充血性心力衰竭患者血浆N末端脑钠肽前体水平与心功能关系的探讨

探讨充血性心力衰竭（CHF）患者血浆氨基末端脑钠肽前体（NT-proBNP）水平与心功能的关系。选择心衰患者（心衰组）108例,正常体检者（对照组）30名,采用电化学发光免疫分析技术（ECLIA）检测血浆NT-proBNP水平,用超声心动图测定心衰患者的左心室射血分数（LVEF）。结果表明：心衰组血浆NT-proBNP水平显著高于对照组（P〈0.01）,并且血浆NT-proBNP浓度随着心功能分级（NYHA分级）的增加而升高（均P〈0.01）,而与LVEF呈负相关（r=-0.633,P〈0.01）。血浆NT-proBNP水平可作为CHF患者心功能检测的有效生化指标,并与心脏功能之间有较好的相关性。     

多种疾病患者血浆copeptin测定

目的：初步研究不同疾病患者血浆copepfin水平变化的意义。方法：我们对21位冠心病患者，16位哮喘病患者，17位肺癌患者以及30位年龄相符合的健康对照者的血浆copepfin水平进行了放射免疫分析（radioimmunoassay，RIA）。结果：对比对照组，冠心病组和肺癌组显著升高（215±41V854±4pg／ml，P〈0．01；336±109vs54±4pg／ml，P〈0．01），而哮喘病组虽有所升高（75±14vs54±4pg／m1），但差异无统计学意义（P〉0．05）。结论：血浆copepfin水平的升高提示在冠心病和肺癌等疾病中血管加压素系统被激活，作为以上疾病的一个潜在的危险因子，在血浆copepfin水平升高时，对患者的早期干预可能具有重要的临床意义。     

心衰患者血浆脑钠肽水平的变化及其临床意义探讨

目的探讨慢性心衰患者血浆脑钠肽（BNP）变化的临床意义。方法采用荧光免疫分析法对328例慢性心衰患者及50例健康对照者进行血浆BNP水平的测定,同时以彩色多普勒超声心电动仪测定慢性心衰患者左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左心室射血分数（LVEF）,并与血浆BNP含量作相关性分析。结果慢性心衰组患者血浆BNP水平明显高于健康对照者（P〈0．01）,且不同心功能患者之间的血浆BNP含量亦存在显著差异（P〈0．01）：慢性心衰组患者血浆BNP水平与LVEF、LVESD、LVEDD呈现良好的相关性（r分别为-0．61、0．55和0．59,P均〈0．01）。结论BNP是反映慢性心衰患者心室功能的灵敏指标。     

肺炎并心力衰竭患儿血浆尾加压素Ⅱ与肌钙蛋白Ⅰ、左室射血分数的关系

目的探讨肺炎并心力衰竭患儿血浆尾加压素Ⅱ（UⅡ）水平与肌钙蛋白（cTnI）、左室射血分数（LVEF）的关系及其临床意义。方法选择肺炎并心衰组、普通肺炎组、健康对照组各30例,放射免疫法检测各组血浆UⅡ含量,并检测cTnI及肌酸激酶心肌同工酶（CK-MB）,多普勒超声心动图测定患儿的LVEF反映心功能变化,其中肺炎并心衰组有20例治疗后复测UⅡ、cTnI、CK-MB、LVEF。结果肺炎并心衰组与普通肺炎组及健康对照组比较,血浆UⅡ含量、cTnI及CK-MB显著升高,LVEF显著下降（P〈0.05）,心衰治疗后血浆UⅡ含量、cTnI及CK-MB下降显著（P〈0.05）,LVEF显著升高（P〈0.05）,肺炎并心衰组治疗前血浆UⅡ与cTnI、CK-MB呈显著正相关,与LVEF呈显著负相关,UⅡ与LVEF的线性回归方程为y=-4.43x＋83.673。结论 UⅡ参与肺炎并心衰的病理生理过程,血浆尾加压素Ⅱ的含量可反映心功能的程度,通过UⅡ与LVEF的线性回归方程计算出LVEF,血浆UⅡ可作为心力衰竭的定量诊断指标,肺炎并心力衰竭时血浆尾加压素Ⅱ的升高与心肌损害有关。     

