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

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 16elderly 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 NTBNP 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.

Association of Atrial Fibrillation and Amino-terminal Pro-brain Natriuretic Peptide Concentrations in Patients After Off-Pump Coronary Artery Bypass Grafting

Objectives To investigate the possible role of amino-terminal pro-brain natriuretic peptide （NT-proBNP） in the occurrence of atrial fibrillation （AF） after coronary artery bypass grafting （CABG）. Methods This study group included 70 consecutive patients scheduled for elective off-pump CABG. The patients with ejection fraction （EF） less than 0. 30, history of AF, use of class Ⅰ or Ⅲ antiarrhythmic drug, implanted pacemaker, postoperative myocardial infarction or chest reopening for pericardial tamponade were excluded. Preoperative and postoperative serum NT-proBNP levels were measured by radioimmunoassay technique. Results Postoperative AF occurred in 15 patients （21.4%）; these patients had significantly higher median NT-proBNP levels when compared with those without AF after the operation （ P 〈 0. 01 ）. Using multivariate logistic regression analyses, an increase in NT-proBNP level after CABG was found to be independently associated with AF （ OR = 3.78, 95% IC = 1.81 - 4. 89, P 〈 0. 01 ）. Increased age, diabetes mellitus, preoperative use of β-blocker, proximal right coronary artery involvement, and longer operation time were al- so associated with AF. Conclusions These results indicated that AF was associated with higher NT-proBNP concentrations after off pump CABG; the increase in NT-proBNP after CABG may play an important role in the occurrence of AF after the operation. The further studies are needed to define the reason that lead to higher NT-proBNP concentrations among the patients who present AF after off pump CABG.

Effect of milrinone on the cardiac function and N-terminal pro-brain natriuretic peptide levels in patients with senile refractory heart failure

Objective:To study the effect of milrinone on the cardiac function and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in patients with senile refractory heart failure. Methods:90 patients with senile refractory heart failure who were treated in our hospital between August 2013 and August 2016 were collected and divided into control group (n=45) and observation group (n=45) according to the random number table. The control group received regular clinical treatment, and the observation group received regular + milrinone treatment. The cardiac function and serum NT-proBN contents were compared between two groups of patients before and after treatment.Results: Before treatment, the differences in ultrasound and serum cardiac function indexes and serum NT-proBN levels were not statistically significant between two groups of patients. After treatment, ultrasound serum cardiac function parameter LVEDD level in observation group was lower than that in control group while CI and SV levels were higher than those in control group;serum cardiac function indexes Cys-C, GDF-15, sST2 and H-FABP contents were lower than those in control group;serum NT-proBNP content was lower than that in control group.Conclusion: Milrinone therapy can optimize the cardiac function and reduce the serum NT-proBN levels in patients with senile refractory heart failure.

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.

Value of Combining Left Atrial Diameter and Amino-terminal Pro-brain Natriuretic Peptide to the CHA2DS2-VASc Score for Predicting Stroke and Death in Patients with Sick Sinus Syndrome after Pacemaker Implantation

Background： The CHA2DS2-VASc score is used clinically for stroke risk stratification in patients with atrial fibrillation （AF）. We sought to investigate whether the CHA2DS2-VASc score predicts stroke and death in Chinese patients with sick sinus syndrome （SSS） after pacemaker implantation and to evaluate whether the predictive power of the CHA2DS2-VASc score could be improved by combining it with left atrial diameter （LAD） and amino-terminal pro-brain natriuretic peptide （NT-proBNP）. Methods： A total of 481 consecutive patients with SSS who underwent pacemaker implantation from January 2004 to December 2014 in our department were included. The CHA2DS2-VASc scores were retrospectively calculated according to the hospital medical records before pacemaker implantation. The outcome data （stroke and death） were collected by pacemaker follow-up visits and telephonic follow-up until December 3 l, 2015. Results： During 2151 person-years of follow-up, 46 patients （9.6%） suffered stroke and 52 （10.8%） died. The CHA2DS2-VASc score showed a significant association with the development of stroke （hazard ratio [HR] 1.45, 95% confidence interval [CI] 1.20-1.75, P 〈 0.00 1） and death （HR 1.45, 95% CI 1.22-1.71, P 〈 0.001）. The combination of increased LAD and the CHA2DS2-VASc score improved the predictive power for stroke （C-stat 0.69, 95% CI 0.61-4）.77 vs. C-stat 0.66, 95% CI 0.57-0.74, P = 0.013）, and the combination of increased NT-proBNP and the CHA2DS2-VASc score improved the predictive power for death （C-stat 0.70, 95% CI 0.64-0.77 vs. C-stat 0.67, 95% CI 0.60--0.75, P= 0.023）. Conclusions： CHA2DS2-VASc score is valuable for predicting stroke and death risk in patients with SSS after pacemaker implantation. The addition of LAD and NT-proBNP to the CHA2DS2-VASc score improved its predictive power for stroke and death, respectively, in this patient cohort. Future prospective studies are warranted to validate the benefit of adding LAD and NT-proBNP to the CHA2DS2-VASc score for predicting stroke and death risk in non-AF populations.

