二尖瓣病变患者围手术期BNP、NT-proBNP、NT-proBNP/BNP的变化及临床意义

目的:观察二尖瓣置换患者围手术期脑钠尿肽（brain natriuretic peptide,BNP）、N末端脑尿钠肽原(N-terminal proBNP,NT-proBNP)及其比值（NT-proBNP/BNP）的变化规律,并探讨其临床意义。方法: 25例二尖瓣狭窄（MS）组的患者和20例二尖瓣关闭不全（MR）组患者,术前按NYHA标准进行心功能标准分级,分别于术前1 d、术后1周、2周、3周、4周测血浆BNP、NT-proBNP浓度,同时予以超声心动图检查,测量左室射血分数（LVEF）、左房内径（LAD）、左室舒张末内径（LVEDD）,分析术前BNP、NT-proBNP、NT-proBNP/BNP浓度与NYHA心功能分级、LVEF、LAD、LVEDD等的关系,并比较它们在MR组与MS组围手术期的变化及其与术后并发症的关系。结果: ①MS组患者术前BNP、NT-proBNP与NYHA、LVEDD均呈正相关（P<0.05）,与LVEF、LAD无相关性,且BNP与NYHA、LVEDD的相关性较NT-proBNP、NT-proBNP/BNP更为密切;②术后出现房颤并发症的患者术前BNP、NT-proBNP高于未出现房颤患者,且随着房颤转复而降低;术后出现肾功能不全的患者其术前NT-proBNP比未出现肾功能不全的患者高,且随着肾功能的恢复而降低,;而NT-proBNP/BNP无此种变化;③术前MR组LVEDD、BNP、NT-proBNP均大于MS组,且随着LVEDD变化,BNP、NT-proBNP在两组间变得无显著差异,而NT-proBNP/BNP于术前两组间无统计学意义;④二尖瓣患者围手术期BNP、NT-proBNP呈先升高后降低的变化趋势,且BNP、NT-proBNP、LVEDD变化趋势大致一致,主要发生在术后1、2、3周,而NT-proBNP/BNP的变化与BNP、NT-proBNP及LVEDD未发现明显规律性的联系。结论: BNP可以反映LVEDD的变化,可作为二尖瓣病变患者术前心功能评估的参考指标,而NT-proBNP/BNP临床应用价值不大。     

支气管哮喘患者血浆TNF-a、IL-6和NT—proBNP的临床意义

目的探讨支气管哮喘急性发作患者血浆TNF—a、IL-6和NT—proBNP的临床意义。方法采用RIA、荧光免疫分析和超敏免疫分析分别检测63例支气管哮喘急性发作患者的TNF—OL、IL-6和NT—proBNP,并与42例对照组进行比较。结果63例支气管哮喘急性发作患者血浆TNF-a和IL-6、NT—proBNP水平较42例对照组明显增高（P均〈0,01）,治疗后症状缓解期,TNF—a和IL-6、NT—proBNP水平呈逐步下降,其中TNF-a和IL-6水平在症状缓解半月后与对照组比较无显著差异（P均〉0．05）。结论血浆TNF—a、IL-6和NT—proBNP是支气管哮喘患者急性发作及治疗后缓解的有价值的指标。     

NT—proBNP在心血管病中的诊疗价值

目的：对NT-proBNP在心血管病中的应用进行初步的探讨,研究其在临床上的诊疗价值。方法选取心血管病患者120例、非心血管疾病患者70例以及健康体检者60例,对其采用电化学发光免疫实验（ECLIA）,对血清NT-proBNP的浓度进行测试,把年龄作为分类依据进行分析。结果研究发现,心血管疾病组患者的血清NT-proBNP水平3.75明显高于非心血管疾病组的1.78以及正常对照组的1.43,心衰程度越重NT-proBNP的浓度越高,不同NYHA分级下的NT-proBNP浓度有显著性差异。结论 NT-proBNP可以用来判断心血管疾病患者、非心血管疾病患者以及正常人,并且其对于心力衰竭的诊断具有敏感性,可以用来评价患者的心功能状况,值得临床上的推广应用。     