慢性心力衰竭患者血浆瘦素水平的变化

目的： 研究慢性心力衰竭（CHF）患者血浆瘦素（leptin）水平的变化。方法：应用放射免疫法测定了60例CHF患者和26例健康对照者的血浆瘦素水平，比较CHF组与对照组、CHF组不同心衰级别及不同病因亚组间的血浆瘦素水平。结果：CHF组患者血浆瘦素水平明显高于对照组（P＜0.01）；心功能Ⅳ级患者的血浆瘦素水平明显高于心功能Ⅲ级患者（P＜0.01）；CHF不同病因亚组间血浆瘦素水平无显著差异（P＞0.05）。结论：CHF患者血浆瘦素水平升高，并与心衰的严重程度相关，而与引起心衰的病因无关。     

甲状腺功能与血浆BNP的临床相关性研究

目的：B型脑钠肽（BNP）由心室心肌细胞分泌,并对血容量和压力负荷增加做出反应。在充血性心力衰竭时血浆BNP水平升高。本文旨在评估甲状腺的功能状态对血浆BNP水平的影响。方法：选择32例甲状腺功能亢进（甲亢）患者和36例甲状腺功能减退（甲减）患者,采用化学发光免疫分析测定其血浆FT3、FT4、TSH和BNP水平,并与33例正常对照作比较。结果：甲亢患者血浆BNP水平显著高于甲减组以及正常对照组,平均值分别为（203.03±48.61）pg/ml,（48.27±12.53）pg/ml,（57.96±13.59）pg/ml（P〈0.01）。血浆BNP水平与甲状腺的功能状态有显著的相关性（与FT4比较：r=0.625,P〈0.01,n=32）。多重线性回归分析提示FT3、FT4的值与BNP的水平具有独立相关性。结论：血浆BNP的水平受甲状腺的功能状态影响,这一点可能源于甲状腺激素是BNP的直接刺激物。     

CHF患者血浆BNP检测的临床价值探讨

目的：探讨慢性心衰（CHF）患者血浆脑钠肽（BNP）检测的临床价值。方法：采用荧光免疫分析对341例CHF患者及55例健康对照者进行血浆BNP测定,同时以彩色多普勒超声心电动仪测定CHF患者左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左心室射血分数（LVEF）,并与血浆BNP水平作相关性分析。结果：CHF组患者血浆BNP水平明显高于健康对照者（P〈0.01）,且不同心功能患者之间的血浆BNP含量亦存在显著差异（P〈0.01）;CHF组患者血浆BNP水平与LVEF、LVESD、LVEDD呈现良好的相关性（r分别为-0.62、＋0.54和＋0.60,P均〈0.01）。结论：BNP是评价CHF患者心室功能的灵敏指标。     

床边快速检测全血NT-proBNP在急诊呼吸困难鉴别诊断中的应用

目的：研究床边快速检测抗凝静脉全血N端脑利钠肽原（NT-proBNP）对急诊心源性呼吸困难和肺源性呼吸困难鉴别诊断的意义。方法：对我院急诊科就诊的158例呼吸困难患者分为心源性组82例,肺源性组76例,另选取58例正常人作为对照组。上述患者入院0.5h内完成床边急诊测定全血NT-proBNP浓度,48h内进行超声心动图检查。结果：①全血NT-proBNP浓度心源性组：（2026.4122.7）pg/ml,显著高于对照组（P〈0.01）;肺源性组：（191.828.12）pg/ml,与对照组无差异（P〉0.05）。②心源性分组,充血性心衰（CHF）按NYHA分级,心功能Ⅱ级（n=15）、Ⅲ级（n=42）、Ⅳ级（n=25）,全血NT-proBNP浓度均值分别为1513、2598、4357pg/ml,NT-proBNP的浓度与心衰的严重程度呈正比。③心功能Ⅱ级、Ⅲ级、Ⅳ级患者全血NT-proBNP水平与左心室射血分数（LVEF）的相关系数分别为r=-0.722（P〈0.05）、r=-0.615（P〈0.01）、r=-0.529（P〈0.01）,NT-proBNP水平与LVEF呈高度负相关。结论：呼吸困难急诊中,床边检测全血NT-proBNP浓度阴性的患者可快速排除心源性呼吸困难。心源性呼吸困难患者全血NT-proBNP浓度明显升高,结合超声心动图检查,提示全血NT-proBNP水平与心功能分级之间有明显的关联,心力衰竭程度越严重全血NT-proBNP越高,全血NT-proBNP测定可作为判断左心功能不全的参考性指标。     

