充血性心力衰竭患者激活素A、基质金属蛋白酶9及N端脑钠肽前体水平的变化及其临床意义

目的 探讨充血性心力衰竭(CHF)患者血浆激活素A(ACT-A)、基质金属蛋白酶9(MMP-9)和N端脑钠肽前体(NT-proBNP)水平变化及临床意义.方法 应用酶联免疫吸附法(ELISA)分别测定86例CHF患者治疗前后及30例正常人血浆ACT-A、MMP-9和NT proBNP水平,并进行统计学分析比较.结果 ①CHF组ACT-A、MMP 9和lgNT-proBNP水平分别为(2.94±1.44) μg/L、(260.01±88.23) μg/L和(5.51±1.73) ng/L明显高于对照组(1.03±0.27) μg/L、(80.51±28.66)μg/L和(4.11±0.16) ng/L(均P＜0.01)；②心功能Ⅱ、Ⅲ、Ⅳ级组ACT-A分别为(1.72±0.25) μg/L、(2.33±0.51)μg/L及(4.78±0.78) μg/L,MMP-9水平分别为(142.60±50.43) μg/L、(225.14±33.03) μg/L及(310.27±75.77) μg/L,lgNT-proBNP水平分别为(4.67±0.35) ng/L、(5.48±1.07) ng/L及(5.91±1.47) ng/L,以上指标均为CHFⅢ级高于CHFⅡ级,CHFⅣ级高于Ⅱ级和Ⅲ级(均P＜0.01).③CHF组治疗后血浆ACT A、MMP-9和lgNT-proBNP水平分别为(2.17±0.79) μg/L、(184.50±52.40) μg/L和(4.39±0.87) ng/L显著低于治疗前水平(2.94±1.44) μg/L、(260.01±88.23) μg/L和(5.51±1.73) ng/L(均P＜0.01).④CHF组血浆ACT A、MMP-9与lgNT-proBNP呈正相关(r＝0.732、0.771,P＜0.05).结论 CHF患者血浆ACT-A、MMP-9和NT-proBNP水平较正常人显著升高,且这些指标随着心功能恶化而明显升高.对其血浆浓度的测定有助于CHF的早期诊断和分级.

Levels and clinical significance of plasma activin-A, matrix metalloproteinase-9 and N-terminal pro-brain natriuretic peptide in patients with congestive heart failure

Objective To evaluate the plasma levels of activin-A(ACT-A),matrix metalloproteinase-9(MMP-9) and N-terminal pro-brain natriuretic peptide(NT-proBNP) in patients with congestive heart failure(CHF),and their clinica1 significance.Methods The levels of plasma ACT-A,MMP-9 and NT-proBNP were measured by enzyme-linked immunosorbent assay(ELISA) before treatment and after treatment respectively in 86 patients with CHF and 30 control subjects.Statistical analysis and comparison were conducted on them.Results ①The plasma levels of ACT-A(2.94±1.44) μg/L,MMP-9(260.01±88.23) μg/L and lgNT-proBNP(5.51±1.73) ng/L in CHF patients before treatment were significantly higher compared with those in control subjects(1.03±0.27) μg/L,(80.51±28.66) μg/L and(4.11±0.16) ng/L(all P<0.01).②The plasma levels of ACT-A in NYHA function classⅡ to Ⅳ subgroup in CHF group,class Ⅱ(1.72±0.25) μg/L,class Ⅲ(2.33±0.51) μg/L,class Ⅳ(4.78±0.78) μg/L,increased with the severity of NYHA functional class(all P<0.05).The plasma levels of MMP-9 in NYHA function class Ⅱ to Ⅳ subgroup in CHF group,class Ⅱ(142.60±50.43) μg/L,class Ⅲ(225.14±33.03) μg/L,class Ⅳ(310.27±75.77) μg/L,increased with the severity of NYHA functional class(all P<0.01).The plasma levels of lgNT-proBNP in NYHA function class Ⅱ to Ⅳ subgroup in CHF group,class Ⅱ(4.67±0.35) ng/L,class Ⅲ(5.48±1.07) ng/L,class Ⅳ(5.91±1.47) ng/L,increased with the severity of NYHA functional class(all P<0.01).Furthermore,all of these in class Ⅳ sulogroup were higher than those in the class Ⅲ subgroup and class Ⅱ sbugroup,and these in the class Ⅲ subgroup were higher than those in the class Ⅱ subgroup(all P<0.01).③The plasma levels of ACT-A(2.17±0.79) μg/L,MMP-9(184.50±52.40) μg/L and lgNT-proBNP(4.39±0.87) ng/L in CHF patients after treatment were 1ower than those before treatment(2.94±1.44) μg/L,(260.01±88.23) μg/L and(5.51±1.73) ng/L(all P<0.01).④There was a significant positive correlation between the plasma levels of ACT-A,MMP-9 and lgNT-proBNP in CHF patients(r=0.732;0.771,P<0.05).Conclusion The plasma levels of ACT-A,MMP-9 and NT-proBNP in CHF patients were significantly higher compared with those in control subjects.Moreover,all the indexes will help early diagnosis and severity classification for CHF.