Plasma N-terminal pro-brain natriuretic peptide levels in elderly patients with isolated diastolic dysfunction

Objective To investigate plasma N-terminal pro-brain natriuretic peptide (NT-BNP) levels and to assess their clinical significance in elderly patients with isolated diastolic dysfunction. Methods Plasma NT-BNP level were measured by electrochemiluminescence immunoassay in 34 symptomatic patients (Group 1), 34 asymptomatic patients (Group 2) with isolated diastolic dysfunction, and in 16 elderly healthy subjects (control group, Group 3), serving controls. Colored Doppler echocardiography was performed to evaluate the patients' cardiac structures and functions. Results The plasma NT-BNP level in Group 1 was significantly higher than those in Group 2 and Group 3 and increased with the severity of heart failure. There was no significant difference of plasma NT-BNP levels between Group 2 and Group 3 (p>0.05). A NT-BNP value of 102.75 pg/mL showed a sensitivity of 88.2%, a specificity of 87.5%, and an accuracy of 88.1% for diagnosing diastolic dysfunction. Patients with restrictive filling pattern on echocardiography had higher NT-BNP levels than those of impaired relaxation pattern (1961.2±304.9 versus 460.1±92.7pg/mL, p<0.001). Conclusion The elevation of plasma NT-BNP level in elderly patients with isolated diastolic dysfunction correlates with the severity of their diastolic abnormalities. The level of plasma NT-BNP has an important clinical value in the diagnosis of elderly patients with isolated diastolic dysfunction.

Prognostic Value of N-Terminal Pro-Brain Natriuretic Peptide in Acute Pulmonary Embolism

Patients with pulmonary embolism (PE) have a high risk of death and it is important to recognize factors associated with high mortality. N-Terminal pro-Brain Natriuretic Peptide (NT-pro BNP) has recently emerged as a promising biomarker for risk assessment in acute pulmonary embolism (PE). The aim of this study is to detect the in hospital prognostic value of NT-pro BNP in patients with acute (PE). Methods: This study included 64 patients diagnosed as (PE) with the mean age of 59.1 ± 16.5 years, 40 patients of them (62.5%) were male. All patients were subjected to 12 leads ECG. X-ray chest, laboratory tests including D-Dimer, troponin I, NT-pro BNP, Doppler ultrasound for the venous system of both lower limbs, Echocardiograhy and 64 multislices CT pulmonary angiography. Results: According to the admission level of NT-pro BNP our patients were divided into two groups: group I included 22 patients with normal NT-pro BNP (less than 300 pg/ml), and group II included 42 patients with elevated NT-pro BNP (more than or equal 300 pg/ml). Patients in group II were found to have a significantly higher incidence of heart failure (28.6% Vs 4.6%, p = 0.025), impaired kidney function (serum creatinine was 1.7 ± 0.6 Vs 1.1 ± 0.2, p = 0.018), tachypnea (85.7% Vs 54.5%, p = 0.006) and cardiogenic shock (26.2% Vs 0%, p = 0.014) but a significantly lower incidence of chest pain (21.4% Vs 45.5%, p = 0.04) and lower left ventricular ejection fraction (51.3% ± 16.9% Vs 67.3% ± 12.8%, p = 0.043) compared to group I. There were a significantly higher treatment with thrombolytic therapy (35.7% Vs 9.1%, p=0.021) and positive inotropics (35.71% Vs 4.55%, p = 0.006) in group II compared to group I. Also group II had a higher need for mechanical ventilation (26.12% Vs 4.55%, p = 0.04) and a longer in hospital stay (19.5 ± 10.3 Vs 5.3 ± 4.5, p = 0.001) than group I. The in hospital mortality was significantly higher in group II compared to group I (19.05% Vs 0.0%, p = 0.042). Conclusion: Elevated NT-pro BNP levels in patients with (PE) are associated with worse short term prognosis in terms of higher morbidity and mortality and it could be used as a valuable prognostic parameter and good indicator for the need of more aggressive therapy.

