Comprehensive effects of traditional Chinese medicine treatment on heart failure and changes in B-type natriuretic peptide levels: A meta-analysis

BACKGROUND Heart failure(HF),a common cardiovascular condition,is characterized by significant morbidity and mortality.While traditional Chinese medicine(TCM)is often used as a complementary approach in HF management,systematic evalua-tions of its impact on clinical outcomes,TCM syndrome scores,and B-type natriuretic peptide(BNP)levels are lacking.This study fills this gap through a comprehensive analysis of randomized controlled trials(RCTs)focusing on TCM for HF treatment.It encompasses an assessment of methodological quality,a meta-analysis,and an evaluation of evidence quality based on established standards.The results offer crucial insights into the potential advantages and constraints of TCM in HF management.RCTs on TCM for HF treatment published since the establishment of the database were searched in four Chinese and English databases,including China National Knowledge Infrastructure,Wanfang,VIP Information Chinese Science and Technology Journal,and PubMed.Methodological quality was assessed for the included studies with the Cochrane risk-of-bias assessment tool,and the meta-analysis and publication bias assessment was performed with the RevMan5.3 software.Finally,the quality of evidence was rated according to the GRADE criteria.RESULTS A total of 1098 RCTs were initially retrieved.After screening,16 RCTs were finally included in our study,which were published between 2020 and 2023.These RCTs involved 1660 HF patients,including 832 in the TCM group[TCM combined with conventional Western medicine(CMW)treatment]and 828 in the CWM group(CWM treatment).The course of treatments varied from 1 wk to 3 months.TCM syndrome differentiation was analyzed in 11 of the included RCTs.In all included RCTs,outcome indicators included comprehensive clinical outcomes,TCM syndrome scores,and BNP levels.The meta-analysis results showed significant differences between the TCM and CWM groups in terms of comprehensive clinical outcomes[risk ratio=-0.54;95%confidence interval(CI)=-0.61,-0.47;P<0.00001],TCM syndrome scores[weighted mean difference(WMD)=-142.07;95%CI=-147.56,-136.57;P<0.00001],and BNP levels(WMD=-142.07;95%CI=-147.56,-136.57;P<0.00001).According to the GRADE criteria,RCTs where"TCM improves clinical comprehensive outcomes"were rated as low-quality evidence,and RCTs where"TCM reduces TCM syndrome scores"or"TCM decreases BNP levels"were rated as medium-quality evidence.CONCLUSION TCM combined with CWM treatment effectively improves comprehensive clinical outcomes and diminishes TCM syndrome scores and BNP levels in HF patients.Given the low and medium quality of the included RCTs,the application of these results should be cautious.

Value of N-Terminal Pro B-Type Natriuretic Peptide,High-Sensitivity C-Reactive Protein,and Homocysteine Levels in Predicting Cardiovascular Events in Chronic Heart Failure Patients After Discharge

Objective:To investigate the value of N-terminal pro B-type natriuretic peptide(NT-proBNP),high-sensitivity C-reactive protein(hs-CRP),and homocysteine(Hcy)levels in predicting cardiovascular events(CV)in patients with chronic heart failure(CHF).Methods:A total of 63 patients with CHF admitted to our hospital between June 2019 and July 2021 were selected.Their NT-proBNP,hs-CRP,and Hcy levels were detected at discharge,and a 12-month follow-up was done after their discharge to collect clinical data.The collected data were inclusive of data from 21 CHF patients with cardiovascular disease and 42 CHF patients without cardiovascular disease.The effect of NT-proBNP,hs-CRP,and Hcy levels on the occurrence of CV was analyzed.Results:The levels of NT-proBNP,hs-CRP,and Hcy in the group with cardiovascular disease were significantly higher than those in the group without cardiovascular disease(P<0.05);the levels of serum NT-proBNP,hs-CRP,and Hcy at discharge had certain value in predicting short-term CV in CHF patients(P<0.05).Conclusion:NT-proBNP,hs-CRP,and Hcy levels can be used to predict CV in CHF patients,thus having clinical application value.

