高血压患者血浆脑钠肽与心功能指标的相关性研究
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摘要
目的:
旨在通过检测原发性高血压(EH)患者血浆B型脑钠肽(BNP),超声心动图指标及心电图V1导联P波终末电势(PtfV1)指标,探讨不同血压水平及发生心功能不全时指标变化,分析高血压患者血浆BNP水平变化及与超声心动图指标、心电图PtfV1的相关性。
方法:
将83例门诊及住院原发性高血压患者分为心功能正常组46例和心力衰竭(HF)组37例。高血压心功能正常组又分三个亚组:高血压1级亚组10例、高血压2级亚组17例、高血压3级亚组19例;高血压心衰组又分两个亚组:高血压伴舒张性心衰(DHF)亚组21例、高血压伴收缩性心衰(SHF)亚组16例,同时选取20名健康对照者。测定血浆BNP水平、利用超声心动图测定每组左室射血分数(LVEF)、左室舒张末期内径(LVEDD)及左房内径(LAD)、常规描记十二导联心电图并计算PtfV1,对结果进行统计学处理。
结果:
(1)高血压组血浆BNP水平(251.7±281.0pg/ml)高于正常对照组(14.5±10.9pg/ml,P<0.01)。高血压无心衰组血浆BNP水平(36.0±20.1pg/ml)高于正常对照组(14.5±10.9pg/ml,P<0.01)。高血压伴心衰组血浆BNP水平(519.9±214.3pg/ml)高于高血压无心衰组高血压组(36.0±20.1pg/ml,P<0.01)、正常对照组(14.5±10.9pg/ml,P<0.01)。
(2)在心功能正常亚组,血浆BNP水平高血压3级亚组(49.0±21.4pg/ml)高于高血压1级亚组(24.5±14.1pg/ml,P<0.05)、高血压2级亚组(28.2±12.6pg/ml,P<0.05)和正常对照组(14.5±10.9pg/ml,P<0.05),高血压2级亚组(28.2±12.6pg/ml)高于正常对照组(14.5±10.9pg/ml,P<0.05)。而高血压1级亚组与正常对照组、高血压1级亚组与2级亚组之间两两比较差异无统计学意义(P>0.05)。随着高血压级别增加BNP水平、LVEDD、LAD呈增大趋势,LVEF、PtfV1呈减小趋势。
(3)在心功能不全亚组,高血压伴SHF组血浆BNP水平(685.6±199.6pg/ml)高于高血压伴DHF组(393.7±118.6pg/ml,P<0.05)、正常对照组(14.5±10.9pg/ml,P<0.05)、高血压心功能正常组高血压组(36.0±20.1pg/ml,P<0.05)、心功能正常组高血压三个亚组组(24.5±14.1pg/ml,P<0.05;28.2±12.6pg/ml,P<0.05;49.0±21.4pg/ml,P<0.05)。高血压伴DHF组(393.7±118.6pg/ml)高于正常对照组(14.5±10.9pg/ml,P<0.05)、高血压心功能正常组高血压组(36.0±20.1pg/ml,P<0.05)、心功能正常组高血压三个亚组(24.5±14.1pg/ml,P<0.05;28.2±12.6pg/ml,P<0.05;49.0±21.4pg/ml,P<0.05)。高血压伴SHF组中的LVEF、LVEDD、LAD、PtfV1与高血压伴DHF组、心功能正常高血压三个亚组、正常对照组分别进行两两比较差异有统计学意义(P<0.05)。随着心功能恶化,BNP、LVEDD、LAD呈明显增大趋势,LVEF、PtfV1呈明显减小趋势。
(4)血浆BNP值与LVEF呈显著负相关性(r=-0.826,P<0.01);与LVEDD呈正相关(r=0.829,P<0.01)。BNP水平与LAD呈较强的正相关(r=0.784,P<0.01);与Ptfv1呈较强负相关(r=-0.754,P<0.01)。
结论:
临床上对高血压患者进行血浆BNP水平测定,结合超声心动图测定指标、心电图Vl导联P波终末电势,有助于了解高血压患者心脏损害程度、诊断舒张性心衰和对心功能进行综合评估。
Objective：
To explore the variance of indices according varying blood pressure and heart function bydetecting plasma concentration of B-type natriuretic peptide(BNP)、echocardiographic heartfunctional parameters and P—wave terminal force in essential hypertensives(EH).To investigatethe correlation of plasma BNP level with echocardiographic heart functional parameters andP—wave terminal force—V1(PtfV1) in patients with EH.
