肾上腺髓质素和脑钠肽在充血性心力衰竭中的对比研究

A comparative study on the roles of adrenomedullin and brain natriuretic peptide in congestive heart failure

目的观察充血性心力衰竭(CHF)患者肾上腺髓质素(ADM)和脑钠肽(BNP)的水平变化,比较两者在CHF中的诊断价值及其灵敏度和特异度。方法CHF组共72例,其中冠心病陈旧性心肌梗死和缺血性心肌病20例,原发性高血压16例,以瓣膜关闭不全为主的风湿性心脏病18例,扩张型心肌病18例。根据NYHA心功能分级标准将CHF组又分为心功能Ⅱ级组20例、Ⅲ级组22例、Ⅳ级组30例。又按射血分数(EF)将CHF组分为EF<40%组(40例)和≥40%组(32例)。对照组45例,为非CHF患者,其中冠心病心绞痛24例,原发性高血压21例。分别用放射免疫法和酶标免疫法测定ADM和BNP的浓度,用心脏彩色多普勒超声心动图测定左室射血分数(LVEF)和左室舒张末内径(LVED)。结果CHF组总体BNP水平较非CHF组显著升高(P<0.05);ADM在CHF组较非CHF组有增高趋势,但两者比较差异无统计学意义。BNP诊断CHF的ROC曲线下面积为0.82,灵敏度和特异度明显优于ADM(P<0.01)。BNP与病因无相关。ADM和BNP与左室射血分数呈显著负相关(P<0.05)。ADM和BNP在NYHA心功能Ⅲ级组较Ⅱ级组显著升高(P<0.05);但心功能Ⅳ级组较Ⅱ级组升高,较Ⅲ级组反有下降趋势。其中仅BNPⅣ级组与Ⅱ级组比较差异有统计学意义(P<0.05)。结论①ADM和BNP有助于不同心功能级别的诊断。②BNP诊断CHF的灵敏度和特异度优于ADM。

Objective To study the plasma levels of adrenomedullin （ADM） and brain natriuretic peptide （BNP） in patients with congestive heart failure （CHF）, and compare the clinical value, sensitivity and specificity between the both as diagnostic approaches for CHF. Methods Seventy-two patients with CHF [mean age = （61＋16） yrs] were recruited as the study group, comprising 20 cases of survived myocardial infarction or ischemic cardiomyopathy, 16 of hypertension, 18 of valvular incompetence predominant rheumatic heart disease （RHD）, and 18 of dilated cardiomy- opathy （DCM）. According to functional classification of New York Heart Association （NYHA）, these patients included 20 with grade 2 cardiac function, 22 with grade 3 and 30 with grade 4 cardiac function. Based on ejection fraction （EF）, 40 patients had an EF 〈40% and 32 had an EF ≥40%. Another 45 non-CHF patients were recruited as controis [mean age = （62＋6） yrs], comprising 24 cases of angina pectoris and 21 of hypertension. Of blood samples, plasma ADM levels were determined by radioimmunoassay, and BNP levels were measured with ELISA. All patients received color Doppler echocardiography to determine left ventricular ejection .fraction （LVEF） and left ventricular end-diastolic diameter （LVED）. Results Overall, BNP levels in CHF group were markedly higher than those in non-CHF subjects （P〈0.05）. ADM levels seemed to be higher in CHF patients, but the difference was of no statistical significance. BNP and ADM levels had significantly negative correlations with LVEF （P〈0.05）. BNP levels were independent of etiologies, and demonstrated accurate for diagnosis of CHF with an area under curve （AUC） of receiver operating characteristics （ROC） of 0.82, showing advantages in sensitivity and specificity as compared with ADM （P〈 0.01 ）. In relation to NYHA cardiac function grading, levels of ADM and BNP were higher in grade 3 than in grade 2 （both P〈0.05）. While ADM （P〉0.05） and BNP （P〈0.05） appeared to be higher in grade 4 than in grade 2, the both tended to be lower in grade 4 compared with grade 3. Conclusion ADM and BNP levels showed benefits in the diagnosis of varied heart functional grading. The sensitivity and specificity of BNP were better than those of ADM.