脉CT评估老年心力衰竭患者预后的价值

目的:研究脑利钠肽（BNP）水平联合肺动脉电子计算机断层扫描（CT）评估老年心力衰竭（HF）患者预后的价值。 方法:选取100例HF患者,根据5年随访的患者生存情况将其分为存活组（n=54）和死亡组（n=46）。检测并比较两组血清 BNP 水平;回顾肺动脉CT 结果,比较右肺动脉直径（RPAD）、室间隔厚度（IVST）、升主动脉直径（AA）、降主动脉直径 （PA）、左肺动脉直径（LPAD）以及主肺动脉直径（MPAD）。结果:与死亡组比较,存活组血清BNP水平、RPAD、LPAD显著 降低,IVST显著升高,差异有统计学意义（P<0.05）;血清BNP水平与RPAD、LPAD呈正相关,与IVST呈负相关,差异均具 有统计学意义（P<0.05）;与单一指标评估相比,BNP水平联合肺动脉CT评估的灵敏度、特异性、准确度、阳性预测值、阴性 预测值、ROC曲线下面积显著升高（P<0.05）。结论:BNP水平联合肺动脉CT评估老年HF患者预后的特异性、灵敏度以 及准确度更高,具有较高的临床参考价值。     

Cellular orientation of atrial natriuretic peptide in the human brain

Many peptide hormones and neurotransmitters have been detected in human neuronal tissue. The localisation of atrial natriuretic peptide (ANP) in the human brain was considered to be both interesting and relevant to the understanding of neurochemistry and brain water–electrolyte homeostasis. This vasoactive peptide hormone has been localised in rat and frog neuronal tissue. In the present study, we report the immunohistochemical localisation of ANP in autopsy samples of human brain tissue employing the avidin–biotin–peroxidase complex technique, using an antibody against a 28 amino acid fragment of human ANP. The most intense staining of immunoreactive ANP was detected in the neurones of preoptic, supraoptic and paraventricular nuclei of the hypothalamus, epithelial cells of the choroid plexus and ventricular ependymal lining cells. Immunoreactive neurones were also observed in the median eminence, lamina terminalis, infundibular and ventromedial nuclei of the hypothalamus, and in neurones of the brain stem, thalamic neurones and some neurones of the caudate nucleus. The network of ANP cells in numerous hypothalamic centres may regulate the salt and water balance in the body through a hypothalamic neuro-endocrine control system. ANP in the brain may also modulate cerebral fluid homeostasis by autocrine and paracrine mechanisms.     

Marked elevation of B-type natriuretic peptide in patients with heart failure and preserved ejection fraction

Marked elevations of B-type natriuretic peptide （BNP） are not generally seen in patients with heart failure and preserved ejection fraction （HFpEF）. The objective of this study was to examine the clinical and laboratory characteristics of a large cohort of patients with HFpEF and markedly elevated BNP. A retrospective examination of 421 inpatients at a university hospital admitted with a diagnosis of HFpEF was performed. Clinical and echocardiographic data in 4 groups of patients with levels of BNP ≤ 100 pg/mL, 100-400 pg/mL, 400-1,000 pg/mL and 〉 1,000 pg/mL were compared. Patients with HFpEF and BNP 〉 1,000 pg/mL （28% of the population） were characterized by impaired renal function and greater use of anti-hypertensive medications. A subset of these patients with BNP 〉 1,000 pg/mL had normal renal function （21%） and were significantly older, more frequently female, and tended to have lower ejection fractions. Conversely, patients with HFpEF and BNP ≤100 pg/mL were younger and had preserved renal function. BNP was inversely related to the likelihood of subsequent admission for heart failure, but not to myocardial infarction or death. In conclusion： BNP 〉 1,000 pg/mL is seen in almost 1/3 of patients hospitalized with HFpEF. This elevation of BNP often reflects impaired renal function, but can also be seen in patients with preserved renal function but relatively impaired systolic function.     

Regional cardiac expression and concentration of natriuretic peptides in patients with severe chronic heart failure

The purpose of this study was to examine the regional cardiac mRNA expression and concentration of brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP) in relation to the circulating peptide concentrations in patients with chronic heart failure (CHF). The myocardial mRNA levels and peptide concentrations of BNP and ANP were analysed in seven different regions of the heart from patients undergoing cardiac transplantation. Autopsy samples from individuals without known cardiovascular disease were used as controls. The plasma levels of natriuretic peptides and their N‐terminal propeptides, Nt‐proBNP and Nt‐proANP, were measured in the CHF patients and healthy volunteers. In the autopsy specimens, the atrial regions appeared to contain the highest peptide levels for BNP as well as ANP, the atrioventricular ratio being 12–262 and 72–637‐fold, respectively. In the CHF patients there was a relative shift towards the ventricle for BNP, reducing the atrioventricular ratio to 6–16‐fold. The circulating concentrations of BNP/Nt‐proBNP in the CHF patients correlated closely to the BNP mRNA expression in most myocardial regions including the left ventricle (r=0.72, P < 0.001). For circulating concentrations of ANP/Nt‐proANP, such correlation were limited to the left atrium free wall (r=0.66, P < 0.002). Thus, of the two natriuretic peptides, BNP/Nt‐proBNP may be a better reflector of left ventricular overload.     

Increased brain natriuretic peptide and atrial natriuretic peptide plasma concentrations in dialysis-dependent chronic renal failure and in patients with elevated left ventricular filling pressure

Brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP) plasma concentrations were measured in patients with dialysis-dependent chronic renal failure and in patients with coronary artery disease exhibiting normal or elevated left ventricular end-diastolic pressure (LVEDP) (n = 30 each). Blood samples were obtained from the arterial line of the arteriovenous shunt before, 2 h after the beginning of, and at the end of hemodialysis in patients with chronic renal failure. In patients with coronary artery disease arterial blood samples were collected during cardiac catheterization. BNP and ANP concentrations were determined by radioimmunoassay after Sep Pak C₁₈ extraction. BNP and ANP concentrations decreased significantly (P < 0.001) during hemodialysis (BNP: 192.1 ± 24.9, 178.6 ± 23.0, 167.2 ± 21.8 pg/ml; ANP: 240.2 ± 28.7, 166.7 ± 21.3, 133.0 ± 15.5 pg/ml). The decrease in BNP plasma concentrations, however, was less marked than that in ANP plasma levels (BNP 13.5 ± 1.8%, ANP 40.2 ± 3.5%; P < 0.001). Plasma BNP and ANP concentrations were 10.7 ± 1.0 and 60.3 ± 4. 0 pg/ml in patients with normal LVEDP and 31.7 ± 3.6 and 118.3 ± 9.4 pg/ml in patients with elevated LVEDP. These data demonstrate that BNP and ANP levels are strongly elevated in patients with dialysis-dependent chronic renal failure compared to patients with normal LVEDP (BNP 15.6-fold, ANP 2.2-fold, after hemodialysis; P < 0.001 or elevated LVEDP (BNP 6.1-fold, ANP 2.0-fold, before hemodialysis; P < 0.001), and that the elevation in BNP concentrations was more pronounced than that in ANP plasma concentrations. The present results provide support that other factors than volume overload, for example, decreased renal clearance, are also involved in the elevationin BNP and ANP plasma levels in chronic renal failure. The stronger elevation in BNP concentrations in patients with chronic renal failure and in patients with elevated LVEDP and the less pronounced decrease during hemodialysis suggest a different regulation of BNP and ANP plasma concentrations.[/ p]Abbreviations ANP atrial natriuretic peptide - BNP brain natriuretic peptide - LVEDP left ventricular end-diastolic pressure Correspondence to: C. Haug