脑钠素N端前体肽在原发性高血压发病中的意义

目的：观察脑钠素N端前体肽Nt-ProBNP1～76水平在原发性高血压患者体内的改变及与血压的关系.方法：选择2003-06/2003-10解放军总医院收治的原发性高血压患者54例,其中高血压1级者31例,高血压2级者23例（血压划分标准按照美国JNC-6标准）.采用放射免疫分析方法检测血浆Nt-ProBNP1～76、心钠素以及内皮素的水平,以同期健康体检的31例正常人为对照组.并应用直线相关分析对两组被试者血压与Nt-ProBNP1～76之间的关系进行了分析.结果：按意向处理分析,54例被试者全部进入结果分析.①Nt-proBNP1～76浓度：高血压组显著高于对照组[（289.67&;#177;52.25）,（178.17&;#177;42.56）ng/L,P＜0.01].②血浆心钠素：高血压组显著高于对照组[（123.46&;#177;8.57）,（76.28&;#177;7.62）ng/L,P＜0.01],2级患者高于1级患者（P＜0.05）.③内皮素：高血压组显著高于对照组[（167.23&;#177;10.54）,（132.29&;#177;11.37）ng/L,P＜0.01],2级患者高于1级患者（P＜0.05）.④血浆Nt-proBNP1～76水平与血压相关性：在对照组,收缩压和舒张压均与Nt-proBNP1～76间呈正相关（r=0.84,0.81;P=0.046,0.035）;在高血压组,收缩压与Nt-proBNP1～76间呈正相关（r=0.59,P=0.027）.结论：血浆ProBNP1～76水平在原发性高血压的发生发展过程中可能起者重要的作用.测定血浆ProBNP1～76水平对于监测高血压患者是否发生左心室肥厚有其重要临床意义,脑钠素前体肽的测定可望成为判断高血压病预后的指标.     

冠心病患者血清同型半胱氨酸和N端前体脑钠肽检测及意义

目的探讨联合检测同型半胱氨酸(Hcy)和N末端前体脑钠肽(NT-proBNP)对冠心病病情评估和预后判断的临床指导意义。方法收集经冠状动脉造影确诊为冠心病的门、急诊及住院患者血清标本检测Hcy及NT-proBNP浓度。根据患者病情及冠状动脉病变支数分组进行统计分析。对照组为排除心血管疾病的体检者标本。结果急性心肌梗死(AMI)组、不稳定型心绞痛(UA)组和稳定型心绞痛(SA)组血清NT-proBNP、Hcy均高于对照组。三组间比较,血清NT-proBNP、Hcy增高依次为AMI组大于UA组大于SA组,差异有统计学意义;且冠状动脉病变支数的增加及血清NT-proBNP水平的升高,三组间差异也有统计学意义;而Hcy水平变化不大,差异无统计学意义。结论冠心病患者血清Hcy水平可对冠状动脉粥样硬化的程度进行一定的评估,而NT-proB-NP水平可直接反映心肌有无缺血及缺血程度。二者联合检测可对冠心病的病情作出客观评价,以便及早采取干预措施,降低发生心血管事件的风险。     

急性脑血管病患者血浆N端脑钠肽前体的检测及意义

【目的】探讨血浆N端脑钠肽前体（NT—proBNP）浓度与急性脑血管病之间的关系。【方法】选择脑出血组20例（CH组）、脑梗死组61例（CI组）、蛛网膜下腔出血组9例（SAH组）,及同期住院的非心脑血管病及肝肾功能正常者38例（ControI组）,用固相免疫层析法检测血浆NT—proBNP浓度。【结果】CH组、CI组、SAH组NT—proBNP水平均显著高于Control组（P〈0．01）。CH组和CI组组间无统计学差异（P〉0．05）,SAH组较CH、CI组显著增高（P〈0．01）;且病情中、重型组显著高于轻型组（P〈0．01）。脑出血和脑梗死大灶组高于小灶组（P〈0．05）。【结论】NT-proBNP异常分泌参与了脑出血、脑梗死、蛛网膜下腔出血的病理、生理过程,急性脑血管病患者血浆NT—proBNP升高对病情评价具有一定的临床价值。     