Effect of atorvastatin on serum oxidative stress and N-terminal brain natriuretic peptide expression in rats

Objective:To investigate the effect of atorvastatin on serum oxidative stress and N-terminal brain natriuretic peptide expression in rats.Methods:A total of 40 healthy male SD rats were randomly divided into the sham group(Croup A,n=10,saline 5 mL/d),ischemia-reperfusion group(Group B,n=10,saline S mL/d),atorvastatin group(Group C,n=10.atorvastatin 20 mg/kg·d),atorvastatin + N-amino-arginine group(Group D,n=10,atorvastatin 20 mg/kg·d + N-amino arginine 15 mg/kg).Myocardial ischemia-reperfusion rat model was eslablished after 3 days of gavage.N-amino arginine 15 mg/kg was given by tail vein injection 15 min before ischemia.After reperfusion,enzymology indicators such us creatine kinase(CK) and lactate dehydrogenase and the oxidative stress parameters such as nitric oxide(NO),malondialdehyde(MDA) and total superoxide dismutase(TSOD),and n-terminal pro-brain natriuretic peptide(NT-proBNP)expression was detected by immunohistochemistry.Results:LDH and CK levels of group A were significantly lower than the outer three groups,and group B was the highest.There was significant difference between group B and group C(P<0.05),and no significant difference between group B and group D(P>0.05).MDA levels in group B were significantly higher than the other three groups.The lowest was group A,followed by group C,the difference among groups was significantly(P<0.05).TSOD and NO levels in group B was the lowest,the level in group A was the highest,followed by group C,the difference among groups was significant(P<0.05).NT-proBNP level in group B was significantly higher than the other three groups,the lowest was group A,followed by group C,the difference among groups was significant(P<0.05).Conclusions:Atorvastatin has a protective effect on the myocardial injury in the myocardial ischemia and reperfusion rats.It can increase NO synthesis and decrease MDA content,increase serum TSOD activity and the oxidative stress effect,meanwhile protect myocardial cells and reduce myocardial injury.

Association of N-terminal pro-brain natriuretic peptide with the severity of coronary artery disease in patients with normal left ventricular ejection fraction

Backround N-terminal pro-brain natriuretic peptide （NT-proBNP） is a reliable predictor in acute coronary artery disease （CAD）. Little is known about patients with stable CAD, especially Chinese patients with CAD. The aim of the present study was to investigate the association of NT-proBNP levels with the severity of CAD in patients with normal left ventricular ejection fraction. Methods A total of 658 consecutive patients were divided into two groups based on angiograms： CAD group （n=484） and angiographic normal control group （n=174）. The severity of CAD was evaluated by modified Gensini score, and its relationship with NT-proBNP was analyzed. Results The prevalence of risk factors such as age, male gender, diabetes mellitus （DM）, dyslipidemia, smoking, and family history of CAD in the CAD group were higher than that in the control group. In multivariate regression model analysis, age, gender, and DM were determinants of the presence of CAD. NT-pro BNP was found to be an independent predictor for CAD （OR：1.66 （95% CI： 1.06-2.61）, P 〈0.05）. In a receiver operating characteristic （ROC）curve analysis, an NT-proBNP value of 641.15 pmol/L was identified as a cut-off value in the diagnosis or exclusion of CAD （area under curve （AUC）=0.56, 95% CI： 0.51-0.61）. Furthermore, NT-proBNP was positively correlated with Gensini score （r=0.14, P 〈0.001） in patients with CAD. Conclusion NT-proBNP was an independent predictor for Chinese patients with CAD, suggesting that the NT-proBNP level might be associated with the presence and the severity of CAD.

Predictive value of N-terminal pro-brain natriuretic peptide in combination with the sequential organ failure assessment score in sepsis

Background The prognostic power of n-terminal pro-brain natriuretic peptide （NT-proBNP） in sepsis is disputable and unstable among different models. We attempt to evaluate the prognostic potential of NT-proBNP in combination with the sequential organ failure assessment （SOFA） score in sepsis. Methods In this retrospective study, 100 consecutive sepsis patients were enrolled. Clinical data such as admission SOFA, the Acute Physiologic and Chronic Health Evaluation score, shock prevalence, use of lung protective ventilation, vasopressors, and glucocorticoids were recorded. Additionally, serum creatinine （Scrl and Scr3） and NT-proBNP （NT-proBNP1 and NT-proBNP3） were assayed and evaluated at admission and on day 3 respectively. Results ANT-proBNP （NT-proBNP3 minus NT-proBNP1） （P 〈0.001, Hazard ratio （HR）=1.245, 95% confidence interval （CI）, 1.137-1.362） and admission SOFA （P 〈0.001, HR=1.197, 95% CI, 1.106-1.295） were independently related to in-hospital mortality. Their combination was a more robust predictor for in-hospital mortality than either of them individually. Patients with high ANT-proBNP and SOFA had the poorest prognosis. Conclusions In our study, both ANT-proBNP and SOFA were independent predictors of septic patients＇ prognosis. Moreover, the combination of ,~NT-proBNP and admission SOFA provided a novel strategy that contained information regarding both the response to treatment and sepsis severity.

