Graves病患者血清氨基端-脑钠肽前体水平的变化

Changes of serum NT-proBNP concentration in patients with Graves＇ disease

目的研究Graves病（GD）甲亢患者血清氨基端．脑钠肽前体（NT-proBNP）的变化特点及临床意义。方法入选GD患者269例，其中初发患者90例。测定血清甲状腺激素、促甲状腺素受体抗体（TRAb）和NT-proBNP水平。结果血清NT-proBNP与FT3（r=0．260，P〈0．01）、FT4（r=0．297，P〈0．01）和心率正相关（r=0．251，P〈0．05）；与超敏TSH（sTSH）负相关（r=-0．157，P〈0．01）。校正年龄、性别和体重指数（BMI）后，血清NT-proBNP仍与FT3、FT4和TRAb正相关（均P〈0．01）。校正血清FT3、FT4、sTSH、TRAb、年龄、性别、BMI后，初发组和治疗组的血清NT—proBNP差异仍有统计学意义（P〈0．01），血清n对NT—proBNP有显著影响（P〈0．01），NT-proBNP水平的升高在甲亢已经控制的患者中同样存在。结论GD患者血清NT-proBNP水平随着FT。的升高而明显上升，不受性别、年龄和BMI的影响。监测血清NT-proBNP有助于了解GD患者的血管僵硬度和容量变化，为早期防治甲亢引起的心血管疾病提供依据。

Objective To investigate the changes of serum N-terminal-pro-B-type natriuretic peptide （ NT- proBNP） concentration in patients with Graves＇ disease （GD） and its clinical significance. Methods Two hundred and sixty-nine patients with GD were enrolled in this study. Serum concentrations of thyroid hormones, TRAb, and NT-proBNP were measured. Results Serum NT-proBNP levels were positively associated with FT3 （r=0.260, P〈0.01）, FT4（r =0.297, P〈0.01） and heart rate （r=0.251, P〈0.05） independent of age, sex and body mass index （BMI）. The difference of serum NT-proBNP concentrations between newly-onset and treated patients existed （ P 〈 0.01 ） after the adjustment for thyroid hormone levels, age, sex and BMI. Serum FT4 level exerted a significant impact on NT-proBNP level （ P 〈 0.01 ）. Serum NT-proBNP increased even in patients with controlled thyroid function. Conclusion Serum NT-proBNP level in patients with GD increases with elevation of FT4 independent of sex, age and BMI. The measurement of serum NT-proBNP concentration appears to be helpful to monitor the alteration of vascular stiffness and fluid volume in GD patients, and may provide useful evidence for early intervention of cardiovascular disease induced by hyperthyroidism.