急性冠脉综合征患者早期N端脑钠肽前体水平测定的意义

目的：研究急性冠脉综合征患者早期N端脑钠肽前体（NT-proBNP）浓度及其与急性冠脉综合征患者急性期心功能及其预后的关系。方法：对50例初发的急性冠脉综合征患者在起病24h内及病程的第4周分别采血，测定患者血清NT-proBNP1及NT-proBNP2；并在病程的第3～4周测定入选患者的左室舒张末径（LVDd）、左室射血分数（LVEF）；根据患者心脏功能状况（Killip分级）分为两组，A组，Ⅰ级，B组，Ⅱ～Ⅳ级，进行NT-proBNP浓度的比较。结果：急性冠脉综合征患者早期的NT-proBNP浓度高于对照组（P〈0．001），无明显心力衰竭的A组与对照组比较也得出类似的结果；有心力衰竭的B组患者与无明显心力衰竭的A组比较其血清NT-proBNP1、NT-proBNP2及血浆TnT1均较高（P〈0．05），EF则较低（P〈0．05）。死亡组与非死亡组的比较，死亡组患者有着较大的年龄和较高的NT-proBNP值（P〈0．001）。急性冠脉综合征患者早期的NT-proBNP浓度与其它的变量的相关性研究表明，NT-ProBNP浓度与年龄、Killip分级正相关，与EF值负相关。结论：急性冠脉综合征患者早期的NT-proBNP浓度与急性期心功能状况及预后密切相关，对急性冠脉综合征患者早期进行血清NT-proBNP浓度的测定具有重要的临床意义。     

N端脑利钠肽前体在急性心力衰竭诊断和治疗中的应用

目的:探讨N端血浆脑利钠肽前体(NT-proBNP)对急性心力衰竭的诊断和指导治疗价值.方法:用免疫荧光法测60例急性心力衰竭患者(研究组)及60例同期肺部感染的患者(对照组)血浆NT-pmBNP浓度、超声心动图测定的左室射血分数(LVEF),比较两组治疗前后血浆NT-proBNP浓度、LVEF的变化.结果:研究组NT-proBNP明显高于对照组(P＜0.01),且血浆BNP水平随NYHA分级增高而升高,亚组分析显示心功能Ⅱ级,Ⅲ级和Ⅳ级组间BNP水平均有明显(P＜0.01);治疗后1周NT-proBNP较治疗前显著降低(P＜0.01).结论:监测NT-proBNP水平对急性心力衰竭的诊断和治疗具有指导作用.     

N端脑利钠肽前体在儿童左向右分流先天性心脏病中评价肺动脉高压的价值

目的评价血浆N端脑利钠肽前体(NT-proBNP)在儿童常见左向右分流先天性心脏病(CHD)中评价肺动脉高压(PAH)的价值。方法 2006～2010年54例介入治疗住院的左向右分流CHD伴PAH的患儿,男25例,女29例,年龄(7.5±5.2)岁(0.5～15岁)。单纯室间隔缺损20例,房间隔缺损11例,动脉导管未闭23例(含并主动脉缩窄1例),以右心导管检查测得肺动脉收缩压(PASP)≥30mmHg(1mmHg=0.133kPa)为PAH,30～40mmHg为轻度,41～70mmHg为中度,≥70mmHg为重度。心功能改良Ross评分>3,心脏超声测量左心室射血分数(LVEF)<50%以及右心室流出道狭窄、血肌酐>115μmol/L的患儿排除在外。血浆NT-proBNP浓度测定应用电化学发光双抗体免疫夹心分析法。采用SPSS13.0软件包进行统计分析血浆NT-proBNP浓度与PASP的相关性和血浆NT-proBNP浓度诊断PAH的敏感性和特异性及ROC曲线。结果 PAH轻度15例、中度25例、重度14例,血浆NT-proBNP浓度(中位数)分别为99.9(75.8～131.6)pg/ml、437.3(194.6～1815.5)pg/ml、2740.0(505.9～3508.2)pg/ml(P<0.001),与PASP呈正相关(r=0.57,P=0.001)。血浆NT-proBNP浓度为128.7pg/ml时,诊断PAH的敏感性和特异性分别为93%和100%,ROC曲线下面积0.97(95%可信限0.92～1.00,非参数检验P=0.000)。血浆NT-proBNP浓度为1456.8pg/ml时,诊断重度PAH的敏感性和特异性分别为46%、83%,ROC曲线下面积0.79(95%可信限0.67～0.91,非参数检验P=0.000)。结论左向右分流CHD患儿血浆NT-ProBNP水平能一定程度反映肺动脉压力的变化,可作为评价PAH的生化指标。     

川崎病患儿血浆N端脑钠肽前体表达水平及临床意义

目的：探讨血浆N端脑钠肽前体（N-terminal pro-brain natriuretic peptide, NT-proBNP）表达水平在川崎病（Kawasaki disease, KD）中的临床意义。方法采用电化学发光免疫学方法测定16例KD患儿应用丙种球蛋白前后及20例呼吸道感染性疾病患儿（对照组）的血浆NT-proBNP水平。结果急性期KD儿童血浆NT-proBNP水平明显高于对照组（t=3.829,P＜0.01）。KD治疗前后比较,KD急性期血浆NT-proBNP水平较恢复期升高,差异有统计学意义（t=12.64,P＜0.01）。KD有冠脉损害组与无冠脉损害组比较,KD急性期冠脉损害组患儿血浆NT-proBNP明显升高,差异有统计学意义（t=8.361,P＜0.01）。结论KD急性期血浆NT-proBNP升高,而在疾病恢复期明显降低,有助于急性期KD的早期诊断,以及NT-proBNP水平升高是KD儿童发生冠脉损害的预测指标之一,值得临床推广应用。     