Marked elevation of B-type natriuretic peptide in patients with heart failure and preserved ejection fraction

Marked elevations of B-type natriuretic peptide （BNP） are not generally seen in patients with heart failure and preserved ejection fraction （HFpEF）. The objective of this study was to examine the clinical and laboratory characteristics of a large cohort of patients with HFpEF and markedly elevated BNP. A retrospective examination of 421 inpatients at a university hospital admitted with a diagnosis of HFpEF was performed. Clinical and echocardiographic data in 4 groups of patients with levels of BNP ≤ 100 pg/mL, 100-400 pg/mL, 400-1,000 pg/mL and 〉 1,000 pg/mL were compared. Patients with HFpEF and BNP 〉 1,000 pg/mL （28% of the population） were characterized by impaired renal function and greater use of anti-hypertensive medications. A subset of these patients with BNP 〉 1,000 pg/mL had normal renal function （21%） and were significantly older, more frequently female, and tended to have lower ejection fractions. Conversely, patients with HFpEF and BNP ≤100 pg/mL were younger and had preserved renal function. BNP was inversely related to the likelihood of subsequent admission for heart failure, but not to myocardial infarction or death. In conclusion： BNP 〉 1,000 pg/mL is seen in almost 1/3 of patients hospitalized with HFpEF. This elevation of BNP often reflects impaired renal function, but can also be seen in patients with preserved renal function but relatively impaired systolic function.

B-type natriuretic peptide in predicting the severity of community-acquired pneumonia

BACKGROUND: Although pneumonia severity index(PSI) is widely used to evaluate the severity of community-acquired pneumonia(CAP), the calculation of PSI is very complicated. The present study aimed to evaluate the role of B-type natriuretic peptide(BNP) in predicting the severity of CAP.METHODS: For 202 patients with CAP admitted to the emergency department, BNP levels, cardiac load indexes, inf lammatory indexes including C-reactive protein(CRP), white blood cell count(WBC), and PSI were detected. The correlation between the indexes and PSI was investigated. BNP levels for survivor and non-survivor groups were compared, and a receiver operating characteristic(ROC) curve analysis was performed on the BNP levels versus PSI.RESULTS: The BNP levels increased with CAP severity(r=0.782, P<0.001). The BNP levels of the high-risk group(PSI classes IV and V) were signifi cantly higher than those of the low-risk group(PSI classes I–III)(P<0.001). The BNP levels were signifi cantly higher in the non-survivor group than in the survivor group(P<0.001). In addition, there were positive correlations between BNP levels and PSI scores(r=0.782, P<0.001). The BNP level was highly accurate in predicting the severity of CAP(AUC=0.952). The optimal cut-off point of BNP level for distinguishing high-risk patients from low-risk ones was 125.0 pg/m L, with a sensitivity of 0.891 and a specifi city of 0.946. Moreover, BNP level was accurate in predicting mortality(AUC=0.823). Its optimal cut-off point for predicting death was 299.0 pg/m L, with a sensitivity of 0.675 and a specifi city of 0.816. Its negative predictive cut-off value was 0.926, and the positive predictive cut-off value was 0.426.CONCLUSION: BNP level is positively correlated with the severity of CAP, and may be used as a biomarker for evaluating the severity of CAP.

The role of B-type natriuretic peptide in the evaluation of congestive heart failure patients in emergency department

Aim: Congestive heart failure (CHF) is a severe cardiovascular disorder seen in the Emergency Department (ED). B-type Natriuretic Peptide (BNP) is usually ordered to evaluate the CHF severity. However, it is difficult to interpret serum BNP level when different clinical entities existed. The aim of this study is to illustrate the correlation between serum BNP level and relevant clinical variables and further determine the role of serum BNP in different CHF patients. Methods: Univariate comparisons between 26 clinical variables and serum BNP level were analyzed. In order to avoid confounding factors, potential independent clinical variables were analyzed together using multivariate regression. Results: 529 CHF patients were reviewed and divided into different groups by 26 clinical variables. Serum BNP levels were found statistically significant different by univariate compareson between groups divided by 8 clinical variables that included obesity, diastolic/systolic heart failure (HF), serum blood urea nitrogen (BUN) level, serum creatinine (Cr) level, serum sodium (Na) level, patients taking loop diuretics, history of cerebrovascular accident (CVA), and history of dementia. Among all 8 clinical variables, obesity, serum BUN, Cr level, and diastolic/systolic HF had weak-to-moderate correlation effects with serum BNP level by correlation coefficient analysis. However, only obesity and dia- stolic/systolic HF were two moderately stronger clini- cal variables that can affect the serum BNP levels by multivariate regression. Analyzing CHF patients separately by obesity and diastolic/systolic HF subsets showed longer hospitalization in diastolic HF patients with relatively higher serum Cr level. In addition, poor correlation was found between serum BNP level and length of hospitalization (LOH) as well. Conclusion: High variability of serum BNP levels exists in CHF patients with weak-to-moderate correlation effects particularly on obesity and diastolic/systolic HF.It is recommended that physicians should be cautious on interpreting BNP in different CHF populations.

