阵发性心房颤动病人血浆脑利钠肽含量的意义

目的：研究阵发性心房颤动病人血浆脑利钠肽（BNP）含量在房颤发作时的变化，探讨房颤发作与BNP水平的关系。方法：测51例阵发性房颤病人在房颤发作时血浆脑利钠肽的含量，复律后48h复查脑利钠肽。所有病人随访三个月，记录房颤发作次数。根据BNP水平分为两组，比较两组病人房颤次数，进行统计学分析。结果：房颤发生时BNP水平高于复律后，BNP水平较高组房颤发生次数较BNP水平较低组为多。结论：阵发性房颤病人中BNP水平在房颤发生时较高，高BNP水平的房颤病人更易房颤复发。     

纤维蛋白肽A测定与缺血性心脏病

性心脏病 FPA(fibrinopeptide A)纤维蛋白肽A FPA是在凝血酶作用下,纤维蛋白原的分解产物,FPA测定是近年发展起来的血栓性疾病的分子标志诊断方法之一。1958年Blomback等人采用层析等方法分离出纤维蛋白肽以后,1971年Nossel等人建立了FPA的放射免疫测定法(RIA),引起了国外学者的关注,对与血液凝固,血栓栓塞     

利钠肽类激素在心律失常后的变化

目的观察心房利钠肽（atrial natriuretic peptide，ANP）、脑钠肽（brain natriuretic peptide，BNP）和C-型利钠肽（C-type natriuretic peptide，CNP）在心律失常后的变化，并探讨3者是否具有相关性。方法各种病因导致心律失常患者22例（NYHA心功能分级〈Ⅱ级），并设正常对照组20例，用竞争性放射免疫分析法测定血浆中ANP、BNP和CNP浓度。结果心律失常组血浆BNP较正常对照组明显升高，差异具有显著性（p〈0．01），而血浆ANP和CNP差异不具有显著性（p〉0．05）。心律失常组患者血浆ANP、BNP与CNP不具有相关性。结论无心力衰竭患者发作心律失常后血浆BNP可能明显升高，而血浆ANP与CNP浓度无明显变化。     

冻干重组人脑利钠肽治疗缺血性心力衰竭28例

传统缺血性心力衰竭治疗与其他心力衰竭治疗相近,通过药物或介入手术改变血流动力学参数,减轻心肌耗氧和心肌缺血引起的损伤,从而改善心肌功能。传统治疗方式和相关药物均存在一定问题。近年来,一种叫新活素的重组人脑利钠肽(rh-BNP)开始运用于各种冠心病和心力衰竭的临床治疗,并取得不错的效果〔1～3〕。本研究通过观察缺血性心力衰竭患者注     

心脏利钠肽类激素在心力衰竭诊断中的应用进展

心力衰竭是很多心血管疾病的最终转归,心脏利钠肽类激素(CNH)作为心力衰竭诊断的新指标近年来颇受重视。由于CNH种类较多又各具特点,故现通过综述近年来CNH在心力衰竭诊断方面的研究结果以比较不同CNH临床应用价值。     

铁在缺血性心脏病中的作用研究进展

铁催化羟自由基生成，介导脂质过氧化作用增加，使氧化型低密度脂蛋白（Ox-LDL)生成增多，这是造成AS损伤的一个重要过程。认为铁储存水平升高是缺血性心脏病的一种重要危险因子。     

缺血性心脏病合并左心衰竭患者血清脑钠肽和内皮素-1的变化

目的观察缺血性心脏病(IHD)合并左心衰竭(LHF)患者血清B型脑钠肽(BNP)、内皮素-1(ET-1)水平及其临床意义。方法将40例IHD患者分成两组,心力衰竭组25例和心功能代偿组15例,分别与对照组20例比较。测定3组入院时BNP、ET-1水平。结果心力衰竭组与心功能代偿组的BNP、ET-1均明显高于对照组,LVEF明显低于对照组,且有心力衰竭组BNP、ET-1明显高于心功能代偿组,差异有统计学意义(P<0.05),但心力衰竭组LVEF与心功能代偿组比较差异无统计学意义(P>0.05)。结论 BNP、ET-1水平可作为IHD合并LHF患者诊断及判断预后的观察指标。     

高血压病左室肥厚患者血浆脑利钠肽与心房利钠肽的变化

目的研究高血压病左心室肥厚患者血浆利钠肽水平的变化，探讨肥厚的左心室心脏内分泌的病理生理改变。方法106例高血压患者人选，其中56例伴左心室肥厚(LVH)，50例无LVH，另有30例健康个体为参照。放射免疫法测定脑利钠肽(BNP)和心房利钠肽(ANP)。结果高血压LVH组在排血分数属正常范围时，即有血浆BNP和ANP显著高于无LVH组，无LVH的高血压病人血浆ANP与BNP与健康人相似。结论LVH的高血压患者在心脏功能失代偿前，心脏利钠肽已出现代偿性合成和分泌增加。     