N-端脑钠肽前体测定在高血压疾病中的应用研究

目的 探讨血清N端脑钠肽前体(NT-proBNP)在高血压疾病的应用研究。方法 选择152例高血压患者纳入研究,根据高血压病情发展分为高血压1级(30例),高血压2级(36例)和高血压3级(86例)。86例高血压3级患者根据有无并发糖尿病又分为单纯高血压组(40例)和高血压并发糖尿病组(46例),分别比较不同分级组的血清NT-proBNP水平变化。结果 高血压1级患者、2级患者和3级患者血清中NT-proBNP水平分别为68±44,122±31和834±309 pg/ml。随着病情发展其血清水平逐渐升高(t=2.455,3.561,P<0.01),高血压3级患者中高血压并发糖尿病组和单纯高血压组血清中NT-proBNP分别为1 178±664 pg/ml和599±411 pg/ml(t=3.785,P<0.01)。结论 NT-proBNP水平能客观反映高血压患者的病情程度,对临床治疗和病情监测有一定的指导意义。     

N-末端脑钠肽前体在呼吸困难鉴别诊断中的意义

目的 探讨N-末端脑钠肽前体(NT-proBNP)在呼吸困难中的鉴别诊断意义.方法 用电化学发光法测定120例呼吸困难患者血浆中NT-proBNP的浓度,包括心源性呼吸困难组、肺源性呼吸困难组、正常对照组.结果心源性呼吸困难组、肺源性呼吸困难组组间差异有统计学意义(F=47.04.P＜0.01).结论 NT-proBNP可以作为鉴别诊断心源性呼吸困难和肺源性呼吸困难的一项观察指标.     

慢性心力衰竭患者N端脑钠肽前体和血清同型半胱氨酸测定的临床意义

慢性心力衰竭(CHF)是大多数心血管疾病的终末阶段,据不完全统计,全世界约有2 000万以上的CHF患者,总发病率约为0.3%～2%,其5年存活率与恶性肿瘤相仿,CHF正成为21世纪最重要的心血管疾病和重要公共卫生问题。CHF发病机制较复杂且尚不明确,目前认为与心室重塑、神经内分泌和细胞因子系统激活有关。N端脑钠肽前体(NT-proBNP)已成为临床公认的重要的CHF诊断的特异性标志物[1],而血清同型半胱氨酸(Hcy)在临床上     

Pediatric brain natriuretic peptide and N-terminal pro-brain natriuretic peptide reference intervals

BACKGROUND: Brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) have been shown to be useful biomarkers for the diagnosis of heart failure. Pediatric reference intervals for these analytes have been reported in part. Previous studies lack large numbers in each group, have not covered all age ranges and have not compared results for BNP with NT-proBNP in simultaneously drawn samples. METHODS: We measured BNP in whole blood using the Biosite Triage point-of-care method and plasma NT-proBNP using the Dade RxL Dimension. We assessed between and within-day precision of both methods and after removing outliers employed the Hoffmann approach to calculate pediatric reference intervals over the age range of 0-21 y. We also compared the 2 methods on simultaneously drawn samples. RESULTS: Reference intervals revealed approximately 20-fold higher 97.5th percentiles for neonates than for children >3 y of age. 97.5th percentiles decreased significantly over the first 3 years of life. As shown by others, the CVs for the automated Dade RxL platform were somewhat lower than those for the POCT method. BNP and NT-proBNP correlated well in simultaneously drawn samples (r=0.947). DISCUSSION: Reference intervals for BNP and NT-proBNP are far higher in neonates and infants than in children older than three years of age. The reasons for this are unknown but resemble the elevated CK-MBs and troponins also found in neonates, although the 97.5th percentiles for these latter 2 cardiac markers decrease more rapidly to values found in older children by 6 months of age.     