The role of B-type natriuretic peptide in the diagnosis and treatment of decompensated heart failure

Heart failure (HF) is a common disease associated with increasing age. B-type natriuretic peptide (BNP), is a cardiac neurohormone, and is released as prepro BNP and then enzyrnatically cleaved to the Ntenninal-proBNP (NT-proBNP) and BNP upon ventricular myocyte stretch. Blood measurements of BNP have been used to identify patients with I-IF. The BNP assay is currently used as a diagnostic and prognostic aid in HF. In general, a BNP level below 100 pg/mL excludes acutely decompensated HF and levels ＞ 500 pg/ml indicate decompensation. Recombinant human BNP (hBNP, nesiritide) is an approved intravenous treatment for acute,decompensated -HF. Nesiritide given in supraphysiologic doses causes vasodilation, natriuresis, diuresis, and improved symptoms over the course of a 48-hour infusion. This paper will sort out the literature concerning the use of this peptide both as a diagnostic test and as an intravenous therapy.

Diagnostic Value of Combined Detection of Galectin-3 and N-Terminal B-Type Natriuretic Peptide in Patients with Acute Heart Failure

Background: Acute heart failure timely and effective diagnosis and treatment directly affects the prognosis of patients, so early diagnosis of acute heart failure treatment is very important. The current diagnosis of acute heart failure has yet to be further improved. To investigate the relationship between plasma levels of Galectin-3 and NT-proBNP in cardiac structure and function in patients with acute heart failure (AHF) Early detection of failure. Methods: The clinical data of 86 patients with acute heart failure in our hospital were analyzed and followed up. Twenty-six healthy subjects with normal cardiac function were used as control group. The plasma Galectin-3 and NT-proBNP levels were compared between the two groups to observe the value of plasma Galectin-3 combined with NT-proBNP in the diagnosis of acute heart failure. Results: There was no significant difference in the level of Galectin-3 and NT-proBNP between heart function group II and control group, and the levels of cardiac function III and IVG plasma Galectin-3 and NT-proBNP were significantly higher in patients with heart failure Compared with the healthy control group, the patients’ LVEF decreased and their cardiac function increased. The levels of plasma Galectin-3 and NT-proBNP increased significantly (P 0.01). Multivariate Logistic regression analysis demonstrated that plasma levels of Galectin-3 and NT-proBNP were independent of cardiac function. The area under the ROC curve for the combined detection of plasma Galectin-3 and NT-proBNP was greater than the area under the two alone tests. Conclusion: The combined detection of Galectin-3 and NT-proBNP has high sensitivity and specificity in the diagnosis of acute heart failure and can be used as a new detection mode.

The Utility of B-type Natriuretic Peptide to Predict Prognosis of Acute Myocardial Infarction Patients Complicated With Cardiogenic Shock Treated With Intra-aortic Ballon Counterpulsation

Objectives To assess the prognostic value of B-type natriuretic peptide （BNP） in severe AMI patients treated with intra-aortic ballon counterpulsation（IABP）. Methods A total of 42 AMI patients with cardiogenic shock were retrospectively studied. BNP plasma level was recorded in the 24th hour and 4th day after myocardial infarction. The different mortality were compared among patients with different BNP levels. Results With aggressive treatment, 20 patients survived short term hospitalization. Plasma concentration of BNP in dying patients is much higher than in survivals（1369 ± 353 vs 651 ± 302 pg/ml. P〈 0.01）.Patients with BNP higher than 1474 pg/mL had a mortality of 92.9 %. Conclusions Elevated BNP level in AMI patients with cardiogenic shock treated with IABP is highly associated with poor prognosis.