Method：
83 patients with EH in hospital and outpatient service were divided into two groups：EHwithout heart failure (HF)group (n=46) and EH with HF group (n=37). EH without HF groupwere divided into three sub-groups: grade 1 hypertensives group(n=10), grade 2 hypertensivesgroup(n=17), grade 3 hypertensives group(n=19). EH with HF group were divided into twosub-groups: diastolic heart failure(DHF) group (n=21)，systolic heart failure(SHF) group(n=16)．Control group(n=20). Plasma BNP level were determined，LVEF，LVEDD，LAD wereexamined by echocardiography，and Ptf V1 were measured by electrocardiogram inabove-mentioned groups，statistical analysis was applied for the data.Results：
(1)The plasma BNP levels in patients with EH(251.7±281.0 pg/ml)were higher than thosein control group(14.5±10.9 pg/ml，P＜0.01). The plasma BNP levels in EH without HF group(36.0±20.1 pg/ml)were higher than those in control group(14.5±10.9 pg/ml，P＜0.01). Theplasma BNP levels in EH with HF group(519.9±214.3pg/ml)were higher than those in EHwithout HF group(36.0±20.1pg/ml P＜0.01)and control group(14.5±10.9 pg/ml，P＜0.01).
(2) In EH without HF sub-group, the plasma BNP levels in grade 3 hypertensivessub-group ( 49.0±21.4pg/ml ) were higher than those in grade 1 hypertensives sub-group(24.5±14.1p g/ml，P＜0.05)、grade 2 hypertensives sub-group(28.2±12.6pg/ml，P＜0.05)and control group ( 14.5±10.9 pg/ml，P＜0.05 ) , grade 2 hypertensives sub-group(28.2±12.6pg/ml)were higher than those in control group(14.5±10.9 pg/ml，P＜0.05).Butas to plasma BNP levels , there were not significant differences comparing grade 1hypertensives sub-group with control group, grade 1 hypertensives group and grade 2hypertensives group ( P＞0.05). With the elevating of hypertension degree the plasma BNPlevel , LVEDD and LAD were increased , but LVEF and PtfV1 were decreased .
(3) In EH with HF sub-group, the plasma BNP levels in EH with SHF(685.6±199.6 pg/ml)were higher than those in EH with DHF group(393.7±118.6 pg/ml，P＜0.05), controlgroup(14.5±10.9 pg/ml，P＜0.05), EH without HF group(36.0±20.1pg/ml P＜0.05), threeEH sub-groups without HF ( 24.5±14.1pg/ml，P＜0.05；28.2±12.6pg/ml，P＜0.05；49.0±21.4pg/ml，P＜0.05).The plasma BNP levels in EH with DHF group(393.7±118.6 pg/ml)were higher than those in control group(14.5±10.9 pg/ml，P＜0.05), EH without HF group(36.0±20.1pg/ml P＜0.05), three EH sub-groups without HF(24.5±14.1pg/ml，P＜0.05；28.2±12.6pg/ml，P＜0.05；49.0±21.4pg/ml，P＜0.05). LVEF、LVEDD、LAD and PtfV1 inEH with SHF group , there were significant differences comparing with DHF group, three EHsub-groups without HF, control group(P＜0.05). With the worsening of HF ,the plasma BNPlevels,LVEDD and LAD were increased,but LVEF and PtfV1 were decreased .
