老年血液透析合并心力衰竭患者血清嗜铬粒蛋白A与B型钠尿肽和心功能分级的关系
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摘要
目的探讨老年血液透析合并心力衰竭患者血清嗜铬粒蛋白A(CGA)与B型钠尿肽(BNP)和心功能分级的关系。方法选择2012年11月～2018年2月大连大学附属中山医院血液透析中心治疗的老年慢性肾功能衰竭患者86例,根据心功能(NYHA)分级分为心功能Ⅰ级组23例,心功能Ⅱ级组20例,心功能Ⅲ级组19例,心功能Ⅳ级组24例,同期选择健康体检者20例为对照组,检测血清CGA、BNP水平,并行心脏彩色超声检查,测量LVEF、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心房内径(LAD)等相关指标。用Pearson相关性分析CGA与心脏超声指标的关系。结果各组CGA和BNP水平比较,差异有统计学意义(P<0.01)。心功能Ⅰ级组、心功能Ⅱ级组、心功能Ⅲ级组和心功能Ⅳ级组CGA和BNP水平较对照组明显增高,差异有统计学意义(P<0.01)。心功能Ⅱ级组CGA和BNP水平较心功能Ⅰ级组明显升高,心功能Ⅲ级组CGA和BNP水平较心功能Ⅰ级组和心功能Ⅱ级组明显增高,心功能Ⅳ级组CGA和BNP水平较心功能Ⅰ级组、心功能Ⅱ级组和心功能Ⅲ级组明显增高,差异有统计学意义(P<0.01)。相关性分析显示,血清CGA与LVEF呈负相关(r=-0.702,P=0.016),与LVEDD、LVESD和LAD呈正相关(r=0.616,P=0.028;r=0.683,P=0.019;r=0.631,P=0.021)。结论检测CGA水平有助于判断老年血液透析合并慢性心力衰竭患者心力衰竭的严重程度。
Objective To study the relationship of serum chromogranin A(CGA)and BNP levels with cardiac function in elderly CHF patients on hemodialysis.Methods Eighty-six elderly CHF patients admitted to our hospital from November 2012 to February 2018 were divided into cardiac functionⅠ group(n=23),cardiac functionⅡ group(n=20),cardiac functionⅢ group(n=19)and cardiac function Ⅳ group(n=24)according to The NYHA,with 20 persons undergoing physical examination served as a control group.Their serum CGA and BNP levels,LVEDD,LVESD and LAD were measured and their LVEF was detected.Results The serum CGA and BNP levels were significantly different in cardiac functionⅠ-Ⅳgroups(P<0.01),and were significantly higher in cardiac function Ⅰ-Ⅳ groups than in control group(P<0.01),in cardiac functionⅡ group than in cardiac function Ⅰ group,in cardiac function Ⅲ group than in cardiac function Ⅰ and Ⅱ groups,in cardiac function Ⅳ group than in cardiac function Ⅰ-Ⅲ groups(P<0.01).Pearson correlation analysis showed that serum CGA level was negatively related with LVEF(r=-0.702,P=0.016)and positively related with LVEDD,LVESD and LAD(r=0.616,P=0.028;r=0.683,P=0.019;r=0.631,P=0.021).Concluion Measurement of serum CGA level helps to assess the severity of HF in elderly CHF patients on hemodialysis.