Effects and safety of natriuretic peptides as treatment of cirrhotic ascites:A systematic review and meta-analysis

BACKGROUND Natriuretic peptides are involved in the cascade of pathophysiological events occurring in liver cirrhosis,counterbalancing vasoconstriction and anti-natriuretic factors.The effects of natriuretic peptides as treatment of cirrhotic ascites have been investigated only in small studies,and definitive results are lacking.AIM To examine the effects and safety of natriuretic peptides in cirrhosis patients with ascites.METHODS We searched MEDLINE,Web of Science,Scopus,Cochrane Library and Embase for all available studies applying intravenous administration of any natriuretic peptide to patients suffering from cirrhotic ascites.Inclusion was not limited by treatment duration or dose,or by follow-up duration.Both randomised controlled trials and non-randomised studies were eligible for inclusion.The primary outcome was change in renal sodium excretion.Secondary outcomes included safety measures and changes in renal water excretion,plasma aldosterone concentration,and plasma renin activity.RESULTS Twenty-two studies were included.Atrial natriuretic peptide(ANP)was the only intensively studied treatment.Sodium excretion increased in response to continuous ANP infusion and was more pronounced when infusion rates of>30 ng/kg/min were administered compared with≤30 ng/kg/min(P<0.01).Moreover,natriuresis was significantly higher in study subgroups with mild/moderate ascites compared with moderate/severe and refractory ascites(P<0.01).ANP infusions increased renal water excretion,although without reaching a statistically significant dose-response gradient.Plasma aldosterone concentration and plasma renin activity were significantly lower at baseline in study subgroups achieving a negative sodium balance in response to an ANP administration compared with treatment non-responders(P<0.01).Blood pressure decreases occurred less frequently when ANP doses≤30 ng/kg/min were applied.The quality of evidence for a natriuretic response to ANP was low,mainly due to small sample sizes and considerable between-study heterogeneity.Data were sparse for the other natriuretic peptides;B-type natriuretic peptide and urodilatin.CONCLUSION Intravenous ANP infusions increase sodium excretion in patients with cirrhotic ascites.Continuous infusion rates>30 ng/kg/min are the most effective.However,safety increases with infusion rates≤30 ng/kg/min.

Effects of short-acting β-adrenergic blocker on B-type natriuretic peptide at early stage of postresuscitation in rabbits

Postresuscitation myocardial dysfunction is reversible heart failure and B-type natriuretic peptide （BNP） is a biochemical marker of ventricular disorders secreted from ventricle, which can be used to assess the status of left ventricular function. This study investigated the effect of β-adrenergic blocker on concentration of BNP and cardiac function after cardiopulmonary resuscitation in rabbits.

Observation of blood B-type natriuretic peptide level changes in different periods and different cardiac pacing modes

In recent years, the indications of cardiac pacing have extended continuously with the rapid development of pacing technique. Pacemaker treatment has not only limited in arrhythmias of bradycardia and the number of pacemaker treatment has increased year by year. However, more and more new congestive heart failure （ CHF ） and aggravated CHF have appeared in patients after pacing therapy. Therefore, it is a hot topic that how to select reasonable pacing mode to reduce CHF occurrence or relieve CHF symptoms in patients with CHF.

Use of B-type natriuretic peptide in evaluation of early percutaneous coronary intervention in patients with acute coronary syndrome

Background Previous studies showed that blood B-type natriuretic peptide (BNP) level could predict the prognosis of acute coronary syndromes (ACS) This study investigated the evaluation value of circulating BNP for early percutaneous coronary intervention (PCI) in patients with ACS Methods Nine hundred and sixty consecutive patients with ACS were enrolled Circulating BNP level was measured when each patient arrived at the emergency room All patients underwent PCI in 90 minutes in spite of contraindication Cardiac events (death from any cause, heart failure, and recurrence of acute myocardial infarction or ACS) were recorded during follow-up KH*2/5DResults In patients with BNP ≥80 pg/ml, mortality from all causes within 1 month and 6 months in those underwent delayed PCI (≥6 hours) was significantly higher than those received early PCI (<6 hours) (9 53% vs 3 49%, P =0 027; 13 61% vs 5 24%, P =0 010, respectively) Similarly, the incidence rate of heart failure in delayed PCI patients was significantly higher than those received early PCI within 1 month and 6 months (12 93% vs 4 66%, P =0 008; 14 97% vs 6 98%, P =0 021, respectively) The recurrence rate of acute myocardial infarction or ACS, however, was not significantly different between early PCI and delayed PCI patients in group BNP ≥80 pg/ml In patients with BNP <80 pg/ml, no significant difference was observed between early PCI and delayed PCI patients with any of the above cardiac events within 1 month or 6 months Conclusion While early level of circulating BNP ≥80 pg/ml, the incidence of mortality and heart failure, but not recurrence of acute myocardial infarction, is significantly reduced in patients with ACS provided by early PCI