(4)The plasma BNP level were negatively correlated with LVEF(r=- 0.826，P＜0．01), butpositively correlated with LVEDD(r=0．829，P＜0．01).The plasma BNP levels were positivelycorrelated with LAD(r=0．784，P＜0．01)，but negatively correlated with PtfV1(r=-0．754，P＜0．01)．
Conclusions：
Meanwhile the plasma BNP level，echocardiographic heart functional parameters and Ptf V1are detected，it will be obtained that heart damage degree, exact diagnosis of DHF andcomprehensive assessment of left heart function in hypertensives．
旨在通过检测原发性高血压(EH)患者血浆B型脑钠肽(BNP),超声心动图指标及心电图V1导联P波终末电势(PtfV1)指标,探讨不同血压水平及发生心功能不全时指标变化,分析高血压患者血浆BNP水平变化及与超声心动图指标、心电图PtfV1的相关性。
方法:
将83例门诊及住院原发性高血压患者分为心功能正常组46例和心力衰竭(HF)组37例。高血压心功能正常组又分三个亚组:高血压1级亚组10例、高血压2级亚组17例、高血压3级亚组19例;高血压心衰组又分两个亚组:高血压伴舒张性心衰(DHF)亚组21例、高血压伴收缩性心衰(SHF)亚组16例,同时选取20名健康对照者。测定血浆BNP水平、利用超声心动图测定每组左室射血分数(LVEF)、左室舒张末期内径(LVEDD)及左房内径(LAD)、常规描记十二导联心电图并计算PtfV1,对结果进行统计学处理。
结果:
(1)高血压组血浆BNP水平(251.7±281.0pg/ml)高于正常对照组(14.5±10.9pg/ml,P<0.01)。高血压无心衰组血浆BNP水平(36.0±20.1pg/ml)高于正常对照组(14.5±10.9pg/ml,P<0.01)。高血压伴心衰组血浆BNP水平(519.9±214.3pg/ml)高于高血压无心衰组高血压组(36.0±20.1pg/ml,P<0.01)、正常对照组(14.5±10.9pg/ml,P<0.01)。
(2)在心功能正常亚组,血浆BNP水平高血压3级亚组(49.0±21.4pg/ml)高于高血压1级亚组(24.5±14.1pg/ml,P<0.05)、高血压2级亚组(28.2±12.6pg/ml,P<0.05)和正常对照组(14.5±10.9pg/ml,P<0.05),高血压2级亚组(28.2±12.6pg/ml)高于正常对照组(14.5±10.9pg/ml,P<0.05)。而高血压1级亚组与正常对照组、高血压1级亚组与2级亚组之间两两比较差异无统计学意义(P>0.05)。随着高血压级别增加BNP水平、LVEDD、LAD呈增大趋势,LVEF、PtfV1呈减小趋势。
(3)在心功能不全亚组,高血压伴SHF组血浆BNP水平(685.6±199.6pg/ml)高于高血压伴DHF组(393.7±118.6pg/ml,P<0.05)、正常对照组(14.5±10.9pg/ml,P<0.05)、高血压心功能正常组高血压组(36.0±20.1pg/ml,P<0.05)、心功能正常组高血压三个亚组组(24.5±14.1pg/ml,P<0.05;28.2±12.6pg/ml,P<0.05;49.0±21.4pg/ml,P<0.05)。高血压伴DHF组(393.7±118.6pg/ml)高于正常对照组(14.5±10.9pg/ml,P<0.05)、高血压心功能正常组高血压组(36.0±20.1pg/ml,P<0.05)、心功能正常组高血压三个亚组(24.5±14.1pg/ml,P<0.05;28.2±12.6pg/ml,P<0.05;49.0±21.4pg/ml,P<0.05)。高血压伴SHF组中的LVEF、LVEDD、LAD、PtfV1与高血压伴DHF组、心功能正常高血压三个亚组、正常对照组分别进行两两比较差异有统计学意义(P<0.05)。随着心功能恶化,BNP、LVEDD、LAD呈明显增大趋势,LVEF、PtfV1呈明显减小趋势。
(4)血浆BNP值与LVEF呈显著负相关性(r=-0.826,P<0.01);与LVEDD呈正相关(r=0.829,P<0.01)。BNP水平与LAD呈较强的正相关(r=0.784,P<0.01);与Ptfv1呈较强负相关(r=-0.754,P<0.01)。
结论:
临床上对高血压患者进行血浆BNP水平测定,结合超声心动图测定指标、心电图Vl导联P波终末电势,有助于了解高血压患者心脏损害程度、诊断舒张性心衰和对心功能进行综合评估。
Objective：
To explore the variance of indices according varying blood pressure and heart function bydetecting plasma concentration of B-type natriuretic peptide(BNP)、echocardiographic heartfunctional parameters and P—wave terminal force in essential hypertensives(EH).To investigatethe correlation of plasma BNP level with echocardiographic heart functional parameters andP—wave terminal force—V1(PtfV1) in patients with EH.
