冠心病患者血浆N-末端脑钠肽浓度与体重指数关系研究

目的肥胖是冠心病和心力衰竭发生的危险因素之一,近来有研究发现肥胖状态会影响血浆BNP和NT-proBNP浓度。本研究旨在探究N-末端脑钠肽（NT-proBNP）与体重指数（BMI）之间的关系;明确在冠心病人群中肥胖状态对NT-proBNP预测心力衰竭的影响。方法选取2005年4月～2006年1月我院住院冠心病患者310例。记录一般临床情况,测量患者身高、体重。超声心动图测定左室射血分数（LVEF）;ELISA法测定血浆和Nt-proBNP浓度。以BMI值将患者分为肥胖组（BMI≥28kg/m2）和非肥胖组（BMI＆lt;28kg/m2）。比较两组间Nt-proBNP浓度差异,描记LogNT-proBNP与BMI相关曲线。比较不同年龄性别亚组内肥胖对Nt-proBNP浓度的影响。结果肥胖组（210例）患者血浆NT-proBNP浓度明显低于非肥胖组（100例）,分别为：627.42±418fmol/ml和1951.71±614fmol/ml（P=0.021）。且在不同年龄组、男性患者、合并高血压组和糖尿病组中肥胖者血浆NT-proB-NP浓度均低于非肥胖者（P〈0.05）。BMI与LogNT-proBNP之间存在负相关关系（r=-0．327,P〈0．001）,两组患者血浆NT-proBNP浓度均随心功能下降而升高,组问差异有统计学意义。结论冠心病肥胖患者中血浆NT—proBNP浓度随BMI增加而降低。在应用NT—proBNP对冠心病患者进行心功能评价时应同时考虑肥胖因素对其产牛的影响。     

利喜定对慢性心力衰竭患者血浆脑钠肽水平及心功能的影响

目的探讨利喜定对慢性心力衰竭（CHF）患者血浆脑钠素（BNP）水平和心功能的影响。方法将42例CHF患者随机分为利喜定组（23例）和硝普钠（19例）,2组其余抗心衰治疗相同,疗程5d。测定治疗前后心率、血压,左心室射血分数（LVEF）,血浆BNP浓度的变化。结果疗程结束后,利喜定及硝普钠组与治疗前相比,心率下降,LVEF升高,血浆BNP浓度降低（P〈0.05）;与硝普钠组相比,利喜定组心率及血浆BNP浓度降低更明显,差异有统计学意义（P〈0.05）,但是LVEF两组间无差别,无统计学意义,利喜定组低血压等并发症明显低于硝普钠。结论利喜定和硝普钠都能改善CHF的心功能,且利喜定降低血浆BNP的疗效优于硝普钠,并且不良反应低于硝普钠。     

血浆脑钠肽与心功能参数的相关研究

目的：探讨心力衰竭患者血浆脑钠肽(BNP)水平与左心室功能的关系及其临床意义。方法：测定并比较60例心力衰竭患者及30名正常人血浆BNP、左室舒张末横径(LVEDD)、左室射血分数(LVEF)等指标。结果：心力衰竭患者血浆BNP、LVEDD均显著高于对照组(P＜0．01),LVEF显著低于对照组(P＜0．01)。BNP水平随着心功能NYHA分级程度的加重而增高,并且BNP水平与LVEDD呈正相关(r=0．687,P＜0．001),而与LVEF呈负相关(r=-0．639,P＜0．001)。结论：血浆BNP水平对心衰患者的诊断、病情和预后判断具有重要临床意义。     