子痫前期患者胎盘及血浆uPA、TGF-β1含量变化及意义

目的探讨子痫前期患者胎盘及血浆uPA和TGF-β1含量的变化及其在子痫前期发病中的意义。方法采用ELISA法测定57例子痫前期患者（轻度24例,重度33例）和30例正常晚孕妇女（对照组）胎盘及血浆uPA和TGF-β1含量。结果 1.对照组胎盘uPA含量为（32.62±2.85）ng/g,子痫前期组为（11.42±4.67）ng/g,两组差异有极显著性（P〈0.001）;重度组明显低于轻度组,差异有极显著性（P〈0.001）;对照组胎盘TGF-β1含量为（0.83±0.21）ng/g,子痫前期组为（1.12±0.37）ng/g,两组差异有显著性（P〈0.05）;轻、重度组间差异无显著性（P〉0.05）。2.对照组血浆uPA含量为（649.47±41.12）pg/ml,子痫前期组为（466.61±34.68）pg/ml,两组差异有显著性（P〈0.01）;轻、重度组间差异无显著性（P〉0.05）。对照组血浆TGF-β1含量为（9.617±4.19）ng/ml,子痫前期组为（13.30±4.57）ng/ml,两组差异有显著性（P〈0.05）;轻、重度组间差异无显著性（P〉0.05）。3.子痫前期患者胎盘及血浆中二者含量呈负相关（r=-0.652,P〈0.001,r=-0.491,P〈0.01）。结论子痫前期患者胎盘及血浆uPA含量异常下降、TGF-β1含量异常升高与其发病及严重程度有关。     

血浆BNP在维持性血液透析患者心功能评估中的应用价值

目的：探讨维持性血液透析患者血浆脑钠素（BNP）的变化及与心脏形态结构和功能改变的关系。方法：40例血液透析龄≥1年的稳定的MHD患者为MHD组;30名健康志愿者为正常对照组。放免法检测MHD患者血液透析前后血浆BNP浓度;分析血浆BNP浓度与心脏形态结构和功能的关系。结果：MHD患者血液透析前后血浆BNP浓度均明显高于正常对照组,差异有统计学意义（P〈0.01）;MHD患者血浆BNP浓度透析后较透析前明显下降,差异有统计学意义（P〈0.01）;MHD患者透析前血浆BNP浓度与左室舒张末期内径（LVEDD）和左室重量（LVM）呈正相关（r分别等于0.598、0.413,P均〈0.01）,与左室射血分数（LVEF）呈负相关（r=-0.429,P〈0.01）,而与左房内径（LAD）和左室后壁厚度（LVPWT）无相关性（P〉0.05）。结论：血浆BNP能够反映左室功能,是一个反映心衰和左心室功能障碍的标志物,对早期诊断和评估MHD合并CVD患者的心功能具有重要的临床意义。     

儿茶酚抑素对慢性心力衰竭大鼠室性心律失常的影响

 目的：探讨儿茶酚抑素(CST)治疗对慢性心力衰竭(CHF)大鼠室性心律失常(VA)的影响。方法：雄性SD大鼠51只，随机分为对照(CTL)组(n=17)和CHF组(n=34)。CHF组给予连续7 d注射异丙肾上腺素(ISO) (5 mg·kg-1·d-1, ip)，CTL组则用生理盐水作为对照 (1 mL·kg-1·d-1, ip)，造模结束2周后，进一步将CHF组再随机分为未治疗组(n=17)和CHF治疗组(CST组)(n=17)。治疗组给予连续3周注射CST(2 nmol·kg-1·d-1, ip)，未治疗组注射0.9%生理盐水(1  mL·kg-1·d-1, ip)。动物完成药物注射后，在整体心脏Langendorff灌流条件下行离体电生理研究，分别记录和测量左室前游离壁(LAF)心外膜单相动作电位(MAP)和心室有效不应期(VERP)；行程控增频电刺激以观察动作电位时程(APD)电交替(ALT)；给予Burst快速电刺激进行VA的诱发。用酶解法分离获得LAF处单个心室肌细胞，采用全细胞膜片钳技术记录L型Ca2+通道电流(ICa-L)。结果：与CTL组相比，未治疗组ICa-L峰电流密度、90%单相动作电位时程(MAPD90)、VERP、诱发APD-ALT最大起搏周长(PCLmax)中位数及VA诱发率均显著增大(均P<0.01)；而CST组MAPD90和VERP均增大(P<0.01)，其它指标差异无统计学意义(均P>0.05)；与未治疗组相比，CST组ICa-L峰电流密度、MAPD90、VERP、诱发APD-ALT的PCLmax中位数(80 ms vs 100 ms)及VA诱发率均减小(均P<0.05)，而VERP/MAPD90增大。结论：CST治疗可减少CHF大鼠VA诱发率，其机制可能与CST抑制CHF大鼠ICa-L有关。     

Extravascular lung water and peripheral volume status in hemodialysis patients with and without a history of heart failure