BNP与NT-proBNP在老年心力衰竭患者中的诊断价值和临床意义

随着老年人口的逐渐增多,近些年,高发于老年人的心脑血管疾病引发的的慢性心力衰竭(CHF)患者数量逐渐增多,及时诊断心衰及指导临床用药,对提高患者生存率有重要意义.本研究就BNP、NT-BNP在老年人心衰诊断价值及其临床意义进行临床研究. 1资料与方法 1.1一般资料所有患者均为我院2009年12月至2011年12月心内科收治的老年CHF患者89例为实验组,其中男46例,女43例,年龄60 ～78[平均(66±5.8)]岁,其中冠状动脉粥样硬化性心脏病38例、高血压26例,扩张性心肌病2例,风湿性心脏病15例,肺心病5例,其他3例.所有入选患者均确诊CHF(符合《内科学》第6版心力衰竭诊断标准),排除非心源性呼吸困难、心包积液、缩窄性心包炎,合并严重感染和肝肾疾病者.     

慢性心力衰竭患者血清Copeptin水平及临床意义

目的:研究不同程度心力衰竭及不同性质心力衰竭患者血清和肽素(Copeptin)水平及临床意义。方法:同时测定80名健康者(健康对照组)和130例慢性心力衰竭(CHF)患者(CHF组)的血清Copeptin和N末端脑钠肽(NT-proBNP)水平,并检测左室射血分数(LVEF)和左室舒张末期内径(LVEDd)值、E/A值、E/e'值。CHF组患者再按不同左室射血分数及收缩性心力衰竭(SHF)和舒张性心力衰竭(DHF)分组,比较各组血清Copeptin和NT-proBNP水平。结果:CHF组患者血清Copeptin和NT-proBNP水平明显高于健康对照组(P0.01),不同程度CHF及不同性质的CHF患者其Copeptin之间比较有统计学意义。结论:Copeptin水平可作为心力衰竭患者临床诊断、评估病情的一个客观指标,有助于鉴别收缩性与舒张性心力衰竭。     

C-反应蛋白和NT-pro BNP对老年脓毒症患者死亡和多器官衰竭的预测价值

目的 分析N末端脑钠肽原(NT pro-BNP)、C反应蛋白(CRP)对老年脓毒症患者死亡和多器官衰竭的预测价值.方法 纳入重症监护室(ICU)住院的老年患者245例,随访1年.收集所有人口统计学和临床特征.连续性变量的优势比(OR)计算每个因素相关的死亡风险.受试者工作特征(ROC)曲线检验其预测ICU死亡率的性能....     

非体外循环下冠状动脉搭桥术围手术期脑钠肽浓度变化及临床意义

【】目的 研究非体外循环下冠状动脉搭桥术围手术期血清心房脑钠肽浓度变化及临床意义。方法 选择我院在2013年9月～2014年9月非体外循环下冠状动脉搭桥患者32例。于术前1d(T1)、术后8h(T2)、1d(T3)、3d(T4)、5d(T5)、7d(T6)测量血清BNP浓度,肌钙蛋白(CTNI)浓度,并同时行超声心动图检查测量患者LVEF,术前行NYHA心功能标准分级,术后观测血管活性药物的应用、呼吸机辅助时间、ICU 时间、住院时间、术后并发症。结果 冠心病患者BNP平均浓度显著高于正常人群。LVEF 与BNP 浓度呈负相关关系(P<0.01)。BNP 浓度术后8h 与术前相比显著增高(P<0.05),术后1d 明显增高(P<0.01),术后3d 达峰值并开始呈下降趋势,术后7d 仍比术前高,但差异无统计学意义(P>0.05)。术前BNP 浓度≥100pg.ml-1 的患者,预后较差。患者BNP水平与NYHA心功能分级呈正相关,与患者LVEF呈负相关。结论：BNP 浓度能反映非体外冠状动脉搭桥术围手术期患者的心功能状态,心功能越差,BNP浓度越高,较LVEF更准确反应心功能状态。BNP 可作为非体外循环下冠状动脉搭桥心功能的定量指标,指导临床治疗及判断预后。     