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.

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.

生脉饮加味联合西药治疗慢性心力衰竭气阴两虚证临床研究

目的:观察生脉饮加味联合西药治疗慢性心力衰竭气阴两虚证的临床疗效。方法:选取76例慢性心力衰竭气阴两虚证患者,按照随机数字表法分为生脉饮组和对照组,每组38例。对照组给予西药治疗,观察组在对照组基础上给予生脉饮加味治疗。2组均治疗4周。比较2组临床疗效、症状评分、心功能指标[左室射血分数(LVEF)、每搏输出量(SV)]、血清N末端B型利钠肽前体(NT-proBNP)水平、6 min步行试验(6MWT)距离及明尼苏达心衰生活质量调查表(MDCAT)评分,记录不良反应。结果:治疗后,生脉饮组总有效率94.74%,高于对照组78.95%,差异有统计学意义(P<0.05)。2组症状、MDCAT评分均较治疗前降低,LVEF、SV均较治疗前升高,血清NT-proBNP水平均较治疗前降低,6MWT距离均较治疗前增加,差异均有统计学意义(P<0.05);生脉饮组症状、MDCAT评分均低于对照组,LVEF、SV均高于对照组,血清NT-proBNP水平低于对照组,6MWT距离大于对照组,差异均有统计学意义(P<0.05)。2组均未发生药物相关不良反应。结论:生脉饮加味联合西药治疗慢性心力衰竭气阴两虚证,可有效改善患者的临床症状,有助于提升其心功能及生活质量。

Cardiac function evaluated by Tei index of tissue doppler imaging and brain natriuretic peptide in patients with acute coronary syndrome and hyperglycemia

Background Recent studies demonstrated that N-terminal pro-brain natriuretic peptide（NT-pro BNP） increases in patients with diabetes mellitus and raised concerns about the diagnostic validity of NT-pro BNP in assessment of cardiac function in patients with hyperglycemia.Current investigation was carried out to observe the influence of hyperglycemia on the correlation of NT-pro BNP and cardiac function index in patients with acute coronary syndrome（ACS）.Methods Fifty patients with ACS were enrolled and divided into hyperglycemia group（fasting plasma glucose（FPG） ≥ 6.1 mmol/L） and euglycemia group（FPG 〈 6.1 mmol/L）.All the patients underwent routine transthoracic ecocardiagraphy and tissue Doppler imaging（TDI） investigation.Blood sample were obtained with 24 hours of hospitalization for measuring of NT-proBNP level.Relation between TDI-Tei index and the level of NT-proBNP were analyzed in the two groups respectively.Result TDI-Tei index,systolic index and diastolic index were all significantly higher in hyperglycemia group than that in euglycemia group（0.679 ± 0.139 vs 0.600 ± 0.093,P = 0.022;0.294 ± 0.074 vs 0.258 ± 0.035,P = 0.036;0.385 ± 0.069 vs 0.342 ± 0.068,P = 0.032）.TDI-Tei index was significantly negatively correlated with the level of log NT-pro BNP in both hyperglycemia group and euglycemia group（rp = 0.673,P = 0.000;rp = 0.354,P = 0.000）.Conclusions（1）Cardiac function in patients with ACS complicated with hyperglycemia is inferior to that in patients with euglycemia;（2）Assessment of cardiac function with NT-proBNP is reliable in patients with hyperglycemia.

Value of red blood cell distribution width in prediction of diastolic dysfunction in cirrhotic cardiomyopathy