Determining volume status in hemodialysis patients with a history of congestive heart failure (CHF) is difficult. Extravascular lung water (EVLW) may be derived from blood ultrasound velocity changes following injections of 0.9% and 5% saline. Bioimpedance spectroscopy can measure total body water (TBW) and its intracellular fluid (ICF) and extracellular fluid (ECF) compartments. We studied 29 clinically euvolemic hemodialysis patients, 12 of whom had a history of CHF. The ECF and ICF were measured before dialysis, and EVLW was measured during dialysis. Values of EVLW were similar between patients without CHF and those with CHF (3.55 ml/kg +/- 0.94 SD versus 3.88 ml/kg +/- 0.82 SD, respectively; p = NS). The ECF/ICF ratio was higher among patients with a history of CHF (1.27 +/- 0.29) than among those without such a history (1.04 +/- 0.04; p < 0.05), indicating that ECF volume overload was present in both groups, but was higher in those with a CHF history. There was a positive correlation between EVLW and ECF/ICF ratios (r = 0.54, p < 0.01). Measurements of EVLW were higher in two pulmonary edema patients ((7.95 ml/kg and 5.95 ml/kg; p < 0.05). The results of this study suggest that 1) hemodialysis patients with a history of CHF have more ECF volume overloaded than those without such a history; 2) the degree of ECF expansion is associated with increasing EVLW volume, even in patients without pulmonary edema; and 3) ECF volume expansion eventually exceeds limits and pulmonary edema occurs. These developing technologies of volume measurement may be of value in this challenging clinical area.     

钙调神经磷酸酶参与心衰患者心肌重构的信号转导

目的：探讨血管紧张素Ⅱ(Ang Ⅱ)介导的钙调神经磷酸酶（CaN）信号通路参与心力衰竭（CHF）患者心肌重塑的机制。方法:选择因瓣膜性心脏病接受二尖瓣置换术的CHF病人39例，正常对照38例(其中8例来自意外伤亡的器官捐献者)。彩色多普勒超声心动图仪检测心脏扩大和心功能参数。放免法检测血浆及心肌组织Ang Ⅱ浓度，免疫沉淀法测心肌组织CaN、活化T细胞核因子(NFAT₃）、锌指转录因子(GATA₄)磷酸化及蛋白表达，RT-PCR检测肌球蛋白重链（β-MHC）mRNA表达。结果:AngⅡ分别与心脏扩大参数呈显著正相关，而与心功能参数呈显著负相关。CHF患者心肌组织CaN蛋白表达、CaN磷酸化、GATA^₄蛋白表达及β-MHC mRNA表达明显高于对照组，随心功能恶化其表达逐渐增加；NFAT₃磷酸化随心功能恶化而减弱。结论：肾素血管紧张素系统（RAS）激活的CaN信号通路在CHF患者心肌重构机制中可能起重要作用。     

Depression profile in patients with and without chronic heart failure

OBJECTIVE: Depression often goes undetected and untreated in patients with chronic heart failure (CHF). To investigate whether patients with CHF show a specific profile of depression symptoms, we compared depression symptoms in depressed patients with and without CHF. METHODS: Of a total of 921 patients from a CHF and a psychosomatic outpatient clinic, 137 met DSM-IV diagnostic criteria for major depressive disorder and 113 for other depressive disorders. Depressed patients with CHF (n=113) and without CHF (n=137) were compared with respect to severity of individual DSM-IV depressive symptoms, as measured with the PHQ-9. To stratify for depression severity, ANCOVAs with sociodemographic characteristics as covariates were performed separately for patients with major depressive disorder and other depressive disorders. RESULTS: Among the patients meeting the criteria for major depressive disorder, patients with CHF reported significantly lower levels of depressed mood (p=.006) and worthlessness/guilt (p=.019) than patients without CHF. In contrast, no significant group differences were found for any of the other depression symptoms. Group comparisons among the patients with other depressive disorders completely replicated these results (p< or =.001, and p=.04, respectively). LIMITATIONS: Our study population of CHF patients may not be representative for CHF patients recruited in the general population. CONCLUSIONS: The diagnostic features discriminating between depressed patients with and without CHF are the cognitive-emotional symptoms of depression, not the somatic symptoms. This finding may partially explain the low recognition rate of depression in patients with CHF. The different profile of depression symptoms in patients with and without CHF should be considered in diagnosis, treatment and medical education.     

