稳定扩张性心肌病患者中血浆B型利钠肽和肾素浓度的相互关系

Relationship between BNP level and PRC of patients with stable dilated cardiomyopathy

目的研究B型利纳肽(B-type natriuretic peptide,BNP)生物学变异是否体现稳定慢性心力衰竭(chronicheart failure,CHF)患者疾病进程。方法比较存在扩张性心肌病(dilated cardiomyopathy,DCM)的稳定CHF患者中BNP和肾素-血管紧张素醛固酮系统(renin-angiotensin-aldosterone system,RAS)因子生物学变量。存在DCM稳定CHF患者80例,测定BNP和RAS因子。结果经梯式多变量分析,血清BNP在基线水平(P=0.005)、存在房颤(P=0.014)、高血浆肾素浓度(plasma renin concentration,PRC)(PRC,P=0.002)是显著性独立优势因子,与高BNP相关。随访2个月,无体重和血压的改变,血细胞比容变化(%)与BNP变化不相关(r=-0.325,P=0.000 7),却与PRC变化相关(r=0.680,P=0.001)。结论 BNP生物学变异与PRC生物学变异显著相关,提示在脑利钠肽系统与RAS系统存在生理学相互作用,导致在DCM患者中发生BNP的生物学变异。

Objective To interpret B-type natriurenic peptide（BNP）level in patients with stable chronic heart failure {CHF） and to learn whether the change in BNP represents disease progression. Methods To compare change in BNP and biological variation in factors of the renin angiotensin aldosterone system（RAS} in stable CHF patients with dilated cardiomyopathy（DCM） ,the level of BNP and RAS factors were measured in 80 stable DCM patients. Results According to stepwise multivariate analysis,serum BNP at baseline（P=0. 005）, presence of atrial fibrilla- tion（P=0. 014）, a high biological variation in plasma renin concentration { PRC, P= 0. 002 ） were significant inde- pendent dominant factors related to a high biological variation in BNP. Although there was no change in body weight or blood pressure during the 2 months following up study period,the change in hematocrit（ % ） was negatively corre- lated with the change in BNP（ % ）（ r=- 0. 325, P=0. 000 7 ） and positively correlated with the change in PRC（ r= 0. 680, P= 0. 001 ）. Conclusions There is significant relationship between biological variation in BNP and biologicao variation in PRC, suggesting that the physiological interaction between natriuretic peptide system and RAS may con- tribute to the biological variation in BNP in stable DCM patients.