Method：
83 patients with EH in hospital and outpatient service were divided into two groups：EHwithout heart failure (HF)group (n=46) and EH with HF group (n=37). EH without HF groupwere divided into three sub-groups: grade 1 hypertensives group(n=10), grade 2 hypertensivesgroup(n=17), grade 3 hypertensives group(n=19). EH with HF group were divided into twosub-groups: diastolic heart failure(DHF) group (n=21)，systolic heart failure(SHF) group(n=16)．Control group(n=20). Plasma BNP level were determined，LVEF，LVEDD，LAD wereexamined by echocardiography，and Ptf V1 were measured by electrocardiogram inabove-mentioned groups，statistical analysis was applied for the data.Results：
(1)The plasma BNP levels in patients with EH(251.7±281.0 pg/ml)were higher than thosein control group(14.5±10.9 pg/ml，P＜0.01). The plasma BNP levels in EH without HF group(36.0±20.1 pg/ml)were higher than those in control group(14.5±10.9 pg/ml，P＜0.01). Theplasma BNP levels in EH with HF group(519.9±214.3pg/ml)were higher than those in EHwithout HF group(36.0±20.1pg/ml P＜0.01)and control group(14.5±10.9 pg/ml，P＜0.01).
(2) In EH without HF sub-group, the plasma BNP levels in grade 3 hypertensivessub-group ( 49.0±21.4pg/ml ) were higher than those in grade 1 hypertensives sub-group(24.5±14.1p g/ml，P＜0.05)、grade 2 hypertensives sub-group(28.2±12.6pg/ml，P＜0.05)and control group ( 14.5±10.9 pg/ml，P＜0.05 ) , grade 2 hypertensives sub-group(28.2±12.6pg/ml)were higher than those in control group(14.5±10.9 pg/ml，P＜0.05).Butas to plasma BNP levels , there were not significant differences comparing grade 1hypertensives sub-group with control group, grade 1 hypertensives group and grade 2hypertensives group ( P＞0.05). With the elevating of hypertension degree the plasma BNPlevel , LVEDD and LAD were increased , but LVEF and PtfV1 were decreased .
(3) In EH with HF sub-group, the plasma BNP levels in EH with SHF(685.6±199.6 pg/ml)were higher than those in EH with DHF group(393.7±118.6 pg/ml，P＜0.05), controlgroup(14.5±10.9 pg/ml，P＜0.05), EH without HF group(36.0±20.1pg/ml P＜0.05), threeEH sub-groups without HF ( 24.5±14.1pg/ml，P＜0.05；28.2±12.6pg/ml，P＜0.05；49.0±21.4pg/ml，P＜0.05).The plasma BNP levels in EH with DHF group(393.7±118.6 pg/ml)were higher than those in control group(14.5±10.9 pg/ml，P＜0.05), EH without HF group(36.0±20.1pg/ml P＜0.05), three EH sub-groups without HF(24.5±14.1pg/ml，P＜0.05；28.2±12.6pg/ml，P＜0.05；49.0±21.4pg/ml，P＜0.05). LVEF、LVEDD、LAD and PtfV1 inEH with SHF group , there were significant differences comparing with DHF group, three EHsub-groups without HF, control group(P＜0.05). With the worsening of HF ,the plasma BNPlevels,LVEDD and LAD were increased,but LVEF and PtfV1 were decreased .