降钙素基因相关肽与脑血管病

文章主要讨论了降钙素基因相关肽对脑血管的作用机制及其与各种脑血管病的关系，并对相关的实验和临床研究进行了综述。     

脑钠肽评估房颤合并心力衰竭的价值

目的:探讨血清B型脑钠肽(BNP)水平在心房颤动(房颤)并发充血性心力衰竭(CHF)中的价值。方法:用免疫荧光定量测定法检测54例心房颤动合并心力衰竭患者的血清脑钠肽水平,按NYHA心功能级别分成4组,并以30例健康成人作为正常对照组。采用多普勒心动超声图判断左心室功能。结果:BNP与年龄存在正相关,年龄越大,BNP越高,但二者关联度不密切(r=0.23)。BNP在治疗组与对照组间分布差异有统计学意义,χ2值为54.25,P<0.01。心动超声图左心室功能测定,5组间比较,NYHA心功能分级Ⅳ组与对照组有统计学意义(P<0.05)。结论:血清脑钠肽水平在房颤并发心力衰竭中,对诊断疾病严重性及判断预后有重要意义。     

Atrial natriuretic peptide inhibits the production of adipokines and cytokines linked to inflammation and insulin resistance in human subcutaneous adipose tissue

Aims/hypothesis Increased adipose tissue secretion of adipokines and cytokines has been implicated in the chronic low-grade inflammation state and insulin resistance associated with obesity. We tested here whether the cardiovascular and metabolic hormone atrial natriuretic peptide (ANP) was able to modulate adipose tissue secretion of several adipokines (derived from adipocytes) and cytokines (derived from adipose tissue macrophages). Subjects and methods We used protein array to measure the secretion of adipokines and cytokines after a 24-h culture of human subcutaneous adipose tissue pieces treated or not with a physiological concentration of ANP. The effect of ANP on protein secretion was also directly studied on isolated adipocytes and macrophages. Gene expression was measured by real-time RT-quantitative PCR. Results ANP decreased the secretion of the pro-inflammatory cytokines IL-6 and TNF-α, of several chemokines, and of the adipokines leptin and retinol-binding protein-4 (RBP-4). The secretion of the anti-inflammatory molecules IL-10 and adiponectin remained unaffected. The cytokines were mainly expressed in macrophages that expressed all components of the ANP-dependent signalling pathway. The adipokines, leptin, adiponectin and RBP-4 were specifically expressed in mature adipocytes. ANP directly inhibited the secretion of IL-6 and monocyte chemoattractant protein-1 by macrophages. The inhibitory effects of ANP on leptin and growth-related oncogene-α secretions were not seen under selective hormone-sensitive lipase inhibition. Conclusions/interpretation We suggest that ANP, either by direct action on adipocytes and macrophages or through activation of adipocyte hormone-sensitive lipase, inhibits the secretion of factors involved in inflammation and insulin resistance.     

贝那普利联合环磷腺苷葡胺治疗充血性心力衰竭的疗效

目的：观察贝那普利联合环磷腺苷葡胺治疗充血性心力衰竭（CHF）的临床疗效。方法：243例CHF患者被随机分为对照组（81例,常规治疗）、治疗1组（80例,常规治疗基础上加贝那普利）、治疗2组（82例,常规治疗基础上加贝那普利和环磷腺苷葡胺）。疗程为14d。分别于用药前及给药14d后测定血浆B型利钠肽（BNP）浓度、左室射血分数（LVEF）、左室短轴缩短率（FS）及心脏指数（CI）。结果：与对照组比较,治疗组LVEF、FS、CI显著改善（P均〈0．05）,血浆BNP浓度显著降低（P〈0．05）,治疗2组与治疗1组相比血浆BNP浓度进一步降低（P〈0．05）,心功能无进一步改善。结论：贝那普利可改善CHF患者心功能,降低血浆BNP浓度,联合环磷腺苷葡胺能进一步降低血浆BNP浓度,治疗CHF疗效显著。     

The obesity paradox in men with coronary heart disease and heart failure: The role of muscle mass and leptin

Aims

We have investigated the role of muscle mass, natriuretic peptides and adipokines in explaining the obesity paradox.

Background

The obesity paradox relates to the association between obesity and increased survival in patients with coronary heart disease (CHD) or heart failure (HF).