BACKGROUND Clinical diagnosis of cirrhotic cardiomyopathy(CCM) often encounters challenges of lack of timeliness and disease severity, with the commonly positive indicator usually associated with advanced heart failure.AIM To explore suitable biomarkers for early CCM prediction.METHODS A total of 505 eligible patients were enrolled in this study and divided into four groups according to Child-Pugh classification: Group Ⅰ, Class A without CCM(105 cases);Group Ⅱ, Class A with CCM(175 cases);Group Ⅲ, Class B with CCM(139 cases);and Group Ⅳ, Class C with CCM(86 cases). Logistic regression and receiver operating characteristic(ROC) curve analyses were performed to determine whether red blood cell distribution width(RDW) was an independent risk factor for CCM risk. The relationships between RDW and Child-Pugh scores, Model for End-Stage Liver Disease(MELD) scores, and N-terminal pro-brain natriuretic peptide(NT-proBNP) were analyzed by Pearson correlation analysis.RESULTS A constant RDW increase was evident from Group Ⅰ to Group Ⅳ(12.54 ± 0.85, 13.29 ± 1.19, 14.30 ± 1.96, and 16.25 ± 2.13, respectively). Pearson correlation analysis showed that RDW was positively correlated with Child-Pugh scores(r = 0.642, P < 0.001), MELD scores(r = 0.592, P < 0.001), and NT-proBNP(r = 0.715, P < 0.001). Furthermore, between Group Ⅰ and Group Ⅱ, RDW was the only significant index(odds ratio: 2.175, 95% confidence interval [CI]: 1.549-3.054, P < 0.001), and it reached statistical significance when examined by ROC curve analysis(area under the curve: 0.686, 95%CI: 0.624-0.748, P < 0.001).CONCLUSION RDW can serve as an effective and accessible clinical indicator for the prediction of diastolic dysfunction in CCM, in which a numerical value of more than 13.05% may indicate an increasing CCM risk.

左西孟旦联合重组人脑利钠肽用于难治性心力衰竭患者治疗心功能、炎症反应及血清NT-proBNP改善价值研究

目的研究探讨左西孟旦联合注射用重组人脑利钠肽对难治性心力衰竭患者心功能、炎症反应及血清N末端B型脑钠肽前体(NT-proBNP)改善价值。方法选取2019年9月~2021年9月海南医学院第二附属医院收治的难治性心力衰竭患者82例,随机数表法分为观察组和对照组,各41例。对照组以注射用重组人脑利钠肽治疗,观察组增加左西孟旦治疗。综合评估两组患者的临床疗效、心功能指标、炎症因子水平、NT-proBNP等心肌损伤指标、不良反应发生率。结果观察组总有效率为90.24%(37∕41),高于对照组总有效率70.73%(29∕41),差异有统计学意义(P<0.05)。观察组心功能指标包括左室射血分数(LVEF)、每搏输出量(SV)、心脏指数(CI)水平均高于对照组,差异有统计学意义(P<0.05)。治疗后观察组患者的血管性血友病因子(vWF)、硫氧还蛋白互作蛋白(TXNIP)、血管内皮素-1(ET-1)水平均低于对照组,差异有统计学意义(P<0.05)。治疗后观察组心肌损伤指标包括NT-proBNP、心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)水平均低于对照组,差异有统计学意义(P<0.05)。治疗期间观察组、对照组不良反应发生率分别为12.20%(5∕41)、7.32%(3∕41),差异无统计学意义(P>0.05)。结论左西孟旦联合注射用重组人脑利钠肽用于难治性心力衰竭患者效果良好,能够改善患者的心功能和心肌损伤指标,降低机体炎症反应状态,不良反应较轻,可临床应用。

脑钠素和N-心钠素在无症状性心力衰竭中的诊断价值

目的：评价脑钠素（ＢＮＰ）和Ｎ心钠素（ＮＡＮＰ）对无症状性心力衰竭的诊断价值。方法：通过放射性核素门控心血池显像，筛选无症状性心力衰竭患者３２例，心力衰竭患者３２例，并选取心功能正常的健康人２０例作为对照组；采用放射免疫法测定３组血浆ＢＮＰ和ＮＡＮＰ水平。结果：无症状性心力衰竭组血浆ＢＮＰ〔（９８．７２±４８．９６）ｎｇ／Ｌ〕和ＮＡＮＰ〔（１３８２．２５±５４９．５１）ｎｇ／Ｌ〕水平显著高于对照组〔分别为（３９．０６±１８．２０）ｎｇ／Ｌ和（４２２．０６±２５５．３８）ｎｇ／Ｌ，Ｐ＜０．０５和Ｐ＜０．００１〕，却显著低于心力衰竭组〔分别为（１５０．９０±８３．６６）ｎｇ／Ｌ和（４０２０．４３±２０９０．９５）ｎｇ／Ｌ，Ｐ＜０．０５和Ｐ＜０．００１〕；血浆ＢＮＰ＞７５．００ｎｇ／Ｌ（对照组的ｘ＋１．９６ｓ）时，诊断无症状性心力衰竭，敏感性为９１％，特异性为９４％；血浆ＮＡＮＰ＞９２３．００ｎｇ／Ｌ（对照组的ｘ＋１．９６ｓ），诊断无症状性心力衰竭，敏感性为７５％，特异性为９４％。结论：ＢＮＰ和ＮＡＮＰ可用来诊断无症状性心力衰竭；且以ＢＮＰ＞７５．００ｎｇ／Ｌ同时ＮＡＮＰ＞９２３．００ｎｇ／Ｌ作为诊断无症状性心力?