人软骨糖蛋白-39、N端脑钠肽前体在川崎病患儿冠状动脉损伤中的应用价值

目的 探讨人软骨糖蛋白-39(YKL-40)、N端脑钠肽前体(NT-proBNP)在川崎病(KD)患儿冠状动脉损伤(CAL)中的临床应用价值。方法 选取125例KD患儿作为研究对象(KD组),并根据是否合并冠状动脉病变分为CAL组(n=53)及无冠状动脉损伤(NCAL)组(n=72)。选取同期体检的健康儿童(HC组)和同期住院的仅消化道感染的发热患儿(FC组)作为对照。检测血浆YKL-40、NT-proBNP水平。绘制受试者工作特征(ROC)曲线评估YKL-40、NT-proBNP对KD患儿不同时期CAL的诊断价值。结果 KD患儿不同时期(急性期、亚急性期和恢复期)的血浆YKL-40、NT-proBNP水平高于HC组、FC组,差异有统计学意义(P<0.05);CAL组YKL-40水平高于NCAL组,急性期NT-proBNP高于NCAL组,差异有统计学意义(P<0.05)。YKL-40、NT-proBNP及两者联合诊断KD急性期CAL的曲线下面积(AUC)分别为0.813、0.832、0.886;YKL-40、NT-proBNP及两者联合诊断KD亚急性期CAL的AUC分别为0.699、0.522、0.701;YKL-40、NT-proBNP及两者联合诊断KD恢复期CAL的AUC分别为0.982、0.435、0.986。结论 血浆YKL-40和NT-proBNP水平可作为KD早期辅助诊断指标。血浆YKL-40可联合其他指标用于监测KD疾病活动及CAL并发症的发展。

血NT-proBNP CRP和NLR水平在评估慢性阻塞性肺疾病急性加重合并肺部感染患者预后的价值

目的:探究血N-末端脑钠肽前体(NT-proBNP)、C-反应蛋白(CRP)和嗜中性粒细胞与淋巴细胞比值(NLR)水平在评估慢性阻塞性肺疾病急性加重(AECOPD)合并肺部感染患者预后中的价值。方法:选择2019年12月至2021年12月医院收治的120例AECOPD合并肺部感染患者的临床资料进行回顾性分析,根据患者预后情况将其分为存活组(n=86)与死亡组(n=34),比较两组一般资料,血NT-proBNP、CRP和NLR水平,三者在评估患者预后中的价值用受试者工作曲线(ROC)进行分析。结果:存活组血NT-proBNP、CRP和NLR水平均低于死亡组(P<0.05);采用ROC曲线分析结果显示:NLR的曲线下面积值(AUC)值最高,敏感度、特异度分别为73.53%、63.95%,以CRP的AUC值最低,敏感度、特异度分别为47.06%、82.56%(P>0.05),血NT-proBNP、CRP、NLR并联诊断后AUC为0.700,敏感度升高,为97.06%,特异度为43.02%。结论:血NT-proBNP、CRP和NLR在AECOPD合并肺部感染患者预后评估中具有较高的价值,临床可将NT-proBNP、CRP和NLR作为辅助判定指标对患者病情进行预测以改善患者预后。