Association between plasma brain natriuretic peptide/N-terminal pro-brain natriuretic peptide levels and atrial fibrillation： evidence from a meta-analysis

Background Several small sample-size observational studies evaluated the association of plasma brain natriuretic peptide （BNP） or N-terminal pro-brain natriuretic peptide （NT-proBNP） with atrial fibrillation （AF）,but the results were contradictory.We aimed to perform a meta-analysis of relevant studies to evaluate the availability of this association.Methods We performed an extensive literature search on PubMed,Web of Science （WOS） and the Cochrane Library databases.Pooled standardized mean difference （SMD） and 95% confidence interval （CI） were calculated to assess the strength of association using random effects models.We performed sensitivity and subgroup analyses to explore the potential sources of heterogeneity.We also estimated publication biases.Statistical analyses were performed using the STATA 12.0 software.Results A total of 11 studies including 777 cases and 870 controls were finally analyzed.Overall,the brain natriuretic peptide/N-terminal pro-brain natriuretic peptide levels were higher in atrial fibrillation patients than controls without atrial fibrillation.Results showed that the SMD in the natriuretic peptide levels between cases and controls was 2.68 units （95%CI 1.76 to 3.60）; test for overall effect z-score=5.7 （P 〈0.001）.There was significant heterogeneity between individual studies （I2=97.8%; P 〈0.001）.Further analysis revealed that differences in the assay of natriuretic peptide possibly account for this heterogeneity.Conclusions Increased BNP/NT-proBNP levels were associated with the presence of atrial fibrillation.This finding indicates that BNP/NT-proBNP may prove to be a biomarker of an underlying predisposition to AF.

Association between high-sensitivity cardiac troponin T and N-terminal pro-brain natriuretic peptide in a community based population

Background N-terminal pro-B-type natriuretic peptide （NT-proBNP） and high-sensitivity cardiac troponin T （hs-cTnT） are excellent biomarkers for detecting heart failure and subclinical myocardial injury.However,it remains unclear whether subclinical myocardial injury is associated with NT-proBNP elevation in a community based population.Methods In a community based study,levels of hs-cTnT and of NT-proBNP were determined in 1 497 participants older than 45 years.The lower detection limit of the hs-cTnT assay used in the present study was 0.003 ng/ml.The association of hs-cTnT levels and NT-proBNP levels was analyzed.Results When the subjects with undetectable （〈0.003 ng/ml）,intermediate （0.003-0.014 ng/ml）,and elevated （≥0.014 ng/ml） levels of hs-cTnT were compared （r=0.175,P 〈0.001）,a strong association between the hs-cTnT levels and NT-proBNP levels was observed （β=-0.206,P 〈0.001; β=-0.118,P 〈0.001,respectively）.In multivariable analyses,older age and hs-cTnT were positively and independently associated with NT-proBNP levels （β=0.341,P 〈0.001; β=0.143,P 〈0.001,respectively）,and male gender and the levels of eGFR were inversely and independently associated with NT-proBNP levels.When the subjects with normal or elevated NT-proBNP were analyzed separately,the hs-cTnT level was not an independent predictor for the NT-proBNP level in the normal NT-proBNP group,whereas the hs-cTnT level was the only independent predictor for NT-proBNP level in the elevated NT-proBNP group （β=0.399,P 〈0.01）.Conclusions In this community based population,NT-proBNP elevation was common.In addition to female gender and older age,subclinical myocardial injury indicated by the hs-cTnT level was another important factor in NT-proBNP elevation.

