冠心病患者血浆N-末端脑钠肽浓度与体重指数关系研究

Impact of Body Mass Index on Levels of N-terminal Pro-brain Natriuretic Peptides in patients with coronary artery disease

目的肥胖是冠心病和心力衰竭发生的危险因素之一,近来有研究发现肥胖状态会影响血浆BNP和NT-proBNP浓度。本研究旨在探究N-末端脑钠肽(NT-proBNP)与体重指数(BMI)之间的关系;明确在冠心病人群中肥胖状态对NT-proBNP预测心力衰竭的影响。方法选取2005年4月～2006年1月我院住院冠心病患者310例。记录一般临床情况,测量患者身高、体重。超声心动图测定左室射血分数(LVEF);ELISA法测定血浆和Nt-proBNP浓度。以BMI值将患者分为肥胖组(BMI≥28kg/m2)和非肥胖组(BMI<28kg/m2)。比较两组间Nt-proBNP浓度差异,描记LogNT-proBNP与BMI相关曲线。比较不同年龄性别亚组内肥胖对Nt-proBNP浓度的影响。结果肥胖组(210例)患者血浆NT-proBNP浓度明显低于非肥胖组(100例),分别为:627.42±418fmol/ml和1951.71±614fmol/ml(P=0.021)。且在不同年龄组、男性患者、合并高血压组和糖尿病组中肥胖者血浆NT-proB-NP浓度均低于非肥胖者(P<0.05)。BMI与LogNT-proBNP之间存在负相关关系(r=-0.327,P<0.001),两组患者血浆NT-proBNP浓度均随心功能下降而升高,组间差异有统计学意义。结论冠心病肥胖患者中血浆NT-proBNP浓度随BMI增加而降低。在应用NT-proBNP对冠心病患者进行心功能评价时应同时考虑肥胖因素对其产生的影响。

Objective Concentrations of both B-type natriuretic peptide （BNP） and its amino-terminal cleavage fragment （NT-proBNP） are relatively lower among patients with a higher body mass index （BMI）. This study aimed to examine the influence of obesity on the diagnoses value of heart failure with the N-terminal brain natriuretic peptide （NT-proBNP） assay in the patients with coronary artery disease （CAD）. Methods 310 CAD patients were enrolled in this study,and height and weight of each patients were measured and BMI were calculated with these parameter. LVEF was measured by the modified Simpson 8 equation with echocardiography. The plasma concentrations of Nt-proBNP were measured by enzyme-linked immunosorbent assay. Patients were divided into two groups according to BMI, obese group （BMI≥28 kg/ m2 ） ; nonobese group （ BMI 〈 28 kg/m2 ）. Result The concentration of Nt-proBNP were significantly lower in obese group compared to nonobese group （obese group： 627. 42±418 fmol/ml; nonobese group： 1951.71±614 fmol/ml, P =0. 021 ）. This phenomenon also can be observed in the subgroup of age, gender, accompanied with hypertension and diabetic mellitus. BMI is inversely correlation with Log NT-proBNP. Conclusion In CAD patient, plasma concentration of NT-proBNP were affected by BMI. The influence of BMI must be considered, when assessment the heart function with NT-proBNP in CAD patient.