川崎病患儿发生血管损伤的影响因素

目的探讨川崎病(KD)合并血管损伤患儿血清可溶性肿瘤发生抑制蛋白2(sST2)、N末端脑利钠肽(NT-proBNP)水平变化及其临床意义。方法选取2019年3月至2023年1月于安徽省儿童医院就诊的105例KD患儿为KD组,根据患儿是否发生血管损伤将其分为损伤组(n=36)和未损伤组(n=69)。另选择同期进行血清sST2、NTproBNP检测的体检健康儿童为对照组(n=58)。比较KD组与对照组儿童的血清sST2、NT-proBNP水平,分析KD患儿发生血管损伤的影响因素,观察血清sST2、NT-proBNP水平对血管损伤的预测价值。结果KD组患儿血清sST2、NTproBNP水平均高于对照组儿童,差异均有统计学意义(P﹤0.05)。损伤组与未损伤组患儿性别、年龄、热程、白蛋白、sST2、NT-proBNP水平比较,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,年龄、性别、热程、白蛋白、sST2、NT-proBNP水平均为KD患儿发生血管损伤的独立危险因素(P﹤0.05)。受试者工作特征(ROC)曲线结果显示,NTproBNP预测KD患儿发生血管损伤的灵敏度、特异度均高于sST2,差异有统计学意义(P﹤0.05);而两者联合预测KD患儿发生血管损伤的AUC、灵敏度、特异度与单一指标比较,差异均无统计学意义(P﹥0.05)。结论KD合并血管损伤患儿血清sST2、NT-proBNP水平明显升高,年龄、性别、热程、白蛋白、血清sST2、NT-proBNP水平均为KD患儿血管损伤的独立危险因素,且NT-proBNP对KD患儿发生血管损伤具有较高的预测价值。

血浆脑钠肽联合氨基末端脑钠肽前体与常规心功能指标对心脏外科瓣膜置换术患者预后的预测价值研究

目的评价血浆脑钠肽(BNP)、氨基末端脑钠肽前体(NT-proBNP)对心脏外科瓣膜置换术患者预后情况的预测能力及临床应用价值,并与常规心功能指标对心脏外科瓣膜置换术患者预后的预测价值进行比较。方法选取2014年8月—2016年2月四川省人民医院心脏外科心瓣膜病患者138例为研究对象,均由风湿性心脏病引起。记录患者一般资料及检测指标;于患者出院1个月后开始随访,随访时间为18个月,根据随访结局分为预后良好组与预后不良组。结果随访的138例患者中,删失14例,其余124例中预后良好73例(预后良好组),预后不良51例(预后不良组),患者不良预后发生率为41.1%(51/124)。多因素Cox回归分析显示左心室舒张末期内径(LVEDD)(RR=1.578,P=0.039)、血浆BNP(RR=1.935,P=0.013)和NT-proBNP(RR=2.346,P<0.001)是心脏外科瓣膜置换术患者不良预后的影响因素;LVEDD、血浆BNP和NT-proBNP预测心脏外科瓣膜置换术患者预后的ROC曲线下的面积分别为0.774、0.814、0.800,血浆BNP联合NT-proBNP预测心脏外科瓣膜置换术患者预后的ROC曲线下面积为0.856,特异度为78.9%,灵敏度为83.6%。结论血浆BNP和NT-proBNP对心脏外科瓣膜置换术患者预后有较好的预测能力,有望作为临床评估患者术后预后风险的指标之一。

阿托伐他汀对慢性心力衰竭患者心功能的影响

目的 探讨阿托伐他汀对慢性心力衰竭患者心功能的影响.方法 纳入我院心血管门诊及住院的慢性心力衰竭患者139例,根据患者是否使用他汀类药物及他汀药物种类分为阿托伐他汀组（44例）、其他他汀组（48例）和无他汀组（47例）.收集并对比各组患者一般资料、血清NT-proBNP浓度及左心室舒张末期内径（LVEDD）、左心室缩短率（LVFS）、左心室射血分数（LVEF）等指标.结果 阿托伐他汀组较无他汀组血清NT-proBNP浓度显著降低[（1552＆#177;3416）pg/ml比（3771＆#177;6763）pg/ml,P＜0.01],LVEDD[（65.2＆#177;8.9）mm比（70.7＆#177; 10.9）mm,P＜0.05]和LVEF[（33.2＆#177; 12.6）％比（28.2＆#177;9.6）％,P＜0.05]显著降低.其他他汀组与无他汀组相比,血清NT-proBNP浓度及各超声心动图指标差异无统计学意义（P＞0.05）.阿托伐他汀组中患者缺血性心衰亚组与非缺血性心衰亚组相比各指标差异无统计学意义.结论 阿托伐他汀可显著改善慢性心力衰竭患者心功能,可作为一种治疗慢性心力衰竭的辅助治疗策略。