Objective To study the relationship of serum chromogranin A(CGA)and BNP levels with cardiac function in elderly CHF patients on hemodialysis.Methods Eighty-six elderly CHF patients admitted to our hospital from November 2012 to February 2018 were divided into cardiac functionⅠ group(n=23),cardiac functionⅡ group(n=20),cardiac functionⅢ group(n=19)and cardiac function Ⅳ group(n=24)according to The NYHA,with 20 persons undergoing physical examination served as a control group.Their serum CGA and BNP levels,LVEDD,LVESD and LAD were measured and their LVEF was detected.Results The serum CGA and BNP levels were significantly different in cardiac functionⅠ-Ⅳgroups(P<0.01),and were significantly higher in cardiac function Ⅰ-Ⅳ groups than in control group(P<0.01),in cardiac functionⅡ group than in cardiac function Ⅰ group,in cardiac function Ⅲ group than in cardiac function Ⅰ and Ⅱ groups,in cardiac function Ⅳ group than in cardiac function Ⅰ-Ⅲ groups(P<0.01).Pearson correlation analysis showed that serum CGA level was negatively related with LVEF(r=-0.702,P=0.016)and positively related with LVEDD,LVESD and LAD(r=0.616,P=0.028;r=0.683,P=0.019;r=0.631,P=0.021).Concluion Measurement of serum CGA level helps to assess the severity of HF in elderly CHF patients on hemodialysis.
引文
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[12]Goetze JP,Hilsted LM,Rehfeld JF,et al.Plasma chromogranin A is a marker of death in elderly patients presenting with symptoms of heart failure[J].Endocr Connect,2014,3(1):47-56.DOI:10.1530/EC-14-0017.
[2]Iacoviello M,Leone M,Antoncecchi V,et al.Evaluation of chronic kidney disease in chronic heart failure:from biomarkers to arterial renal resistances[J].World J Clin Cases,2015,3(1):10-19.DOI:10.12998/wjcc.v3.i1.10.
[3]Cioffi G,Tarantini L,Faggiano P,et al.Left ventricular systolic dysfunction in chronic kidney disease:from asymptomatic changes in geometry and function to overt heart failure[J].Monaldi Arch Chest Dis,2014,82(1):10-15.DOI:10.4081/monaldi.2014.36.
[4]Goetze JP,Alehagen U,Flyvbjerg A,et al.Chromogranin A as a biomarker in cardiovascular disease[J].Biomark Med,2014,8(1):133-140.DOI:10.2217/bmm.13.102.
[5]Ottesen AH,Christensen G,Omland T,et al.Glycosylated chromogranin A:potential role in the pathogenesis of heart failure[J].Curr Heart Fail Rep,2017,14(6):478-488.DOI:10.1007/s11897-017-0360-x.
[6]Gallo MP,FemminòS,Antoniotti S,et al.Catestatin induces glucose uptake and GLUT4trafficking in adult rat cardiomyocytes[J].Biomed Res Int,2018,2018:2086109.DOI:10.1155/2018/2086109.
[7]Kiranmayi M,Chirasani VR,Allu PK,et al.Catestatin Gly364Ser variant alters systemic blood pressure and the risk for hypertension in human populations via endothelial nitric oxide pathway[J].Hypertension,2016,68(2):334-347.DOI:10.1161/HYPERTENSIONAHA.116.06568.
[8]Mahata SK,Kiranmayi M,Mahapatra NR.Catestatin:a master regulator of cardiovascular functions[J].Curr Med Chem,2018,25(11):1352-1374.DOI:10.2174/0929867324666170425100416.
[9]Mir SA,Li Y,Story JD,et al.Mice overexpressing chromogranin A display hypergranulogenic adrenal glands with attenuated ATP levels contributing to the hypertensive phenotype[J].J Hypertens,2018,36(5):1115-1128.DOI:10.1097/HJH.0000000000001678.
[10]王瑞英,康玉华,薛文生,等.老年高血压患者血压昼夜波动与肾小球滤过率下降的关系[J].中华老年心脑血管病杂志,2012,14(5):481-484.DOI:10.3969/j.issn.1009-0126.2012.05.011.
[11]陈亚南,王岚峰.心力衰竭相关生物学标记物的研究近况[J].中华老年心脑血管病杂志,2012,14(2):211-213.DOI:10.3969/j.issn.1009-0126.2012.02.033.
[12]Goetze JP,Hilsted LM,Rehfeld JF,et al.Plasma chromogranin A is a marker of death in elderly patients presenting with symptoms of heart failure[J].Endocr Connect,2014,3(1):47-56.DOI:10.1530/EC-14-0017.