检测血清中NT—proBNP、CRP和ADA对呼吸困难患者的鉴别价值

目的检测呼吸困难患者血清中N端B型脑钠肽前体（NT—proBNP）、C-反应蛋白（CRP）和腺昔脱氨酶（ADA）的含量,讨论三个指标对心源性呼吸困难患者和肺源性呼吸困难患者鉴别价值。方法选择临床上明确诊断为心源性呼吸困难和肺源性呼吸困难患者各50例,分别为A组和B组,检测两组血清中NT—proBNP、CRP和ADA含量,并作统计学分析。结果A组血清中NT—proBNP和CRP含量高于B组血清中NT—proBNP和CRP含量,差异有统计学意义,B组血清中ADA高于A组血清中的ADA,差异有统计学意义P〈0．05。结论检血清中NT—proBNP、CRP和ADA含量,在临床上鉴别心源性呼吸困难和肺源性呼吸困难有一定应用价值。     

慢性心力衰竭病人血清胆红素、尿酸、NT—proBNP与心功能的相关性研究

目的探讨慢性心力衰竭（CHF）病人血清胆红素（TBIL）、尿酸（UA）、N端脑钠肽前体（NT—proBNP）与心功能的相关性。方法选择我院120例慢性心力衰竭病人作为观察组,纳入同期我院40名健康体检者作为对照组。检测两组血清TBIL、UA、NT—proBNP等水平,运用超声心动图进行左室射血分数（LVEF）、左室舒张末期内径（LVEDD）测定,进行相关性分析。结果观察组TBIL、UA、NT—proBNP均较对照组明显升高（P〈0．01）,且随着纽约心脏病协会（NYHA）心功能分级增高逐渐升高。观察组治疗后TBIL、UA、NT—proBNP均较治疗前明显降低（P〈0．01）。结论慢性心力衰竭病人TBIL、UA、NT—proBNP随着心力衰竭严重程度的增加而相应升高,并与LVEF及LVEDD有良好的相关性。从而对慢性心力衰竭的诊断及病情、预后判断有重要的临床价值。     

急性呼吸困难患者血浆BNP水平的临床意义

目的：探讨血N-末端脑钠肽前体（NT-proBNP）水平对老年急性呼吸困难患者的诊断价值。方法：用电化学发光免疫法测定96例老年急性呼吸困难患者血浆NT-proBNP,包括心源性呼吸困难和肺源性呼吸困难,比较2种急性呼吸困难患者、健康体检者血浆NT-proBNP水平,同时比较心源性呼吸困难组不同心功能分级（NYHA）患者的血NT-proBNP水平。结果：心源性呼吸困难患者血NT-proBNP水平明显高于肺源性呼吸困难组患者（P〈0．01）;心源性呼吸困难组血NT-proBNP水平在心功能不同级别间差异有显著性意义,与左室射血分数（I。VEF）呈负相关。结论：血NT-proBNP水平有助于心源性与肺源性呼吸困难患者的鉴别诊断,特别在老年患者病情危重复杂,需要短时间内明确病因时,通过监测血NT-proBNP水平可能有助于鉴别。

Abstract：

Objective： To investigate the value of serum level of NvproBNP in diagnosis of patients with acute dyspnea. Methods： The serum level of Nt-proBNP in 96 patients with acute dyspnea including cardiac aspnea and pulmonary aspnea were measured by ELISA. The serum level of Nt-proBNP was compared between patients with 2 different aspnea and healthy people, meanwhile, serum level of Nt-proBNP was compared between different cardiac function in cardiac aspnea group. Results： The serum level of Nt-proBNP was significantly higher in patients with cardiac aspnea than that in pulmonary aspnea （P〈0. 01）. The serum level of Nt- proBNP was significantly different in different stages of heart function in cardiac aspnea group, and negatively correlated with left ventricular ejection fraction （LVEF）. Conclusions： Serum NT-proBNP contributes to differ ential diagnosis of cardiac and pulmonary dyspnea, especially for elderly patients in critical and complex condi tion, requiring a clear cause in short time.     