(4)The plasma BNP level were negatively correlated with LVEF(r=- 0.826，P＜0．01), butpositively correlated with LVEDD(r=0．829，P＜0．01).The plasma BNP levels were positivelycorrelated with LAD(r=0．784，P＜0．01)，but negatively correlated with PtfV1(r=-0．754，P＜0．01)．
Conclusions：
Meanwhile the plasma BNP level，echocardiographic heart functional parameters and Ptf V1are detected，it will be obtained that heart damage degree, exact diagnosis of DHF andcomprehensive assessment of left heart function in hypertensives．
引文
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[31]霍明芳，孙艳敏.异常PTFV1与冠心病左心功能不全及心律失常的关系.第四军医大学学报, 2005, 26 (15) .
[32]张登芳，才晓君. PTFv1与左心衰竭32例临床分析[ J ].中国现代医学杂志, 2004, 14(9) : 148～150.
[33] De Simone G, Greco R,Mureddu G, et al. Relation of left ventricular diastolic properties tosystolic in arterial hypertersion [ J ]. Circulation, 2000, 101 (2) : 152.
[1] Jiang He, DongfengGu, Xigui Wu, et al. Major causes of death among men and women inChina[J]. N Engl J Med, 2005, 353( 11) : 1124- 1134.
[2] Yusuf S, Reddy S, Ounpuu S, et al. Global burden of cardiovascular disease: part I: generalconsiderations, the epidemiologic transition,risk factors, and impact of urbanization[J].Circulation, 2001, 104( 13) :2746- 2753.
[3] World Health Organization, Internationl Society of Hypertension Writing Group. 2003World Health Organization(WHO) /I nternational Society of Hypertension( ISH) statement onmanagement of hypertension[J].J Hypertens, 2003, 21( 11) : 1983- 1992.
[4] Sudoh T, Kangaw a K, M inam ino N, etal A new natriuretic peptide in porcine brain Nature,1988, 332: 78-81.
[5]任节，段宝祥，毛建华等.脑钠肽的来源结构及作用.临床医学2004，24（6）：47-48.
[6] NakaoK, Ogaw aY, Suga S, etal Mo lecular biology and biochemistry of the natriuretic peptide systemⅡ: Natriuretic peptide receptors J Hypertens, 1992, 10( 10) : 1111-1114.
[7] Sudoh T, Kangawa K,Minamino N , et al . A new natriuretic peptide in porcine brain[J ] .Nature ,1988 ,332(3) :78281.
[8] L IM H S , PATEL J V , NADAR S , et al. Comparison of brain natriuretic peptide and leftventricular diastolic functiong dctemined by tissue Doppler in patients with diabetesmellitus ,patients with hypertensiong without diabetes , and in healthy subjects [ J ] .Am JCardiol , 2005 ,95 :905 - 908.
[9] MAISEL A S , KRISHNASWAMY P , NOWA K RM , etal. Rapid measurement of B-typenatriuretic peptide in enmergency diagnosis of heart failue[J ] . NEngl J Med ,2003 ,437 :161 -167.
[10]吴波，张书富，陈德等.脑钠肽与高血压左室重塑、左室功能的关系[J ] .临床心血管病杂志,2007 ,23 (7) :510 - 512.
[11] Simon de Denus,Chantal Pharand,etal.Brain natriuretic peptide in the management of heartfailure.Chest,2004,125:625-688.