Plasma N-terminal pro-Brain natriuretic peptide levels after hybrid therapy with pulmonary vein isolation and amiodarone for atrial fibrillation

Background The purpose of this study was to investigate the effect of hybrid therapy and the relationship between the plasma N-terminal pro-Brain natriuretic peptide （NT-pro BNP） levels and the recurrence rate of the atrial fibrillation （AF） patients underwent pulmonary vein isolation （PVI） with or without amiodarone. Methods There were two groups in this study： control group and hybrid group. In the control group, 54 patients （36 males, 54±13 years） including paroxysmal （PAF） 22, persistent （Pers-AF） 15, and permanent AF （perm-AF） 17, respectively, underwent the PVI procedure only; In the hybrid, 63 AF patients （41 males, 53±12 years） including PAF 24, Pers-AF 18, and perm-AF 21, respectively,underwent the PVI procedure and used amiodarone to enhance the effect of PVI. Blood samples were collected before and 3 months after PVI. NT-pro BNP concentrations were determined by immunoassays. Results In the control group, AF recurred in 29 patients （PAF 5 in 22, Pers-AF 11 in 15, and perm-AF 13 in 17） after the initial PVI procedure; And in the hybrid group, AF recurrred in 20 patiens （PAF 3 in 24, Pers-AF 7 in 18, and perm-Af 11 in 21 ）. The average recurrent rate decreased significantly in the hybrid group （53.7% vs 31.7%, P0.01）. While the NT pro- BNP level （pg/mL） was significantly different between the 2 groups （PAF 294.34±54.4 versus 241.69±17.6 pg/mL, P=0.047; Pers-AF 487.51±47.9 versus 248.76±19.4, P=0.001; Perm-AF 490.91±38.3 versus 300.86±31.8, P=0.032）, While the NT pro- BNP level was also much lower in hybird group than control group in total （263.43±26.1 versus 409.88±49.7, P=0.02）. Conclusions Sinus rhythm（SR）following AF ablation is associated with a dramatic decrease in NT-pro BNP. The hybrid group which had the administration of amiodarone after PVI would significantly decrease the plama NT pro-BNP levels and the recurrent rate of AF.

血清NT-pro-BNP、MMP-2水平与糖尿病合并急性脑梗死患者冠状动脉病变程度的关系

目的探讨血清N末端脑钠肽前体(NT-pro BNP)、基质金属蛋白酶-2(MMP-2)水平与糖尿病合并急性脑梗死(ACI)患者冠状动脉病变程度的关系。方法选择首都医科大学电力教学医院2021年1月—2022年12月收治的126例糖尿病合并ACI患者为观察组,其中单支病变62例,双支病变33例,三支病变31例,轻度狭窄37例,中度狭窄43例,重度狭窄46例。另将同期于我院体检的60例单纯糖尿病患者纳为对照组以及60例健康体检者设为正常组。比较三组心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶MB(CK-MB)、NT-pro BNP、MMP-2、I型胶原交联羧基末端肽(ICTP)水平;以ROC分析NT-pro BNP、MMP-2诊断糖尿病患者并发ACI的价值;比较不同冠状动脉病变支数及不同冠状动脉狭窄程度患者NT-pro BNP、MMP-2、ICTP水平;以Spearman秩相关分析NT-pro BNP、MMP-2、ICTP水平与冠状动脉病变支数、冠状动脉狭窄程度之间的相关性。结果观察组cTnI、CK-MB、NT-pro BNP、MMP-2、ICTP水平显著高于对照组(P<0.05),对照组cTnI、CK-MB、NT-pro BNP、MMP-2、ICTP水平显著高于正常组(P<0.05)。ROC结果显示,NT-pro BNP、MMP-2诊断糖尿病患者并发ACI训练集的曲线下面积为0.953、0.872,测试集的曲线下面积为0.902、0.842(P均<0.05)。NT-pro BNP、MMP-2、ICTP水平随着冠状动脉病变支数的增加及冠状动脉狭窄程度的加重而上升(P<0.05)。NT-proBNP、MMP-2、ICTP水平与糖尿病合并ACI患者冠状动脉病变支数、冠状动脉狭窄程度呈正相关(均有P<0.05)。结论NT-pro BNP、MMP-2、ICTP水平与糖尿病合并ACI患者冠状动脉病变支数、冠状动脉狭窄程度呈正相关,临床关注以上指标可对糖尿病合并ACI患者冠状动脉病变程度进行评估。

