B型利钠肽在结缔组织病相关肺动脉高压中的诊断价值

目的 通过观察结缔组织病(CTD)相关肺动脉高压(PAH)患者外周血B型利钠肽(BNP)和N末端B型利钠肽原(NT-proBNP)的水平,探讨BNP在CTD相关PAH中的诊断价值.方法 对2006-2009年北京协和医院收治的30例CTD合并PAH患者进行超声心动图、右心导管检查及外周血BNP和NT-proBNP水平测定.结果 (1)30例CTD相关PAH患者全部为女性,年龄(39.5±11.6)岁,均经右心导管检查证实为PAH.患者血BNP水平[(325.2±426.3)(8.0～1590.0)ng/L]、NT-proBNP水平[(1444.9±1651.4)(55.0～7839.6)ng/L]升高.(2)不同程度PAH患者WHO临床功能分级、右心房压(RAP)、右心室舒张末压(RVEDP)、肺毛细血管楔压(PCWP)、肺血管阻力(PVR)、心指数(CI)、混合静脉血氧饱和度(SvO2)、左心室舒张末内径(LVEDd)、右房大小、右心室与左心室舒张末内径比值(RV/LV)、三尖瓣跨瓣压差(TGP)、心包积液发生情况、NT-proBNP差异有统计学意义.(3)应用受试者工作特征曲线(ROC)分析NT-proBNP、BNP对重度PAH的诊断价值,其曲线下面积(AUC)分别为0.74、0.64,提示NT-proBNP优于BNP.NT-proBNP为745.2 ng/L对区分重度PAH的敏感性为68.8%,特异性为57.1%;BNP为141.5 ng/L时的敏感性为62.5%,特异性为64.3%.(4)相关性分析:NT-proBNP与WHO临床功能分级、RAP、RVEDP、平均肺动脉压(MPAP)、PVR呈正相关(r分别为0.55、0.55、0.36、0.53、0.69,P＜0.05),与CI、S(v)O2呈负相关(r分别为-0.58、-0.62,P≤0.001).BNP与RAP、MPAP、PVR呈正相关(r分别为0.42、0.40、0.61,P＜0.05),与CI、S(v)O2呈负相关(r分别为-0.46、-0.54,P=0.005),与RVEDP、WHO临床功能分级无相关性(r分别为-0.46、-0.54,P＞0.05).NT-proBNP与LVEDd呈负相关(r=-0.41,P=0.025),与RA1、RA2、RV、RV/LV比值、TGP呈正相关(r分别为0.40、0.53、0.55、0.49、0.45,P＜0.05).BNP与RA1、RA2、RV、RV/LV比值、TGP呈正相关(r分别为0.39、0.45、0.37、0.40、0.36,P＜0.05).NT-proBNP、BNP均与心包积液明显相关(r分别为0.46、0.43,P＜0.05).结论 CTD相关PAH患者血BNP、NT-proBNP均升高,与WHO临床功能分级、血流动力学参数、超声心动图反映右心室功能参数之间有显著的相关性.提示BNP是判断CTD合并PAH严重程度和预后的一种简单、无创和可信的指标.

Abstract：

Objective To explore the potential role of brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide(NT-proBNP) in the assessment of patients with connective tissuediseases(CTD) associated pulmonary arterial hypertension (PAH). Methods Thirty patients with CTD associated PAH were evaluated by WHO function, echocardiography, right heart catheterization and blood biomarkers. All the clinical data was analyzed statistically. Results All patients [age (39.5 ± 11.6) yr]were female. Both NT-proBNP and BNP were significantly increased and significantly correlated ( all P ＜0. 05 ) respectively with mean pulmonary arterial pressure ( r = 0. 53 and r = 0. 40 ), right arterial pressure ( r = 0. 55 and r = 0. 42 ), pulmonary vascular resistance ( r = 0. 69 and r = 0. 61 ), cardiac index ( r = - 0. 58and r = - 0. 46), mixed venous blood oxygen saturation ( r = - 0. 62 and r = - 0. 54 ), pericardial effusion ( r = 0. 46 and r = 0. 43 ), right atrial sizes ( r = 0. 40 and 0. 53, and r = 0. 39 and 0. 45 ) and right ventricular size ( r = 0. 55 and r = 0. 37 ). Furthmore, NT-proBNP, but not BNP, significantly correlated with WHO function class ( r = 0. 55 ). Conclusion Blood NT-proBNP and BNP were elevated in patients with CTD associated PAH and paralleled the extent of function class, pulmonary hemodynamic changes and right ventricular remodeling.

The value of brain natriuretic peptide in connective tissue diseases associated with pulmonary arterial hypertension

Objective To explore the potential role of brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide(NT-proBNP) in the assessment of patients with connective tissuediseases(CTD) associated pulmonary arterial hypertension (PAH). Methods Thirty patients with CTD associated PAH were evaluated by WHO function, echocardiography, right heart catheterization and blood biomarkers. All the clinical data was analyzed statistically. Results All patients [age (39.5 ± 11.6) yr]were female. Both NT-proBNP and BNP were significantly increased and significantly correlated ( all P ＜0. 05 ) respectively with mean pulmonary arterial pressure ( r = 0. 53 and r = 0. 40 ), right arterial pressure ( r = 0. 55 and r = 0. 42 ), pulmonary vascular resistance ( r = 0. 69 and r = 0. 61 ), cardiac index ( r = - 0. 58and r = - 0. 46), mixed venous blood oxygen saturation ( r = - 0. 62 and r = - 0. 54 ), pericardial effusion ( r = 0. 46 and r = 0. 43 ), right atrial sizes ( r = 0. 40 and 0. 53, and r = 0. 39 and 0. 45 ) and right ventricular size ( r = 0. 55 and r = 0. 37 ). Furthmore, NT-proBNP, but not BNP, significantly correlated with WHO function class ( r = 0. 55 ). Conclusion Blood NT-proBNP and BNP were elevated in patients with CTD associated PAH and paralleled the extent of function class, pulmonary hemodynamic changes and right ventricular remodeling.