经皮二尖瓣球囊成形术对N-心钠素分泌的影响

目的：探讨经皮二尖瓣球囊成形术（ＰＢＭＶ）对Ｎ心钠素（ＮＡＮＰ）分泌的影响。方法：研究了２４例二尖瓣狭窄（ＭＳ）患者ＰＢＭＶ前后血浆ＮＡＮＰ浓度，并与平均二尖瓣跨瓣压差（ＭＭＰＧ）、二尖瓣口面积（ＭＶＡ）、左房内径（ＬＡＤ）及血流动力学参数作相关分析。结果：ＭＳ患者术前血浆ＮＡＮＰ浓度高于对照组（Ｐ＜０．００１），术后显著下降（与术前比较，Ｐ＜０．００１），但仍高于对照组（Ｐ＜０．００１）。血浆ＮＡＮＰ改变量（ΔＮＡＮＰ）与ＭＭＰＧ改变量（ΔＭＭＰＧ，ｒ＝０．６７７０，Ｐ＜０．０００５）、ＬＡＤ的改变量（ΔＬＡＤ，ｒ＝０．４７０４，Ｐ＜０．０２５０）及平均左房压改变量（ΔＭＬＡＰ，ｒ＝０．７２７２，Ｐ＜０．０００５）均呈正相关，与ＭＶＡ的改变量（ΔＭＶＡ）呈负相关（ｒ＝－０．６４５１，Ｐ＜０．０００５）。结论：ＮＡＮＰ在ＭＳ引起的病理生理改变中起重要作用，测定ＮＡＮＰ变化有可能作为判定ＭＳ狭窄程度及ＰＢＭＶ疗效的一个指标。

失血性休克患者N端脑钠肽前体、血清胱抑素水平及其对早期凝血功能变化影响研究

目的探讨创伤失血性休克患者N端脑钠肽前体(NT-pro BNP)、血清胱抑素(CysC)水平及其对早期凝血功能变化的影响。方法选取自2014年10月至2016年12月我院收治的创伤失血性休克患者105例为研究对象,根据患者的严重程度分为轻中度组(n=61)和重度组(n=44),同期选择60例行体检健康者作为健康组。分别检测并比较各组研究对象的血浆NT-proBNP和血清CysC水平及早期凝血功能指标,同时采用Pearson相关性分析NT-proBNP、CysC与早期凝血功能指标的相关性。结果轻中度组、重度组患者的凝血酶原时间(PT)、血浆凝血酶(TT)、活化的部分凝血活酶时间(APTT)、血浆NTproBNP和血清CysC水平均明显高于健康组,维维蛋白原(FIB)明显低于健康组;重度组患者的PT、TT、APTT、血浆NT-proBNP和血清CysC水平均明显高于轻中度组,FIB明显低于轻中度组;组间比较,差异均有统计学意义(P<0.05)。NT-proBNP和CysC与PT、TT、APTT均呈正相关(P<0.05),与FIB呈负相关(P<0.05)。结论创伤失血性休克患者常合并凝血功能障碍,且凝血功能越严重,NT-proBNP、CysC升高越明显,发生急性心力衰竭风险越高,临床需加强对此类患者重视。

血浆NT-proBNP水平与不稳定型心绞痛近期预后的关系

目的:探讨血浆N末端-脑钠肽前体(NT-proBNP)水平与不稳定型心绞痛(UAP)患者近期预后的关系。方法:因胸痛住院并经冠状动脉造影检查确诊为UAP的患者52例,分别检测症状发作后18h和症状缓解96h血浆NT-proBNP水平,并计算差值比。对UAP患者随访30天,记录患者主要心血管事件(MACE)的发生情况,并应用受试者工作曲线(ROC)分析差值比对UAP患者发生近期心血管事件的预测价值。结果:发生心血管事件患者的NT-proBNP差值比高于未发生者,差异具有统计学意义(P<0.05)。ROC结果显示,NT-proBNP差值比为0.99时,其预测UAP患者近期发生心血管事件的灵敏度和特异度分别为64.3%和81.8%。结论:NTproBNP差值比可用来预测UAP患者近期心血管事件的发生情况,可作为筛选高危病例的一个指标。