脓毒症患者血浆PCT、NT-pro-BNP与cTnT水平检测的临床意义

目的探讨脓毒症患者血浆降钙素原(PCT)、氨基末端脑钠肽前体(NT-pro-BNP)与肌钙蛋白T(cTnT)水平是否存在相关,以及对患者预后的意义。方法选取2014年9月—2015年3月某院重症监护病房(ICU)收治的48例脓毒症患者,按严重程度分成重度和轻度两组,检测患者血浆中PCT、NT-pro-BNP及cTnT水平,并统计患者的死亡结局情况,比较分析两组患者血浆PCT、NT-pro-BNP、cTnT水平与其死亡情况的关系。结果重度脓毒症组患者血浆中PCT、NT-pro-BNP、cTnT水平均高于轻度脓毒症组患者,差异具有统计学意义(均P<0.05);轻度脓毒症患者病死率为10.53%,低于重度脓毒症患者(41.38%),差异有统计学意义(P<0.05);死亡组患者的PCT、NT-pro-BNP与cTnT水平均高于存活组(均P<0.05);相关分析发现脓毒症患者血浆中PCT与NT-pro-BNP呈正相关(rs=0.337,P<0.05),NT-pro-BNP与cTnT之间也呈正相关(rs=0.456,P=0.001),而PCT与cTnT无显著相关。预后分析发现脓毒症患者血浆中PCT、NT-pro-BNP、cTnT水平均与患者预后相关(P<0.05),并且对患者的预后均有较好的判别作用,与独立指标相比,当三个指标组合时对预后判别能力更好。结论联合检测脓毒症患者血浆PCT、NP-pro-BNP与cTnT水平可评估脓毒症患者感染的严重程度,并初步判断脓毒症患者的预后。

血清NT-pro-BNP和MMP-9水平变化评价慢性心力衰竭患者心脏再同步化治疗疗效的可行性研究

目的探讨心脏再同步化治疗(CRT)前后心力衰竭患者血清N端脑钠肽(NT-pro-BNP)、基质金属蛋白酶9(MMP-9)水平变化评价CRT疗效的可行性。方法 21例慢性心力衰竭患者行CRT(CRT组),另21例慢性心力衰竭患者因经济等原因未接受CRT(对照组)。两组基础用药相似。观察并比较两组患者治疗前与治疗后1、3、6个月的NYHA心功能分级、心电图QRS宽度、LVEDD、LVEF、血清NT-pro-BNP及MMP-9的水平(采用ELISA法)。结果 CRT组治疗前血清NT-pro-BNP和MMP-9水平分别为(912.5±194.2)pmol/L、(682.9±282.1)ng/L,CRT 1、3、6个月血清NT-pro-BNP水平分别为(379.8±200.5)、(284.7±151.6)、(185.4±82.0)pmol/L,MMP-9水平分别为(543.5±208.3)、(401.1±144.8)、(383.0±198.4)ng/L;而对照组治疗1、3、6个月血清NT-pro-BNP水平分别为(614.1±234.6)、(572.1±165.6)、(553.6±130.1)pmol/L。MMP-9水平分别为(665.6±227.8)、(641.2±268.6)、(573.7±1 35.9)ng/L。CRT组术后血清NT-pro-BNP和MMP-9水平显著低于术前及对照组(均P<0.05)。结论慢性心力衰竭患者CRT后血清中NT-pro-BNP和MMP-9水平显著下降,心功能得到改善,血清MMP-9和NT-pro-BNP可以作为评价CRT疗效的生化指标。

左室收缩功能正常的心房颤动患者血清NT-pro-BNP水平的变化及影响因素探讨

目的:观察左室收缩功能正常的心房颤动(房颤)患者氨基末端-脑钠肽前体(NT-pro-BNP)的变化并探讨其影响因素。方法:对116例左室射血分数正常(LVEF>50％)患者测定血清NT-pro-BNP水平,行经胸超声心动图检查,并调查人口学特征、心血管病主要危险因素情况、合并症、用药情况、血生化学检查。除外既往心功能不全、肝肾功能不全、甲状腺疾病或肿瘤病史患者。结果:持续性房颤血清NT-pro-BNP水平的中位值显著升高(1018．0ng／L比137．9 ng／L,P<0．001),多因素分析发现房颤类型(P<0．0001)、年龄(P=0．0004)、LAD(P<0．0001)是影响NT-pro-BNP的因素,而性别、体重指数、LVEF,房颤的病程和伴随疾病与NT-pro-BNP水平无关。结论:房颤类型,患者年龄和左房内径是房颤患者NT-proBNP升高的独立预测因素。

