风湿性心脏病继发三尖瓣关闭不全患者血清BNP、sST2蛋白水平的变化

Serum levels of brain natriuretic peptide and soluble ST2 in patients with tricuspid regurgitation secondary to rheumatic left heart valve disease

目的观察风湿性心脏病继发不同程度三尖瓣关闭不全患者血清B型脑钠肽（B-type natriuretic peptide）和可溶性ST2蛋白（sST2）水平，探讨血清BNP、sST2蛋白与继发性三尖瓣关闭不全程度的相关性及意义。方法选取2014年3-5月在我院心血管外科单纯行二尖瓣置换术，伴或不伴三尖瓣手术的患者80例，其中男性20例，女性60例，中位年龄50（18-73）岁，按超声心动图测定的三尖瓣返流面积分为四组：①返流面积＜2.0 cm^2为无或局限性返流组（A组），②2.0 cm^2≤返流面积＜5.0 cm^2为轻度返流组（B组），③5.0 cm^2≤返流面积＜10.0 cm^2为中度返流组（C组），④返流面积≥10.0 cm^2为重度返流组（D组）。用酶联免疫吸附法检测四组患者血清BNP及sST2蛋白水平，比较不同程度三尖瓣返流患者之间血清BNP及sST2蛋白水平的差异。结果C组血清BNP水平为（422.52±376.62）pg/mL，D组为（436.90±290.40）pg/mL，较A组（142.71±83.71）pg/mL明显升高，差异具有统计学意义（P〈0.01），但C、D组间差异无统计学意义（P〉0.05），B组为（210.62±181.83）pg/mL，与A组比较差异无统计学意义（P〉0.05）。C组血清sST2蛋白水平为（74.90±57.51）ng/L，A、B、D组分别为（35.25±23.33）、（48.76±32.83）、（56.87±34.46）ng/L，C组较A、B、D组明显升高，差异有统计学意义（P〈0.05），A、B、D三组组间差异无统计学意义（P〉0.05）。血清BNP水平与三尖瓣返流面积（r=0.54，P〈0.01）、左房径（r=0.28，P=0.01）、右房径（r=0.40，P〈0.01）、右室径（r=0.32，P〈0.01）呈正相关，血清sST2蛋白水平与三尖瓣返流面积（r=0.35，P〈0.01）、右房径（r=0.32，P〈0.01）呈正相关。结论继发性三尖瓣中重度返流患者血清BNP及sST2蛋白水平明显高于三尖瓣无或局限性返流患者，且二者水平三尖瓣返流面积、右房径、右室径具有显著相关性。

Objective To detect the serum levels of brain natriuretic peptide （BNP） and soluble ST2 （sST2） in the patients with tricuspid regurgitation secondary to rheumatic heart disease and estimate the correlation of the BNP and sST2 levels with the severity of secondary tricuspid regurgitation. Methods A total of 80 patients with rheumatic heart disease undergoing mitral valve replacement with or without tricuspid surgery in our center from March to May 2014 were enrolled in this study. They were 20 males and 60 males, at a median age of 50 （ranging from 18 o 73 years old）. Based on the regurgitation area measured by echocardiography, they were divided into 4 groups （n=20）, that is, local regurgitation group （regurgitation area 〈2.0 cm^2, group A）, mild regurgitation group （2.0 cm^2 ≤area〈5.0 cm^2, group B）, moderate regurgitation group （5.0 cm^2 area〈10.0 cm^2, group C）, and severe regurgitation group （area≥10.0 cm^2, group D）. The serum levels of BNP and sST2 were measured by ELISA, and the differences were compared among the 4 groups. Results Compared with group A （142.71±83.71 pg/mL）, the serum level of BNP was significantly increased in groups C and D （422.52±376.62 and 436.90±290.40 pg/mL, P〈0.01）, but no statistical difference was seen between the latter 2 groups （P〉0.05） and between group B （210.62±181.83 pg/mL） and group A. The serum level of sST2 was the highest in group C （74.90±57.51 ng/L） when compared with the other 3 groups （P〈0.05）, and was 35.25±23.33, 48.76±32.83 and 56.87±34.46 ng/L respectively in the groups A, B and D, without significant difference among them （P〉0.05）. Correlation analysis showed that the serum level of BNP had positive correlation with tricuspid regurgitation area （r=0.54,P〈0.01）, left atrium diameter （r=0.28, P〈0.01）, right atrium diameter （r=0.40,P〈0.01） and right ventricular diameter（r=0.32, P〈0.01）, meanwhile that of sST2 was positively correlated with tricuspid regurgitation （r=0.35, P〈0.01） and right atrium diameter were （r=0.32, P〈0.01）. Conclusion Serum BNP and sST2 levels are significantly higher in the patients with moderate and severe tricuspid regurgitation than those with local tricuspid regurgitation, and are positively correlated with the regurgitation area, right atrium diameter and right ventricular diameter.