胰岛素敏感性对心力衰竭患者NT-proBNP浓度变化的影响

Effect of insulin sensitivity on NT-proBNP levels change in patients with heart failure

目的：观察胰岛素敏感性对心力衰竭患者N-末端脑钠肽（NT-proBNP）浓度变化的影响。方法：NYHA分级Ⅲ～Ⅳ级的严重心力衰竭住院患者80例，每日测量体重，检测入院次日晨血NT—proBNP、空腹血糖、胰岛素、肌酐、糖化血红蛋白（GHB）、左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）、肺动脉收缩压、平均动脉压首次数值，每隔7d检测NT-proBNP浓度、血肌酐、空腹血糖、胰岛素，直至心功能改善为Ⅱ级持续72h后复测上述指标，并计算出相应的内生肌酐清除率（Ccr）、BMI、胰岛素敏感性指数（ISI）。结果：治疗7d后，NT-proBNP明显下降（P〈0．01），之后下降变缓；ISI呈现下降趋势，但前后差异无统计学意义。NT-proBNP浓度降低百分比与ISI、LVEDD及年龄呈负相关（r=-0．6、-0．095、-0．01，均P〈O．05），与Ccr呈正相关（r=0．408，P〈0．01）。结论：心力衰竭患者住院期间血中NT-proBNP浓度变化受多种因素影响，胰岛素敏感性未发生明显变化，但影响NT-proBNP浓度的降幅。

Objective： To evaluate the effect of insulin sensitivity on NT-proBNP levels change in patients with heart failure. Methods： 80 patients with severe heart failure （NYHA class 1] --IV were treated with individualized therapy, and weighted every day. NT-proBNP, glucose and insulin, creatinine, glycosylated hemoglobin （GHB） in fasting plasma, left ventricular end diastolic diameter （LVEDD）, left ventricular ejection fraction （LVEF）, pulmonary artery systolic pressure and mean arterial pressure were measured in morrow morning after admission. The levels of NT-proBNP, glucose and insulin were detected repeatedly every 7 days until cardiac function improved to NYHA class [I for 72 hours, and then those biochemical indexes, blood pressure and color doppler echocardiography variables were mearured for the last time. The corresponding creatinine clearance rate （Ccr）, body mass index and insulin sensitivity index （ISI） were calculated. Results： NT-proBNP decreased significantly after 7 days treatment （P〈0. 01）, and then it decreased slowly. ISI value presented a falling trend like NT-proB- NP, but the change was not significant. NT-proBNP concentration decrease was negatively correlated with ISI, LVEDD and age （r= -0. 521, -0. 322 and -o. 290, all P〈0. 05）, while positively correlated with Ccr （r= 0. 314, P〈0. 01）. Conclusion：The alteration of NT-proBNP level in patients with heart failure is affected by sever- al factors including insulin sensitivity. Insulin sensitivity has not significant change during hospitalization in pa- tients with heart failure, while affecting the degree of reduction of NT-proBNP level.