脓毒症患者血NT-pro-BNP水平与APACHEⅡ评分相关性研究

目的探讨脓毒症患者血N端前体脑钠肽(NT-pro-BNP)及APACHEⅡ评分的相关性。方法选取本院连续收治的80例脓毒症患者作为研究对象,在24 h内进行APACHEⅡ评分,并测定血浆NT-pro-BNP水平,比较不同APACHEⅡ评分分值组血NT-pro-BNP水平。结果 C组血NT-pro-BNP水平明显高于B组,差异有统计学意义(P<0.05);D组血NT-pro-BNP水平明显高于C组,差异有统计学意义(P<0.01);血NT-pro-BNP水平与APACHEⅡ评分显著相关(r=0.682,P<0.01);死亡组血NT-pro-BNP水平及APACHEⅡ评分明显高于存活组(P<0.05)。结论随着APACHEⅡ评分增高,血NT-pro-BNP水平也相应增高;血NT-pro-BNP水平与APACHEⅡ评分呈正相关,是脓毒症患者预后临床评价的较好指标。

脓毒性休克患者血清C-反应蛋白、降钙素原和NT-pro-BNP水平及预后意义

目的脓毒性休克患者血清C-反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)和血清氨基末端脑钠肽前体(N-terminal-pro BNP,NT-pro-BNP)水平及预后意义。方法选取2010年1月—2016年5月西安市中心医院收治的80例脓毒症患者及同期40例体检正常者作为研究对象,采用系统性回顾法分析其临床及随访资料,80例脓毒症患者分为脓毒症未休克组(A组)48例和脓毒性休克组(B组)32例,根据脓毒性休克组中是否死亡分为脓毒性休克非死亡组(C组)20例和脓毒性休克死亡组(D组)12例,将40例正常者作为对照组。记录所有纳入研究者的一般临床资料,并比较不同患者间CRP、PCT、NT-pro-BNP、白介素-6(interleukin-6,IL-6)和肿瘤坏死因子α(tumor necrosis factor,TNF-α)水平及其之间的相关性,通过非条件单因素及多因素Logistic回归模型分析上述指标对脓毒性休克患者预后的影响。结果脓毒症患者其CRP、PCT、NT-pro-BNP、IL-6和TNF-α水平均明显高于对照组,且脓毒性休克患者较脓毒症未休克者高,脓毒性休克死亡患者更明显高于脓毒性休克非死亡者,差异间均具有统计学意义(P<0.05);通过非条件单因素Logistic回归模型分析可得,菌血症(感染部位为血液)、APACHEⅡ评分及CRP、PCT、NT-pro-BNP、IL-6和TNF-α的表达水平可能为影响脓毒性休克患者预后的主要因素(P<0.05);通过Spearman等级相关分析可得,APACHEⅡ评分与CRP、PCT、NT-pro-BNP、IL-6及TNF-α之间呈正相关(P<0.05),CRP、PCT、NT-pro-BNP、IL-6及TNF-α之间均呈正相关(P<0.05);通过非条件多因素Logistic回归模型分析可得,CRP、PCT和NT-pro-BNP为影响脓毒性休克患者预后的独立危险因素(P<0.05)结论脓毒性休克患者CRP、PCT和NT-pro-BNP水平较正常者显著升高,为影响脓毒性休克患者预后的独立危险因素,随着他们水平的升高,脓毒性休克患者其预后越差,可作为临床上评估脓毒症病情严重程度及脓毒性休克患者预后的指标。

CRT前后血清MMP-2、9和NT-pro-BNP水平及意义

回顾性分析我院行心脏再同步化治疗(CRT)前后心力衰竭患者血清N端脑钠肽(NT-pro-BNP)、基质金属蛋白酶2、9(MMP-2、9)水平变化对评价CRT疗效的可行性。采用酶联免疫法(ELISA)检测血清MMP-2、9和NT-pro-BNP水平。结果表明,CRT组术后3、6个月血清MMP-2、9和NT-pro-BNP水平显著低于术前及对照组(P<0.05)。血清MMP-2、9和NT-pro-BNP可以作为评价CRT疗效的生化指标。