Relationship between salivary Chromogranin-A and stress induced by simulated monotonous driving

The purpose of the present study was to evaluate the use of salivary Chromogranin-A (CgA), which is already used in general as a mental stress marker, for studying the stressful situation created by simulated monotonous driving. After informed consent, 25 healthy male and female subjects were studied under constant environment-controlled conditions. We measured the following physiological variables: blood pressure (BP), cardiac output, total peripheral resistance (TPR), normalized pulse volume (NPV) as an index of alpha-adrenergic sympathetic activity to the finger arteriolar vessels, levels of cortisol and CgA during monotonous driving. The induced stress led to the expected decreases in NPV and increases in TPR and BP caused by peripherally related sympathetic acceleration. However, CgA levels were found to fall gradually in accordance with the gradual increase of subjective rating of stress (SRS) and significantly (p < 0.01) decreased over the period of the simulated monotonous driving. Our hypothesis for the gradual decrease of CgA levels during the simulated monotonous driving is as follows. CgA, catestatin and catecholamines are co-released into the extra-cellular environment. Peripheral sympathetic activity was accelerated by stress resulting from the simulated monotonous driving. Upon peripheral vessel constriction, an increase in TPR then increased BP which, in turn, activated catestatin. Consequently, secretion of CgA was blocked by the co-secreted catestatin from chromaffin granules. The results obtained strongly indicate that, although CgA has been reported as a possible marker of stress, CgA levels are not increased in the stressful situation of simulated monotonous driving.     

Interleukin-18 in patients with congestive heart failure: induction of atrial natriuretic peptide gene expression.

Activated inflammatory responses appear to play a role in the development of congestive heart failure (CHF). We investigated interleukin-18 (IL-18), which is a cytokine synthesized by activated macrophage, changes in patients with CHF. We evaluated 11 Japanese patients with angina pectoris (n=4) or CHF (n=7). Blood was sampled immediately after admission and at 1, 2, 3, 6, and 9 hours after admission and then every 12 hours until 5 days after admission. Plasma IL-18 concentrations were measured by an enzyme-linked immunosorbent assay. Expression of atrial natriuretic peptide (ANP) mRNA and protein synthesis was examined in cardiac myocyte by stimulation of IL-18. Plasma IL-18 concentration was significantly higher in patients with CHF than in 15 healthy volunteers (51+/-21 pg/mL, and 28+11 pg/mL, respectively, P<0.05). Increased expression of ANP mRNA was demonstrated in IL-18 treated myocytes. Protein synthesis in myocytes was increased by IL-18 in a dose-dependent manner. Increased secretion of IL-18 is induced in patients with CHF and correlates with the severity of myocardial damage and dysfunction.     

黄芪对充血性心力衰竭患者免疫调节的影响

目的 :探讨充血性心力衰竭 (CHF)患者的免疫学变化和黄芪注射液治疗对其影响。方法 :对正常体检者 (体检组 )和充血性心力衰竭 (CHF)组进行IgA、IgG、IgM、C3 、IL Ⅱ、E RFC、T LTT、抗心肌抗体的检测 ,并将CHF患者随机分为治疗组和对照组 ,治疗组在应用转换酶抑制剂、利尿剂和强心甙治疗的基础上加用黄芪注射液 6 0ml+10 %葡萄糖注射液 5 0 0ml静脉滴注 ,每日 1次 ;对照组不加用黄芪注射液 ,15日后重复上述指标的检查。结果 :体检组与CHF组比较 ,IL Ⅱ、E RFC、T LTT、抗心肌抗体CHF组明显高于体检组 (P <0 .0 1) ;治疗 15日后 ,治疗组与对照组比较 ,治疗组IL Ⅱ、E RFC、T LTT和抗心肌抗体的改善明显优于对照组 (P <0 .0 1)。结论 :CHF以细胞免疫异常为主 ,黄芪干预治疗可获满意的效果     

慢性CHF患者BNP与AT-Ⅱ及ALD水平的探讨

目的：探讨慢性充血性心力衰竭患者血中脑利钠肽（BNP）与血管紧张素-Ⅱ（AT-Ⅱ）及醛固酮（ALD）的水平,并进行相关性分析,以提示其在充血性心力衰竭（CHF）发展中的临床意义和价值。方法：使用美国博适公司生产的Triage Meter Plus型免疫荧光定量心衰快速检测仪,检测全血BNP水平。采用放射免疫分析（RIA）受试者血浆AT-Ⅱ、ALD含量。结果：CHF组BNP、AT-Ⅱ、ALD均显著高于对照组,且BNP与AT-Ⅱ、ALD水平呈正相关（P〈0.05）,治疗后血中水平均下降与治疗前差异有显著性（P〈0.01）。结论：同步监测BNP、AT-Ⅱ、ALD有助于早期发现CHF,判断病情及预后。