先天性心脏病患儿N末端前脑利钠肽的变化及临床意义

目的:探究N末端前脑利钠肽(NT-proBNP)在儿童先天性心脏病的变化及临床意义。方法:选取我院2011年至2016年间,患有由左向右分流型先天性心脏病(LRS)儿童受试者80例(男性35例,女性45例)参与研究(观察组)。选取80例健康儿童作为对照组。测定两组受试者的NT-proBNP。并用B超测定以下参数:收缩功能(EF和左心室短轴缩短率),肺循环与体循环血流量之比(Qp/Qs),肺动脉血流和肺动脉压,左心室舒张功能(E波,A波,E/A比值,减速时间),分析NT-proBNP与上述指标的相关性。结果:①观察组NT-proBNP水平显著高于对照组,其差异有统计学意义(P<0.05)。②在观察组中,心功能Ⅲ-Ⅳ级的患者NT-proBNP的水平明显高于心功能Ⅰ级和心功能Ⅱ级的患者,其差异有统计学意义(P<0.05)。③NT-proBNP升高组, EF低于NT-proBNP正常组,肺动脉血流,肺动脉压,Qp/Qs高于NT-proBNP正常组,其差异有统计学意义(P<0.05)。④经Pearson线性相关分析显示,NT-proBNP与射血分数呈负相关,与肺动脉血流、肺动脉压、Qp/Qs呈正相关。结论:NT-proBNP对于LRS的病情判断具有一定的参考价值。

脂蛋白a及N末端BNP前体与冠心病及冠状动脉狭窄程度的关系

目的：探讨脂蛋白a[LP（a）]与N末端脑钠肽前体（NT-proBNP）在冠心病及冠状动脉狭窄程度中的作用。方法连续性收集我科行冠状动脉造影的患者121例，根据造影结果将患者分为冠心病组89例与对照组32例，对2组患者的临床及实验室资料，采用单因素和多因素Logistic回归分析LP（a）及NT-proBNP与冠心病及冠状动脉狭窄程度的关系。结果①单因素分析发现冠心病组中男性比例、LDL-C、LP（a）与NT-proBNP水平均高于对照组（P＜0．05），HDL-C水平低于对照组（P＜0．05），多因素Logistic回归分析仅NT-proBNP水平是冠心病的独立危险因素（OR：1．002，95％ CI：1．001～1．003；P＝0．003）。②冠状动脉中度狭窄组与轻度狭窄组比较：LP（a）、NT-proBNP水平均高于轻度狭窄组（P值分别为0．002，0．044），冠状动脉重度狭窄组与轻度狭窄组比较：LP（a）、NT-proBNP水平均高于轻度狭窄组（P值分别为0．001，＜0．001），随着冠状动脉狭窄程度加重，LP（a）、NT-proBNP水平呈增高趋势。结论 NT-proBNP是冠心病的独立危险因素，而LP（a）、NT-proBNP水平均与冠脉狭窄程度存在显著相关性。

不同剂量参附注射液对心力衰竭患者中医证候积分及BNP水平的影响

目的探讨不同剂量参附注射液对心力衰竭患者中医证候积分及N端B型利钠肽前体(NT-proBNP)水平的影响。方法收集2014年5月—2015年2月我院心内科收治的慢性心力衰竭患者84例,随机分为对照组、观察组1、观察组2,每组28例。对照组进行基础治疗,观察组在对照组基础上加用参附注射液。观察组1以参附注射液40mL加入5%葡萄糖注射液250 mL中静脉输注,每日1次,14d为1个疗程;观察组2以参附注射液80mL加入5%葡萄糖注射液250mL中静脉输注,每日1次,14d为1个疗程。治疗结束后,对比各组中医证候积分、生活质量评分及血清N端B型利钠肽前体(NT-proBNP)水平。结果治疗后,3组患者中医证候积分、明尼苏达生活质量积分、NT-proBNP水平均有明显下降(P<0.05),观察组1、观察组2治疗后中医证候积分、生活质量积分、NT-proBNP水平均较对照组明显下降,且观察组2下降更为明显,差异有统计学意义(P<0.05)。结论参附注射液对心力衰竭患者中医证候积分改善及血清NT-proBNP水平降低有着重要的作用,随着剂量的加大,其治疗作用随之增强。