脑钠肽与肝硬化患者心功能的关系

Role of brain natriuretic peptide on cardiac function in cirrhosis

目的通过测定脑钠肽、彩色多普勒超声和同位素心血池显像评价肝硬化患者脑钠肽水平和心脏结构、功能之间的关系,以利用脑钠肽作为肝硬化心功能不全的标志物。方法32例各种病因的肝硬化患者,无心脏病史和症状,19例有腹水,13例无腹水,另有18例为对照组。治疗前后分别行心脏彩色多普勒超声、同位素心血池显像以观察心脏结构参数和收缩、舒张功能,并测定脑钠肽。结果治疗后腹水组和无腹水组射血分数值改变明显(P<0.01),腹水组左心房内径明显缩小[(37.2±2.8)mm vs(29.4±2.3)mm,P<0.01],无腹水组和腹水组治疗前后室间隔厚度明显减轻[(7.5±0.3)mm vs(6.7±0.3)mm;(8.3±0.8)mm vs(7.2±0.9)mm,P<0.01];治疗后肝硬化组等容松弛时间(IVRT)均明显缩短[(95.8±6.0)ms vs(83.2±6.8)ms;(103.5±7.9)ms vs(91.5±7.6)ms,P<0.01],说明存在舒张功能不全;脑钠肽水平无腹水组和腹水组与对照组治疗前比较明显升高(25.9±6.3)pg/L和(33.5±4.9)pg/L vs(18.6±3.9)pg/L(P<0.01),治疗后脑钠肽水平明显下降,无腹水组与对照组者相似(P>0.05),脑钠肽降低和IVRT缩短呈正相关(r=0.6,P<0.01)。结论肝硬化患者脑钠肽水平升高和心脏舒张功能受损有关,说明脑钠肽水平可用作筛选肝硬化患者硬化性心肌病的标志物,以便于患者做进一步检查。

Objective To evaluate the plasma levels of brain natriuretic peptide（BNP） and their relationship with cardiac structure and function in patients with cirrhosis by BNP measured, color Doppler echocardiography and radionuclide angiography in order to use BNP as a marker of cardiac dysfunction in cirrhosis. Methods The study population comprised of 32 patients with cirrhosis of mixed etiologies, but without cardiac history and symptoms; 19 of the patients had ascites and 13 did not. Control group consisted of 18 subjects. Before and after treatment, the subjects underwent color Doppler echocardiography, and radionuclide angiography for measurements of cardiac structural parameters,diastolic and systolic function. BNP levels were also measured. Results After treatment the ejection fraction（EF） varied significantly in both patients＇ groups（ P 〈0.01）, together with left atrial diameter diminished in ascitic-patientg group[（37.2 ±2.8） mm vs （29.4 ± 2.3） mm, P 〈 0.011 and interventricular septal thickness was alleviated significantly in both patientg groups[（7. 5±0. 3） mm vs （6.7 ±0.3） mm; （8.3±0.8） mm vs （7.2 ± 0.9） mm, P 〈0. 011; After treatment isovolumic relaxation time（IVRT） shortened significantly in both patients＇ groups [（95. 8±6. 0） msvs （83.2±6.8） ms;（103.5±7.9） ms vs （91.5±7.6） ms, P 〈0.011, which shows diastolic dysfunction. Before treatment,BNP levels of both patients＇ groups were higher than that of control group （25.9 ± 6.3 ） pg/L and （33.5±4.9） pg/L vs （18.6±3.9） pg/L（ P 〈0.01）,but BNP level in non-ascites group was similar to that of control group after treatment（ P〉0.05）. BNP levels of ascite-patient＇s group decreased significantly after treatment [（33. 5±4. 9） pg/L vs （23.0±5.0） pg/L, P 〈0. 01]. BNP decrease positively correlated with IVRT shortness（ r =0.6, P 〈0.01）. Conclusion BNP increase is related to the impairment of diastolic function in patients with cirrhosis. BNP level may prove useful as a marker for screening patients with cirrhosis for the presence of cirrhotic cardiomyopathy,and therefor identifying such patients for further investigations.