[12]徐丽，陈兰英利钠肽的结构、受体与生理作用．生物化学与生物物理进展，2002，29(5):78O．
[13] Januzzi JL Jr, Cam argo CA, Anw aruddin S, etal The NTerm inalPro-BNP investigation ofdyspnea in the emergency department( PR IDE ) study Am J Cardio ,l 2005, 95 ( 8 ):948-954.
[14] N ishik im iT, M aeda N, M a tuoka H The role of natriuretic peptides in cardio protectionCardiovasc Rds, 2006, 69( 2):318-328．
[15]潘柏申心脏标志物的临床应用中华检验医学杂志,2005, 28( 1): 124-126.
[16] Frans Boonsma, Anton H.van den Meiracker.Plasma B-type natriuretic peptides:physiology,methodology and clinical use.Cardiovascular Research, 2001, 51:442-449 .
[17] Vicky A.Cameron Leigh J.Natriuretic peptides during development of the fetal heart andcirculation.Endocrinology,2003,144(16):2191-2194.
[18]史晓敏，徐国宾，夏铁安.B型尿钠肽的生物学特性及其测定的临床应用.临床检验杂志2005,23(1):67-69.
[19]杨传高，李红霞，周业峰等.血浆BNP浓度与高血压病LVH及心功能的关系[ J] .苏州大学学报医学版, 2004, 24 ( 2) : 193-195.
[20] Z ile MR, Ba icu CF, GaaschWH. D iastolic heart failure abnorma lities in active relaxationand passive stiffness of the left ventricle [ J] . N Engl JM ed, 2004, 350( 19 ): 1953-1959.
[21]田昌俊，程龙献，心房利尿钠肽和脑利尿钠肽基因多态性与原发性高血压病的关联性研究华中科技大学学报(医学版) 2010年2月第39卷第1期13-17。
[22] Raizada V, Thakore K, Luo W, eta1. Cardiac cham be rspecific alteration of ANP and BNPexpression with advancing age and with systemic hypertension Mo l Ce ll B iochem,2001,216( 1-2): 137-140.
[23] Saka ta Y, Yam am oto K, M asuyam a T, eta1.Ventriclar production of natriuretic peptidesand ventricular structura l remodeling in hypertensive heart failure. JH ypertens, 2001, 19( 10):1905-1912.
[24]宋浩明，邓兵，沈艺，张佳，罗明高血压病患者脑钠肽水平与心脏测量指标的相关性心脏杂志( Chin Heart J) 2007, 19( 1) 85-87.
[25] SuzukiM, H am adaM, Yam am oto K, eta1. Brain natriuretic peptide as a risk marker forincident hypertensive cardio-vascular event Hypertens Res, 2002, 25( 5): 669-676.
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[27]陈广胜，李新立，许迪等原发性高血压患者血清脑利钠肽水平与左室重构的关系.心脑血管病防治, 2005,5( 2): 7-9.
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[30]孙娴超，孙小平，胡立群.原发性高血压患者24小时平均脉压与PTFV1的相关性研究.浙江临床医学, 2005, 3: 235～236.
[31]霍明芳，孙艳敏.异常PTFV1与冠心病左心功能不全及心律失常的关系.第四军医大学学报, 2005, 26 (15) .
[32]张登芳，才晓君. PTFv1与左心衰竭32例临床分析[ J ].中国现代医学杂志, 2004, 14(9) : 148～150.
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[1] Jiang He, DongfengGu, Xigui Wu, et al. Major causes of death among men and women inChina[J]. N Engl J Med, 2005, 353( 11) : 1124- 1134.
[2] Yusuf S, Reddy S, Ounpuu S, et al. Global burden of cardiovascular disease: part I: generalconsiderations, the epidemiologic transition,risk factors, and impact of urbanization[J].Circulation, 2001, 104( 13) :2746- 2753.