利钠肽评估获得性心脏病心功能的研究进展

<正>成人心脏疾病患者进行风险评估及选择适宜手术时机是一项极具挑战性的工作,传统的评估手段由于仪器设备因素、操作者主观条件等可能出现很大差异。快速诊断的生物标志物监测,为不同类型患者心功能衰竭存在与否、急重症鉴别诊断以及治疗危险分级提供了新的思路。其中尤其以利钠肽的研究最为详尽,本文就利钠肽在成人获得性心脏病患者的研究做一综述。1.利钠肽与心功能监测生物标志物是某一特定组织或器官在损伤或疾病状态     

高原心脏病心功能指数与B型利钠肽相关研究

目的 通过观察高原心脏病心力衰竭患者心功能综合指数(Tei)和外周血N末端B型利钠肽前体(NT-proBNP)水平,探讨右室Tei指数、NT-proBNP在高原心脏病中的诊断价值.方法 对2008-2010年在解放军第二十二医院心内科住院的34例高原心脏病患者进行超声指标Tei指数和NT-proBNP水平测定,并进行相关性比较.结果 根据超声心动图征象将高原心脏病患者分为A、B两组,A组与健康对照组(C组)相比,肺动脉收缩压[86.6 mm Hg比9.7 mm Hg(1 mum Hg =0.133kPa)]、右室Tei指数(0.90比0.33)均显著增高(P＜0.05);B组C组相比,肺动脉收缩压(57.1比9.72) mm Hg、右室Tei指数(0.78比0.33)显著增高(P＜0.05);A、B两组患者外周血NT-proBNP水平分别为(1246.8±512.6)ng/L、( 637.3±351.3) ng/L,均显著高于C组(98.6±21.7) ng/L水平,P＜0.05.结论 右心室Tei指数和NT-proBNP浓度是反映右心整体功能的较敏感指标,两者对于诊断高原心脏病具有一定的临床意义.     

利钠肽及其在呼吸道疾病和右心中的作用

利钠肽在右室功能障碍和肺动脉高压中的临床应用正在成为热点,作为一个非侵入性检测被用于诊断和指导治疗.本文概述了利钠肽在呼吸道疾病,右室功能障碍和肺动脉高压中广泛的生理作用和潜在的治疗作用.     

Natriuretic Peptides in Chronic Kidney Disease

Background and objectives: B-type natriuretic peptide (BNP) and amino-terminal pro-B-type natriuretic peptide (NT-proBNP) are biomarkers of cardiovascular disease that is common in patients with chronic kidney disease (CKD). Conflicting data on the influence of glomerular filtration rate (GFR) on BNP and NT-proBNP levels in CKD may stem from failure to account fully for the effects of coexistent cardiac disease, dysfunction, and volume overload.Design, setting, participants, & measurements: Prospective head-to-head comparison of plasma BNP and NT-proBNP in ambulatory euvolemic CKD patients with normal LV ejection fraction and no manifest cardiac or vascular disease. GFR was estimated by the Modification of Diet in Renal Disease formula, BNP and NT-proBNP measured using Abbott AxSYM and Roche Elecsys assays, respectively, and cardiac morphology and function assessed by transthoracic echocardiography.Results: In 142 patients (42% female) of mean age 60 ± 11 yr, mean left ventricular ejection fraction was 71% ± 6%, GFR 38 ± 14 ml/min per 1.73 m², and median BNP and NT-proBNP level 59 and 311 pg/ml, respectively. Multivariate predictors of NT-proBNP level were GFR, β-blocker usage, LV mass index, and hemoglobin level. Plasma BNP was independently predicted by LV mass index and β-blocker usage but not GFR. In the 74 patients without diastolic dysfunction, there was a significant rise in NT-proBNP but not BNP as GFR declined.Conclusions: Unlike NT-proBNP, plasma BNP level is relatively independent of GFR. BNP may therefore be the more appropriate biomarker to screen for cardiac dysfunction in CKD.Patients with chronic kidney disease (CKD) are at increased risk of cardiovascular disease. Natriuretic peptides (NPs), biomarkers of myocardial dysfunction (1), offer the potential for early detection and risk stratification of cardiac disease, as evident in emergency department (2) and community (3,4) settings. This screening utility could be extended to CKD patients asymptomatic of cardiovascular disease.However, the precise influence of CKD on circulating levels of B-type natriuretic peptide (BNP) and amino-terminal pro-B-type natriuretic peptide (NT-proBNP), the two commonly used NPs in clinical practice, continues to be debated. Dependence of plasma BNP on glomerular filtration rate (GFR) has been reported among patients with and without heart failure (HF) (5,6), but this relationship may not be independent of cardiac or volume-related factors (7,8). The data on NT-proBNP in renal dysfunction are more concordant but were derived from populations that included patients with myocardial infarction, reduced left ventricular (LV) ejection fraction (LVEF), or HF (9,10). Indeed, most studies examining the impact of renal dysfunction on NPs uniformly included such patients (5,6,8–10). Recent Doppler myocardial imaging studies have shown that even HF patients with normal LVEF have reduced LV contractility compared with controls (11,12).To limit confounding by cardiac dysfunction or volume overload, we prospectively constituted a clinically euvolemic CKD cohort without symptoms or history of cardiac disease and normal LVEF and regional function. We measured circulating levels of both NPs, hypothesizing that, in these patients, BNP can be shown to be relatively independent of GFR compared with NT-proBNP if cardiac and loading factors can be comprehensively accounted for.     

