循环利钠肽胶原水平与慢性心力衰竭的关系

Relation between concentrations of natriuretic peptide,collagen and chronic heart failure

目的:探讨慢性心力衰竭(CHF)患者循环利钠肽、胶原水平与心功能的关系。方法:采用放射性免疫法和酶联免疫吸附法检测63例CHF(CHF组:其中NYHAⅡ级17例,Ⅲ级27例,Ⅳ级19例)及17例健康者(对照组)血浆心纳素(ANP)、脑纳素(BNP)、C型利钠肽(CNP)、Ⅰ型前胶原羧基端肽(PICP)、Ⅲ型前胶原端肽(PCⅢ)的浓度,同时用多谱勒超声心动图测定左室射血分数(LVEF)。结果:(1)与对照组比较,心力衰竭患者血浆ANP、BNP、CNP、PICP、PCIII浓度显著升高(P<0.01)。(2)CHF患者血浆ANP、BNP、PICP、PCⅢ浓度随心功能的恶化逐渐升高(均P<0.01),血浆CNP浓度在NYHAⅡ级患者显著升高(P<0.01),而NYHAⅢ～Ⅳ级患者血浆CNP浓度无明显改变(P>0.05)。(3)ANP、BNP、PICP、PCIII浓度与LVEF之间呈明显的负相关,BNP的相关性更为显著(P<0.05,P<0.01,P<0.05,P<0.05),CNP浓度与LVEF之间无明显相关性(P>0.05)。结论:血浆利钠肽可反映CHF的发生发展,BNP可评价CHF的严重程度,PICP、PCIII可作为CHF时心脏胶原重塑严重程度的检测指标。

Objective：To investigate the relation between the concentrations of natriuretie peptide,collagen and NYHA functional class in the patients with chronic heart failure. Methods：The concentrations of atrial natriuretie peptide （ANP）,brain natriuretic peptide （BNP） ,C-type natriuretie peptide （CNP）,carboxyterminal propeptide of type Ⅰ proeollagen（PICP）,preeollagen Ⅲ （PC Ⅲ ）and left ventrieular fraction （LVEF） of 63 patients with chronic heart failure （CHF group：NYHAII Ⅱ =17 ; NYHA Ⅲ =27 ;NYHAⅣ=19） and 17 healthy subjects（control group） were measured by radioimmunoassay, enzyme-linked immunosorbent assay and Doppler echocardiography respectively.Results： （1） Compared with the control group ,the concentrations of ANP,BNP,CNP,PICP and PCⅢ of the CHF group were significantly higher （P〈0.01）. （2）The concentrations ANP, BNP,PICP and PCⅢ were gradually increased with deterioration of NYHA function.The concentration of CNP in the patients with NYHAⅡ was higher than that in the control group （P〈0.01）. But the concentration of CNP in the patients with NYHAⅢ-Ⅳ were not significantly changed compared with control group （P〉0.05）.（3）There were significantly negative correlations between ANP,BNP,PICP,PCⅢ and LVEF （respectively P〈0.01）,but no correlations between CNP and LVEF （P〉 0.05）. Conclusion：ANP,BNP and CNP could play an important role in the pathophysiologic changes of CHF,BNP could be used to assess the severity of chronic heart failure,PICP and PCⅢ could be served as serological indicators to detect the gravity of collagen remodeling of chronic heart failure.