血清N端前体脑钠肽在心血管病患者的表达及其临床意义

目的 测定心血管疾病患者血清N端前体脑钠肽(NT-proBNP)浓度变化,并探讨其临床意义.方法 采用电化学发光免疫试验(ECLIA)测定460例心血管疾病患者及50名健康体检者的血清NT-proBNP浓度,超声心动图测定左室射血分数(LVEF),分析NT-proBNP与美国纽约心脏病协会(NYHA)心功能分级、LVEF、心血管疾病危险因素之间的关系.结果 心血管病组患者血清LgNT-proBNP浓度为3.74,显著高于健康对照组的1.42;单因素方差分析示不同的心血管病组间患者血清NT-proBNP浓度差异有统计学意义(F=17.761,P<0.001).心血管病患者血清NT-proBNP浓度随着NYHA心功能分级升高而显著上升,相同NYHA心功能和LVEF分级下,不同心血管病组间血清NT-proBNP浓度差异亦有统计学意义(P<0.001).多变量相关分析表明,血清NT-proBNP浓度与患者年龄、NYHA心功能分级之间具有良好的正相关性(r=0.152,P<0.001及r=0.725,P<0.001),与LVEF分级、预后之间呈良好的负相关关系(r=-0.634,P<0.001和r=0.581,P<0.001).Logistic回归分析显示,NT-proBNP是心血管疾病事件强的预测因子(HR=2.763,P<0.01),并与患者的临床治疗结局密切相关.结论 心血管病患者血清NT-proBNP水平随着心力衰竭程度的增加而升高,可用来评价患者的心功能状况,且与临床预后关系密切,但其对心血管疾病的分层诊断价值有待进一步研究.

Changes of serum N-terminal pro-brain natriuretic peptide levels in patients with cardiovascular diseases and its clinical significance

OBJECTIVE: To detect the changes in serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in patients with cardiovascular diseases and explore its clinical significance. METHODS: Serum NT-proBNP concentrations were measured by electrochemiluminescent immunoassay (ECLIA) in 460 patients with cardiovascular diseases and in 50 normal controls, and echocardiographic examination was performed to determine the left ventricular ejection function (LVEF). Analysis of NT-proBNP was performed for its correlation to New York Heart Association (NYHA) functional classifications LVEF, and risk factors of cardiovascular diseases. RESULTS: The serum LgNT-proBNP concentrations was 3.74 in patients with cardiovascular diseases, significantly higher than that of normal controls (1.42, P<0.001). NT-proBNP concentrations also varied significantly among patients with different cardiovascular diseases as shown by one-way ANOVA analysis (F=17.761, P<0.001). The NT-proBNP levels increased with the severity of heart failure according to NYHA functional classifications (P<0.001), and varied significantly in patients suffering different cardiovascular diseases with the same NYHA functional class. Multivariable regression analysis indicated there were significant correlations of NT-proBNP levels with the patients' age (r=0.152, P<0.001), NYHA functional classifications (r=0.725, P<0.001), LVEF (r=-0.634, P<0.001), and clinica outcomes (r=-0.581, P<0.001). Logistic regression analysis identified NT-proBNP level as a strong indicator for cardiovascular events (HR=2.763, P<0.01) with close correlation to the treatment results. CONCLUSIONS: Serum NT-proBNP level varies significantly with the severity of heart failure and can be indicative of the patients' cardiac function in close correlation to the clinical prognosis, but its value for diagnostic stratification of cardiovascular diseases awaits further investigation.