The Role of Biomarkers in Valvular Heart Disease: Focus on Natriuretic Peptides

The optimal timing of valve surgery remains controversial. Biomarkers can be serially monitored and are objective laboratory measurements. Plasma B-type natriuretic peptide (BNP) and its N-terminal pro-form are well known predictors in heart failure. Diastolic stretch induces cardiomyocyte BNP expression in volume-loaded conditions like aortic or mitral regurgitation (MR) or pressure-loaded conditions like aortic stenosis (AS). Here, we review the value of natriuretic peptide measurements in valve disease. Cardiac decompensation is reflected by increased BNP in AS and in MR. Repeated marked increases in natriuretic peptides are a potential indication for valve replacement in severe asymptomatic AS with normal ejection fraction and exercise test results. High BNP level also predicts postoperative outcome. Increased BNP level is associated with low-flow AS, impaired left ventricular longitudinal strain, and myocardial fibrosis. The BNP ratio to the reference value for age and sex incrementally predicts mortality in AS. Increased BNP reflects the hemodynamic consequences of MR and is associated with exercise-induced pulmonary-arterial hypertension and reduced contractile reserve. In severe primary MR, increased and serially increasing BNP or N-terminal pro-form BNP might be helpful in guiding early mitral replacement. In conclusion, baseline (N-terminal pro-form) BNP should be obtained in all severe valve disease patients and interpreted together with clinical and echocardiography findings. Very high BNP values are associated with increased mortality and should lead to close monitoring peri- and postoperatively. Progressively increasing BNP in asymptomatic patients points to advancing valve disease. BNP adds important incremental prognostic information that is useful for valve patient management and for optimal timing of surgery in particular.     

微血管病变与缺血性心脏病

冠状动脉微血管在心肌的血供中起着重要作用,冠状动脉微循环对冠心病的发生、发展、疗效及预后具有重要影响而备受人们重视。目前冠状动脉微血管病变主要分为X综合征和冠脉内慢血流现象,二者都与缺血性心脏病存在着密切的关系,但发病机制有所不同。X综合征主要是冠状动脉微血管痉挛所致,而冠脉内慢血流现象传统上被认为与微血管功能失调有关。此外慢血流现象可能是缺血性心脏病的一种新的发病机制,它可能代表了动脉粥样硬化和内皮功能失调的早期阶段。并且二者在治疗上有所不同。     

HIV and Ischemic Heart Disease

The association of coronary heart disease (CHD) and human immunodeficiency virus (HIV) infection has been well recognized for many years. The etiology of the increased prevalence of CHD in HIV-infected populations is the result of complex interactions among the viral infection, host factors, traditional risk factors, and therapies for HIV. As the HIV population is living longer, largely attributable to combination antiretroviral therapy, there is concern about the effect of the rising prevalence of CHD on morbidity and mortality, as well its effect on health systems around the world. This review will highlight the epidemiological evidence linking HIV infection and CHD. It will also focus on our current understanding of the pathogenesis and factors associated with HIV infection and CHD. In addition, the review will highlight modes of presentation and management strategies for mitigating risk and treatment of HIV-positive patients presenting with CHD.     

脑利钠肽与心脏瓣膜病

脑利钠肽是一种主要由心室肌细胞合成和分泌的多肽类激素,心肌缺血、坏死、损伤、心室壁张力和压力过重时可刺激其分泌增加.许多研究中表明,脑利钠肽作为血浆中重要的标记物,对心脏瓣膜病的诊断、治疗和预后判断等起着非常重要的作用.