脓毒血症患儿血浆NT-pro-BNP、PCT的变化及临床意义

目的观察脓毒血症患儿血浆氨基末端脑钠肽前体（NT-pro-BNP）和血清降钙素原（PCT）水平的变化及其临床意义。方法选择2012年4月至2014年4月本院儿科重症监护病房的41例脓毒血症患儿作为研究对象，检测其在发病第1天、第3天和转出儿科重症监护病房当天的血浆NT-pro-BNP水平和血清PCT水平，记录当天的急性生理和慢性健康状况-Ⅱ（APACHE-Ⅱ）评分，随访上述患儿的生存状况，并据此将患儿分为存活组29例和死亡组12例。结果发生脓毒血症第1天，两组的APACHE-Ⅱ评分、血浆NT-pro-BNP血清、PCT水平无明显差异（P〉0．05）；发生脓毒血症第3天，死亡组患儿和生存组相比，血浆NT-pro-BNP水平和APACHE-Ⅱ评分均明显增高（P〈0．05），而血清PCT水平无明显差异（P〉0．05）；转出重症监护室当天，死亡组患儿和生存组相比，死亡组患儿的血浆NT-pro-BNP水平、血清PCT和APACHE-II评分均明显增高（P〈0．05）。结论脓毒血症患儿随着病情的进展，血浆NT-pro-BNP水平和血清PCT水平都明显增高，血浆NT-pro-BNP比血清PCT更灵敏反映脓毒血症病情的变化，故根据两者水平的变化可以及早对患儿采取治疗。

老年慢性心力衰竭合并R波递增不良患者心功能、NT-pro-BNP水平及预后研究

目的分析老年慢性心力衰竭(CHF)合并R波递增不良(PRWP)患者心功能、血清氨基末端B型脑钠肽前体(NT-pro-BNP)水平及预后情况,为患者的恢复提供临床指导。方法回顾性分析2018年4月至2020年4月江门市新会人民医院收治的100例老年CHF患者的诊疗情况,根据其是否合并PRWP进行分组,其中50例CHF合并PRWP患者为观察组,50例单纯CHF患者为对照组。记录两组患者入院时的心力衰竭分布类型、纽约心脏病学会(NYHA)心功能分级情况以及入院后6 min步行试验分级与距离情况、心脏彩超结果、NT-proBNP水平和终点事件发生情况,采用多因素Logistic回归分析法分析其预后影响因素。结果观察组患者中射血分数降低型心力衰竭(HFrEF)28例,射血分数中间范围型心力衰竭(HFmrEF)12例,射血分数保留型心力衰竭(HFpEF)10例,对照组则分别为16例、15例、19例,两组患者心力衰竭类型分布比较差异有统计学意义(P<0.05);观察组患者的NYHA心功能分级为(3.5±0.5)级,明显高于对照组的(2.8±0.3)级,差异有统计学意义(P<0.05);观察组的6 min步行试验距离为(315.4±76.3)m,明显短于对照组的(351.7±81.2)m,差异有统计学意义(P<0.05);两组患者左心室收缩末期内径(LVESd)、左室舒张功能早晚期充盈的充盈值之比(E/A)、心脏彩超指标值比较,差异均无统计学意义(P>0.05);观察组患者的LVEF水平为(35.8±6.3)%,明显低于对照组的(42.6±7.1)%,LVEDd和NT-proBNP水平分别为(61.4±7.6)mm、(5105.3±2065.7)ng/L,明显高于对照组的(57.3±6.2)mm、(4321.7±1874.8)ng/L,差异均有统计学意义(P<0.05);观察组患者的终点事件总发生率为46.0%,明显高于对照组的22.0%,差异有统计学意义(P<0.05);Logistic回归分析结果显示,PRWP、NT-proBNP、NYHA分级均是老年慢性心力衰竭患者预后不良的独立影响因素(P<0.05),而6 min步行试验距离增加是患者预后不良的保护性因素。结论老年慢性心力衰竭合并R波递增不良患者的NYHA心功能分级和NT-pro-BNP水平偏高,老年CHF合并PRWP通常与心功能不全、左心室扩大、预后不良等因素有关。