[3] World Health Organization, Internationl Society of Hypertension Writing Group. 2003World Health Organization(WHO) /I nternational Society of Hypertension( ISH) statement onmanagement of hypertension[J].J Hypertens, 2003, 21( 11) : 1983- 1992.
[4] Sudoh T, Kangaw a K, M inam ino N, etal A new natriuretic peptide in porcine brain Nature,1988, 332: 78-81.
[5]任节，段宝祥，毛建华等.脑钠肽的来源结构及作用.临床医学2004，24（6）：47-48.
[6] NakaoK, Ogaw aY, Suga S, etal Mo lecular biology and biochemistry of the natriuretic peptide systemⅡ: Natriuretic peptide receptors J Hypertens, 1992, 10( 10) : 1111-1114.
[7] Sudoh T, Kangawa K,Minamino N , et al . A new natriuretic peptide in porcine brain[J ] .Nature ,1988 ,332(3) :78281.
[8] L IM H S , PATEL J V , NADAR S , et al. Comparison of brain natriuretic peptide and leftventricular diastolic functiong dctemined by tissue Doppler in patients with diabetesmellitus ,patients with hypertensiong without diabetes , and in healthy subjects [ J ] .Am JCardiol , 2005 ,95 :905 - 908.
[9] MAISEL A S , KRISHNASWAMY P , NOWA K RM , etal. Rapid measurement of B-typenatriuretic peptide in enmergency diagnosis of heart failue[J ] . NEngl J Med ,2003 ,437 :161 -167.
[10]吴波，张书富，陈德等.脑钠肽与高血压左室重塑、左室功能的关系[J ] .临床心血管病杂志,2007 ,23 (7) :510 - 512.
[11] Simon de Denus,Chantal Pharand,etal.Brain natriuretic peptide in the management of heartfailure.Chest,2004,125:625-688.
[12]徐丽，陈兰英利钠肽的结构、受体与生理作用．生物化学与生物物理进展，2002，29(5):78O．
[13] Januzzi JL Jr, Cam argo CA, Anw aruddin S, etal The NTerm inalPro-BNP investigation ofdyspnea in the emergency department( PR IDE ) study Am J Cardio ,l 2005, 95 ( 8 ):948-954.
[14] N ishik im iT, M aeda N, M a tuoka H The role of natriuretic peptides in cardio protectionCardiovasc Rds, 2006, 69( 2):318-328．
[15]潘柏申心脏标志物的临床应用中华检验医学杂志,2005, 28( 1): 124-126.
[16] Frans Boonsma, Anton H.van den Meiracker.Plasma B-type natriuretic peptides:physiology,methodology and clinical use.Cardiovascular Research, 2001, 51:442-449 .
[17] Vicky A.Cameron Leigh J.Natriuretic peptides during development of the fetal heart andcirculation.Endocrinology,2003,144(16):2191-2194.
[18]史晓敏，徐国宾，夏铁安.B型尿钠肽的生物学特性及其测定的临床应用.临床检验杂志2005,23(1):67-69.
[19]杨传高，李红霞，周业峰等.血浆BNP浓度与高血压病LVH及心功能的关系[ J] .苏州大学学报医学版, 2004, 24 ( 2) : 193-195.
[20] Z ile MR, Ba icu CF, GaaschWH. D iastolic heart failure abnorma lities in active relaxationand passive stiffness of the left ventricle [ J] . N Engl JM ed, 2004, 350( 19 ): 1953-1959.
[21]田昌俊，程龙献，心房利尿钠肽和脑利尿钠肽基因多态性与原发性高血压病的关联性研究华中科技大学学报(医学版) 2010年2月第39卷第1期13-17。
[22] Raizada V, Thakore K, Luo W, eta1. Cardiac cham be rspecific alteration of ANP and BNPexpression with advancing age and with systemic hypertension Mo l Ce ll B iochem,2001,216( 1-2): 137-140.
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