Methods

Prospective study of 4046 men aged 60–79 years followed up for a mean period of 11 years, during which 1340 deaths occurred. The men were divided according to the presence of doctor diagnosed CHD and HF: (i) no CHD or HF ii), with CHD (no HF) and (iii) with HF.

Results

Overweight (BMI 25–9.9 kg/m²) and obesity (BMI ≥ 30 kg/m²) were associated with lower mortality risk compared to men with normal weight (BMI 18.5–24.9 kg/m²) in those with CHD [hazards ratio (HR) 0.71 (0.56,0.91) and 0.77 (0.57,1.04); p = 0.04 for trend] and in those with HF [HR 0.57 (0.28,1.16) and 0.41 (0.16,1.09; p = 0.04 for trend). Adjustment for muscle mass and NT-proBNP attenuated the inverse association in those with CHD (no HF) [HR 0.78 (0.61,1.01) and 0.96 (0.68,1.36) p = 0.60 for trend) but made minor differences to those with HF [p = 0.05]. Leptin related positively to mortality in men without HF but inversely to mortality in those with HF; adjustment for leptin abolished the BMI mortality association in men with HF [HR 0.82 (0.31,2.20) and 0.99 (0.27,3.71); p = 0.98 for trend].

Conclusion

The lower mortality risk associated with excess weight in men with CHD without HF may be due to higher muscle mass. In men with HF, leptin (possibly reflecting cachexia) explain the inverse association.     

芪苈强心胶囊与美托洛尔对心力衰竭大鼠心功能及BNP影响的对比研究

目的对比观察芪苈强心(QLQX)胶囊和美托洛尔对心力衰竭大鼠心功能、心室重塑及脑利钠肽(BNP)的影响。方法将饲养4周的44只心肌梗死合并心力衰竭的心衰模型大鼠分成5组:心衰模型组、QLQX胶囊低剂量(0.25 g/kg.d)组、QLQX胶囊高剂量(1.0 g/kg.d)组、美托洛尔(10 mg/kg.d)组、假手术组。灌胃给药,1/日,连续4周后,测心率及超声心动测定左室收缩末内径(LVESD)、左室舒张末内径(LVEDD)、左室射血分数(LVEF)、左室短轴缩短率(LVFS),计算全心质量指数(HW/BW),酶免法测定脑钠肽(BNP)。结果与心衰模型组相比,高剂量QLQX胶囊组和美托洛尔组均可显著性缩小LVESD、LVEDD,升高LVEF、LVFS,(P0.05);高剂量QLQX胶囊组与心力衰竭模型组相比HW/BW和BNP显著性下降,(P0.05)。结论高剂量QLQX胶囊与美托洛尔一样均能改善心衰大鼠的左室功能,并在短期内可显著改善心力衰竭大鼠心肌重塑。     

胃泌素释放肽前体、神经元特异性烯醇化酶、碳酸酐酶IX联合诊断非小细胞肺癌诊断价值研究

目的：研究胃泌素释放肽前体、神经元特异性烯醇化酶、碳酸酐酶IX联合诊断对非小细胞肺癌的诊断价值。方法分析2012年6月-2013年6月我院收治的45例非小细胞癌患者的临床资料,选取52例在我院进行健康体检者作为对照组。分别检测两组研究对象血清中ProGRP、NSE、CAIX水平,分析其在外周血中的变化及临床意义。结果观察组研究对象血清中ProGRP、NSE、CAIX水平显著高于对照组,差异均具有统计学意义(P<0．05);观察组Ⅲ期患者血清ProGRP、NSE、CAIX水平明显高于I+Ⅱ期患者,差异均具有统计学意义( P<0．05);ROC曲线显示,当CAIX诊断分界点取值96．91 pg/mL时诊断敏感性为93．37%,特异性为92．31%,诊断价值均好于ProGRP、NSE,采用三种指标联合诊断发现,其诊断价值优于三者指标单独诊断;结论非小细胞肺癌患者外周血ProGRP、NSE、CAIX水平升高明显,与肿瘤分期正相关,联合诊断价值较高,可作为手术治疗效果新型评价指标。