超声心动图联合SPECT心肌灌注显像及NT-pro-BNP检测评价胸部放射治疗致心脏损伤的研究

目的:探讨多普勒超声心动图联合单光子发射计算机断层扫描(SPECT)心肌灌注显像及氨基末端脑钠肽前体(NTpro-BNP)检测在胸部放射治疗致心脏损伤评价中的应用。方法:选取医院收治的96例胸部肿瘤患者,均采用放射治疗,并于放射治疗前后采用多普勒超声心动图、SPECT心肌灌注显像、心电图等方法检测患者左心室射血分数(LVEF)、左心室短轴缩短率(FS)等常规心脏超声指标;左房室瓣舒张早期最大峰值速度(E峰)、舒张晚期最大峰值速度(A峰)等脉冲式多普勒超声检测指标,计算E峰与A峰比值(E/A);舒张早期左房室瓣环运动速度(Ea峰)、舒张晚期左房室瓣环运动速度(Aa峰)等经组织多普勒超声检测指标,计算Ea峰与Aa峰比值(Ea/Aa),并检测患者血清NT-pro-BNP水平,比较不同检查方法心脏损伤的检出率。结果:所有患者放射治疗后LVEF、FS、E峰、E/A、Ea峰、Ea/Aa等超声心动图指标明显低于放射治疗前(t=9.079,t=5.713,t=3.106,t=7.733,t=8.062,t=7.665;P<0.05),EDV、ESV等SPECT心肌灌注显像指标明显高于放射治疗前,LVEF指标明显低于放射治疗前(t=2.026,t=2.553,t=2.838;P<0.05),血清NT-pro-BNP水平与放射治疗前比较明显升高(t=11.639,P<0.05)。放射治疗后超声心动图联合SPECT心肌灌注检出率为46.88%,明显高于超声心动图、SPECT心肌灌注单项检测(x^(2)=5.629,x^(2)=4.269;P<0.05),而心电图、超声心动图及SPECT心肌灌注联合检出率为48.96%,明显高于超声心动图、SPECT心肌灌注及NT-pro-BNP单项检测(x^(2)=7.056,x^(2)=5.528,x^(2)=14.139;P<0.05)。结论:多普勒超声心动图和SPECT心肌灌注显像均能有效的检出放射治疗后心脏损伤,两者联合后能提高心脏损伤的检出率,NT-pro-BNP虽也能在一定程度检出心脏损伤,但对于提升检出率价值不高。

H-FABP、NT-proBNP与急性心力衰竭患者容量负荷状态及预后的相关性

目的 研究心型脂肪酸结合蛋白(H-FABP)、氨基端脑钠肽前体(NT-proBNP)对急性心力衰竭患者容量负荷状态及预后的评估。方法 本研究为前瞻性研究,以2021年1月至2022年1月于安阳市人民医院急诊住院的老年急性心力衰竭患者83例作为研究组,另选取83例健康者作为对照组。根据相对容量平衡水平,将以上83例患者分为容量超负荷组和非容量超负荷组,对所有出院患者随访3个月,将发生死亡的患者归为死亡组,其余为生存组。比较研究组与对照组不同容量负荷、不同预后的H-FABP、NT-proBNP水平之间的差异,研究H-FABP、NT-proBNP与生存状况以及容量负荷状态的相关性。结果 研究组患者的H-FABP、NT-proBNP水平高于对照组(P<0.001);容量超负荷组患者的H-FABP、NT-proBNP水平高于非容量超负荷组(P<0.05);死亡组患者的H-FABP、NT-proBNP水平高于生存组(P<0.05)。通过相关性分析,患者的死亡以及容量超负荷与H-FABP、NT-proBNP呈现正相关(P<0.001)。结论 H-FABP、NT-proBNP与急性心力衰竭患者容量负荷状态及预后呈现相关性,有助于评估急性心力衰竭的严重程度,对预后不良患者起到积极的指导治疗作用。

Early monitoring of pro-brain natriuretic peptide and its diagnostic value in burn victims

Background Myocardial impairment is often precipitated after burn. Previously, cardiac enzyme profile was often measured to determine myocardial injury, but was hardly specific. In this study, we investigated early changes of plasma N-terminal pro-brain natriuretic peptide （NT-proBNP） over time and its diagnostic value in burn patients. Methods 131 patients with heat burn were assigned to mild group （n = 19）, moderate group （n = 31）, severe group （n = 35） and extremely severe group （n = 35） based on their conditions. NT-proBNP and troponin I （cTnI） were continuously measured on days 1, 3, 5 and 7, respectively after admission. Results Significant differences were found on day 3, 5 and 7 between moderate burn group and mild burn group （P 0.05）; increase appeared earlier and lasted longer in severe group and extremely severe group as compared to mild and moderate groups （P 0.05）. Conclusions NT-proBNP is related to the severity of burn and can well reflect the status of myocardial injury in patients with severe burn, making it an ideal marker for myocardial injury in burn patients.