The time-course changes of NT-proBNP and tissue Doppler indices in patients undergoing mitral valve replacement

Background: In severe mitral regurgitation, a subset of patients who are asymptomatic may develop left ventricular decompensation before changes in echocardiographic parameters become evident. Since N-terminal brain natriuretic peptide (NT-proBNP) is used to detect early heart failure, we hypothesised that NT-proBNP would be activated in patients with mitral regurgitation. Methods: Patients submitted to surgery were prospectively evaluated over eight months in the Department of Cardiology at Inkosi Albert Luthuli Central Hospital. Control patients with severe mitral regurgitation were obtained from the outpatient clinic. In order to define their value in identifying left ventricular decompensation, NT-proBNP levels and tissue Doppler imaging (TDI) indices were simultaneously measured and compared with conventional echocardiographic indices at baseline and this was repeated at one week and at six weeks after valve replacement. Results: Mean NT-proBNP levels were markedly elevated pre-operatively in all surgical cases compared to controls (p = 0.0001). The diastolic E-mitral/E-annulus ratio, measured using TDI, was higher in the study group, indicating higher left ventricular filling pressure present in the study group. NT-proBNP levels increased further at one week after surgery and subsided at the six-week follow-up visit to levels similar to the control group. The TDI diastolic ratio also decreased at one week, and increased slightly again at the six-week follow up. These changes were accompanied by significant reduction in left atrium and left ventricular chamber dimensions with an increase in the ejection fraction from one to six weeks. Conclusion: Marked differences in mean NT-proBNP levels and TDI ratios between the study and control groups suggest that using TDI and NT-proBNP assays may detect covert left ventricular decompensation.     

心脏不停跳二尖瓣置换术对血浆氨基末端脑钠肽前体的影响及其研究

目的 研究氨基末端脑钠肽前体（NT-proBNP）在浅低温体外循环下心脏不停跳二尖瓣置换术围手术期的变化,探讨心脏不停跳二尖瓣置换术的心肌保护效果.方法 40例风湿性心脏病二尖瓣病变患者随机分为试验组（浅低温不停跳组）与对照组（中度低温停跳组）,每组20例,于6个时点采取静脉血,测定静脉血浆NT-proBNP水平.结果 两组NT-proBNP水平在术后2 h无明显升高（P＞0.05）,在术后6 h明显升高,并在术后24 h达到峰值.在术后6 h、24 h、48 h、72 h,停跳组NT-proBNP水平均低于不停跳组（P＜0.05）.结论 浅低温心脏不停跳二尖瓣置换术能减轻缺血缺氧及再灌注损伤引起的心肌损伤,有较好的心肌保护效果.     

Hemoptysis,recurrent cerebrovascular accident,and emergency mitral valve replacement

Hemoptysis in mitral stenosis may occur frequently, but massive pulmonary hemorrhage is uncommon. We describe a patient with mitral stenosis who had severe hemoptysis and required anticoagulation for recurrent embolic cerebrovascular accidents. The patient underwent successful mitral valve replacement with a Hancock bioprosthesis. There was no evidence of pulmonary bleeding following operation. This case illustrated that mitral valve operation may be performed in acutely ill patients for the relief of hemoptysis.     

经皮球囊二尖瓣成形术后房颤患者ANP和BNP水平变化研究

目的探讨房颤患者行经皮球囊二尖瓣成形术（PBMV）后心房利钠肽（ANP）和脑钠肽（BNP）变化及与血流动力学参数的关系。方法选择因风湿性二尖瓣狭窄伴持续性房颤成功行PBMV患者38例,术前、术后1d及半年分别用放射免疫法和酶链免疫法测定血浆中ANP、BNP值,由超声心动图测左房内径（LAD）、二尖瓣口面积（MVA）、二尖瓣跨瓣压差（MPG）及肺动脉压（PAP）。结果PBMV术后患者血流动力学参数明显改善;术后1d及半年ANP水平较术前明显下降,BNP变化不明显。术后半年与术前比较,LAD与ANP下降相关（r=0．774,P〈0．05）,△BNP与△MPG相关（r=0．574,P〈0．05）。结论房颤患者PBMV术后半年血中ANP逐步下降,BNP降低不明显。房颤律时△ANP和△BNP仍是反映LAD和MPG变化的有效指标。     

Mechanisms,pathophysiology, and diagnostic imaging of left ventricular outflow tract obstruction following mitral valve surgery and transcatheter mitral valve replacement

Left ventricular outflow tract obstruction is a serious complication of mitral valve surgery (repair and replacement) and transcatheter mitral valve replacement. An appreciation of the various mechanisms which cause outflow obstruction in these settings is critical to avoiding this complication and to initiating appropriate treatment. This article discusses the mechanisms, pathophysiology, and imaging of left ventricular outflow tract obstruction which can arise following insertion of a variety of mitral valve prosthetics.     

