心血管病患者N末端B型脑钠肽水平变化及与其它生化指标的相关性研究

NT-proBNP Levels in Cardiovascular Disease and Its Comparison with Others Biochemical Indicators

目的研究N末端B型脑钠肽(NT-proBNP)在心血管患者中的水平,并与其它生化指标进行比较。方法采用Roche Elecsys2010电化学发光检测仪定量检测376例心血管病患者以及61例正常体检者(为对照组)NT-proBNP水平,并同时检测心肌肌钙蛋白T(cTnT)、心肌肌钙蛋白I2(cTnI2)、肌红蛋白(MYO)、肌酸激酶MB型同工酶(CK-MB)等生化指标。将患者按照纽约心脏病协会心功能分级法(NYHA)分级,各组间进行对比。结果心血管病患者组血浆LogNT-proBNP浓度(3.38±0.36 fmol/ml)显著高于正常对照组(2.45±0.10 fmol/ml),且方差分析显示不同的心血管病患者组间血清NT-proBNP浓度差异亦有统计学意义(F=43.167,P<0.001)。各心血管病组血清NT-proBNP浓度随着心力衰竭程度的加重(NYHA心功能分级升高)而显著上升(P<0.001)。心血管病各组间NT-proBNP浓度与生化指标cTnT,cT-nI2,CK-MB,MYO相比较,具有更显著的差异。结论心血管病患者血浆NT-proBNP浓度随着心力衰竭严重程度的增加而升高,是评价心功能的敏感指标。而cTnT,cTnI2,CK-MB,MYO等生化指标在心血管病患者分级组中一般没有显著性差异,且与心功能衰竭程度关系不如NT-proBNP密切。而血浆NT-proBNP水平的升高在心功能改变早期、不同心血管疾病期以及预后都可能给予不同的贡献。

Objectives To study the levels of NT-pro Brain Natriuretic Peptide（NT-proBNP） in cardiovascular disease and comparison with others biochemical indicators. Methods By Roche Elecsys2010 electroehemiluminescence assay plasma NT-proBNP and cardiac troponinT （cTnT） leves in 376 patients with cardiovascular disease and 61 of normal controls were measured. And cardiac troponinI2 （cTnI2）, moyglobine （MYO） and creatin kinase myocardial type （CK-MB） were measured. Study the correlations of plasma NT-proBNP concentration with severity of heart failure,underling heart disease and functional classifications （NYHA） in patients with cardiovascular diseas. Results The plasma Log NT-proBNP concentrations of patients were significantly higher than those of the normal controls 3.38±0. 36 fmol/ml vs 2.45±0. 10 fmol/ml（P〈0. 001）. Furthermore the concentrations of NT-proBNP between every 2 subgroups with different type cardiovascular diseases had significant differences （F= 23. 167,P〈0. 001） and they also increased with the increased severity of heart failure according to NYHA functional classification （P〈0. 001）. There were significant differences between every 2 subgroups with different type cardiovascular diseases among the patients with NYHA functional. Conclusion The plasma levels of NT-proBNP increased significantly with the increased severity of heart failure （NYHA functional classes）. But there was a significant increase in cTnT,cTnI2,MYO and CK-MB of acute myocardial infarction. At the early stage of cardiac function injury,different cardiovascular diseases may contribute to the increase of plasma NT-proBNP differently.