血清N末端B型钠尿肽原在不明原因呼吸困难病因分析中的临床意义

目的探讨血清N末端B型钠尿肽原(NT-proBNP)在不明原因呼吸困难病因分析的临床意义。方法针对急诊入院不明原因呼吸困难的患者,应用电化学发光法检测患者血清NT-proBNP的浓度;详细追问病史、体格检查,结合心电图、心脏彩超、胸片、肺功能测定等相关检查,进一步明确患者呼吸困难的原因。结果心源性呼吸困难患者血清NT-proBNP浓度在829.20~18700.50 pg/ml间,NT-proBNP呈偏态分布,中位数水平分别为4474.80 pg/ml,非心源性呼吸困难患者血清NT-proBNP浓度在10.20~389.50 pg/ml间,NT-pro BNP呈偏态分布,中位数水平分别为174.20 pg/ml,两组患者血清NT-proBNP浓度中位数比较差异有统计学意义(P值0.05)。结论血清NT-proBNP浓度在鉴别心源性或非心源性呼吸困难中有重要意义。     

Head-to-head comparison of N-terminal pro-brain natriuretic peptide, brain natriuretic peptide and N-terminal pro-atrial natriuretic peptide in diagnosing left ventricular dysfunction

Brain natriuretic peptide (BNP), NT-proBNP and NT-pro-atrial natriuretic peptide (NT-proANP) were measured in blood samples from 57 patients using immunoassays and immunoradiometric assays to evaluate the usefulness as diagnostic markers for the detection of heart failure. For the detection of impaired left ventricular ejection fraction (LVEF), receiver operating characteristic curves showed that BNP had the best diagnostic performance with an area under curve (AUC) of 0.75±0.06. However, NT-proBNP (AUC: 0.67±0.07) and NT-proANP (AUC: 0.69±0.08) showed no significant difference to BNP. In a further analysis for the detection of resting LVEF <40%, BNP again was the best marker with an AUC of 0.83±0.06. NT-proBNP showed only a slightly smaller AUC (0.79±0.07). The AUC for NT-proANP was significantly smaller (0.65±0.08) compared to BNP. Additionally, BNP and NT-proBNP correlated negatively with the resting LVEF (BNP: −0.472, p<0.001; NT-proBNP: −0.306, p=0.026), whereas NT-proANP showed no significant correlation. In summary, BNP was the best marker to detect patients with impaired LVEF compared to NT-proBNP and NT-proANP. However, NT-proBNP showed no significant differences to BNP and it is therefore a new promising alternative marker for the detection of left ventricular dysfunction.     

N-末端脑钠肽与心力衰竭的相关性

目的探讨血浆N-末端脑钠肽(NT-ProBNP)水平与心力衰竭程度的相关性。方法选择器质性心脏病心力衰竭患者443例(心力衰竭组)和同期住院的无器质性心脏病患者110例(对照组)作为研究对象,采用电化学发光全自动免疫分析仪测定两组患者血浆NT-ProBNP水平,评价NT-ProBNP水平与心力衰竭及心血管事件发生的关系。结果心力衰竭组NT-ProBNP水平显著高于对照组(P<0.05);且心力衰竭患者的NYHA心功能分级越高,NT-ProBNP水平越高(P<0.05),再发心血管事件发生率也越高。结论 NT-ProBNP在心力衰竭临床诊断、心功能分级及预后评估中具有重要的地位和价值,可作为监测心功能的良好指标。     

Plasma N-terminal pro-brain natriuretic peptide and brain natriuretic peptide in assessment of acute dyspnea.

We examined the analytical correlation between non-radioimmunometric plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and B-type natriuretic peptide (BNP) and evaluated whether NT-proBNP or BNP was superior in the emergency diagnosis of heart failure and whether this was influenced by age, gender, body mass index (BMI) and renal function. Data were collected prospectively from patients admitted to the emergency department for acute dyspnea. Plasma BNP (Triage, Biosite) and NT-proBNP (Elecsys, Roche diagnostic(R)) were measured at admission in addition to other standard biological parameters and clinical variables. Reference diagnosis was adjudicated by two independent cardiologists using the European society of cardiology guidelines. We evaluated the influence of creatinine clearance, age, gender and BMI on plasma BNP and NT-proBNP levels. One hundred and sixty consecutive patients were included: 84 females and 76 males, mean age 80.1 + 13.5 (16-98). The analytical correlation between the automated electro-chemiluminescence immunoassay for NT-proBNP and the single use fluorescence immunoassay for BNP was satisfactory using the equation: NT-proBNP = 1.1 BNP + 0.57 and a correlation r = 0.93. This was established over a wide range of concentration (5-6400 pg/ml for BNP). Areas under receiver operating characteristic (ROC) curve for BNP and NT-proBNP as a diagnostic marker for heart failure were 0.82 and 0.84, respectively and a BNP level of 150 pg/ml has similar sensitivity and specificity that NT-proBNP level of 1000 pg/ml. The correlation was not influenced by age, gender and BMI of patients. Renal dysfunction did not affect significantly this correlation (r = 0.93). We conclude that NT-proBNP, as assayed in the present study, correlates closely with BNP. This correlation is only slightly modulated by creatinine clearance values. The NT-proBNP appears as accurate as BNP according to area under ROC curve. Used in conjunction with other clinical information, rapid measurement of BNP or NT-proBNP is useful in establishing or excluding the diagnosis of congestive heart failure in patients with acute dyspnea.