B型脑利钠肽及N端脑利钠肽前体与舒张性心力衰竭的诊断

心力衰竭患者中舒张性心力衰竭占相当大的比例,其预后与收缩性心力衰竭相似,而目前对于舒张性心力衰竭的诊断尚缺乏简便客观的手段及统一的标准,尤其早期诊断更加困难,以致漏诊率、误诊率较高。B型脑利钠肽及N端脑利钠肽前体作为充血性心力衰竭的客观生化指标,其对舒张性心力衰竭的诊断价值也为一系列临床研究所证实,虽然尚存在争议,但相信在将来随着研究的深入,B型脑利钠肽及N端脑利钠肽前体可能会成为早期诊断舒张性心力衰竭的可靠的生化指标之一,并且可能有明确的分界值,从而使舒张性心力衰竭诊断变得简便易行、客观可靠。     

The impact of mitral stenosis on outcomes of aortic valve stenosis patient undergoing surgical aortic valve replacement or transcatheter aortic valve replacement

Background

The concomitant presence of mitral stenosis (MS) in the setting of symptomatic aortic stenosis represent a clinical challenge. Little is known regarding the outcome of mitral stenosis (MS) patients undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). Therefore, we sought to study the outcome of MS patients undergoing aortic valve replacement (AVR).

Method

Using weighted data from the National Inpatient Sample (NIS) database between 2011 and 2014, we identified patients who were diagnosed with MS. Patients who had undergone TAVR as a primary procedure were identified and compared to patients who had SAVR. Univariate and multivariate logistic regression analysis were performed for the outcomes of in‐hospital mortality, length of stay (LOS), blood transfusion, postprocedural hemorrhage, vascular, cardiac and respiratory complications, permanent pacemaker placement (PPM), postprocedural stroke, acute kidney injury (AKI), and discharge to an outside facility.

Results

A total of 4524 patients were diagnosed with MS, of which 552 (12.2%) had TAVR and 3972 (87.8%) had SAVR. TAVR patients were older (79.9 vs 70.0) with more females (67.4% vs 60.0%) and African American patients (7.7% vs 7.1%) (P < 0.001). In addition, the TAVR group had more comorbidities compared to SAVR in term of coronary artery disease (CAD), congestive heart failure (CHF), chronic lung disease, hypertension (HTN), chronic kidney disease (CKD), and peripheral vascular disease (PVD) (P < 0.001 for all). Using Multivariate logistic regression, and after adjusting for potential risk factors, TAVR patients had lower in‐hospital mortality (7.9% vs 8.1% adjusted Odds Ratio [aOR], 0.615; 95% confidence interval [CI], 0.392–0.964, P = 0.034), shorter LOS. Also, TAVR patients had lower rates of cardiac and respiratory complications, PPM, AKI, and discharge to an outside facility compared with the SAVR group.

Conclusion

In patients with severe aortic stenosis and concomitant mitral stenosis, TAVR is a safe and attractive option for patients undergoing AVR with less complications compared with SAVR.

     

Peri-procedural management of transcatheter mitral valve replacement in patients with heart failure

Over the past decade, transcatheter mitral valve replacement (TMVR) technologies have evolved with the objective of improving outcomes for patients with severe mitral regurgitation (MR) deemed unsuitable for conventional mitral valve surgery. Although the safety and efficacy of transcatheter edge-to-edge mitral valve repair (TEER) is well-established, there is a sense amongst innovators that a major advantage of TMVR may be to offer a more complete solution for the correction of MR in patients whose complex anatomy means that the likelihood of achieving grade 0 or 1 MR with TEER is low. However, abrupt correction of MR in a poorly prepared left ventricle poses a number of unique haemodynamic challenges, particularly when sudden elimination of regurgitant flow causes a relative increase in left ventricular (LV) afterload. Rapid reduction in LV cavity size following MR elimination may itself result in relative LV outflow tract obstruction (LVOTO), irrespective of the intrinsic risk of LVOTO associated with TMVR. Nevertheless, TMVR on a beating heart affords the opportunity to study real-time invasive cardiac indices in high-risk patients with acute reversal of severe MR.