N-末端脑利钠肽与内皮素在左、右心功能不全患者中水平的比较
摘要
目的:观察慢性心功能不全患者血浆NT-proBNP和ET的水平以及超声心动图反映心室功能的有关参数,研究NT-porBNP和ET对心脏功能的评价作用及在心衰诊断中的应用价值,并对左、右心室功能不全心力衰竭患者血浆NT-proBNP和ET的水平进行比较,并探讨二者的相关性。
方法:选取中南大学湘雅医院心血管内科的门诊和住院患者共96例,分为左心室功能不全组62例(其中左室收缩功能不全组31例,左室舒张功能不全组31例),右心室功能不全组14例,对照组心功能正常者20例。采集入选病例所有临床资料,并对左心室功能不全患者心功能进行NYHA分级。入院或就诊24小时内行超声心动图检查,对所有患者抽静脉血测定血浆中NT-proBNP和ET水平。
结果:(1)左室收缩功能不全组、左室舒张功能不全组、右心室功能不全组和对照组四组间比较,以左室收缩功能不全组中NT-proBNP水平(2743.47±2276.52pg/ml)最高,其次为左室舒张功能不全组(446.94±415.76pg/ml),而右心室功能不全组NT-proBNP水平(387.24±333.46pg/ml)较低,但均高于对照组(97.60±84.43pg/ml),各组间差异有统计学意义(p=0.000)。(2)四组间比较,ET水平在左室舒张功能不全组(39.17±24.49ng/L)较左室收缩功能不全组(55.31±33.62ng/L)和右心室功能不全组(54.04±38.15ng/L)低,但高于对照组(15.98±12.37ng/L),各组间差异有统计学意义(P=0.000)。(3)NT-proBNP水平随着NYHA心功能分级的逐级增加而升高(NYHAⅡ级:189.46±161.47pg/ml,NYHAⅢ级:770.43±727.69pg/ml,NYHAⅣ级:2782.69±2470.11pg/ml),各级间差异有统计学意义(P=0.001)。(4)ET水平随着NYHA心功能分级的逐级增加而升高(NYHAⅡ级:31.42±20.57ng/L,NYHAⅢ级:45.18±21.41ng/L,NYHAⅣ级:60.38±38.64ng/L),各级间差异有统计学意义(P=0.013)。(5)在左心室功能不全组中,NT-proBNP与ET呈正相关,(r=0.407,P=0.001),与左室射血分数呈负相关(r=-0.430,P=0.000),与左室舒张末期内径呈正相关,(r=0.451,p=0.000);ET与左室射血分数呈弱负相关(r=-0.272,P=0.033),与左室舒张末期内径呈弱正相关(r=0.256,P=0.045)。
结论:(1)NT-proBNP与ET是诊断心力衰竭的重要指标。(2)左心室功能不全患者NT-proBNP水平明显较右心室功能不全患者高,左室收缩功能不全患者NT-proBNP和ET水平明显较左室舒张功能不全患者高。(3)NT-proBNP与ET水平均随着NYHA心功能分级的逐级增加而升高,可以预测心力衰竭的严重程度。(4)左心室功能不全患者NT-proBNP与ET呈正相关性,提示二者在心力衰竭的发生、发展中起重要作用。(5)NT-proBNP与超声心动图评价左心室功能的方法具有良好的相关性。
Objective:To investigate the concentrations of N-terminal pro-brain natriuretic peptide(NT-proBNP)、endothelin(ET) and the indexes of ventricular function examed by ultrasonic cardiogram(UCG) in patients with heart failure.To study the roles of NT-proBNP and ET on cardiac function evaluation and diagnosis of heart failure.To compare NT-proBNP and ET levels in patients between left and right ventricular dysfunction.The relationship between NT-proBNP and ET was also studied.
Methods:Ninety-six patients were included in the study.The patients were divided into 4 groups:the left ventricular systolic dysfunction group,the left ventricular diastolic dysfunction group,the right ventricular dysfunction group,and the control group.The left ventricular dysfunction group were divided into 3 groups:NYHAⅡ,NYHAⅢ,NYHAⅣ.NT-proBNP and ET were measured in all subjects.
Results:1.In the left ventricular systolic dysfunction group,the left ventricular diastolic dysfuncton group and the right ventricular dysfunction group,the concentrations of NT-proBNP and ET were much higher than that of control group(97.60±84.43pg/ml),(P=0.000).Among the four groups,the concentration of NT-proBNP was highest in the left ventricular systolic dysfunction group(2743.47±2276.52pg/ml),second in the left ventricular diastolic dysfunction group(446.94±415.76pg/ml),third in the right ventricular dysfunction group(387.24±333.46pg/ml).2.Among the four groups,the concentration of ET in the left ventricular diastolic dysfunction group(39.17±24.49ng/L) was much lower than that of left ventricular systolic dysfunction group(55.31±33.62ng/L) or right ventricular dysfunction group(54.04±38.15ng/L),but showed higher concentration than that in the control group(15.98±12.37ng/L),(P=0.000).3.There were significant differences of NT-proBNP levels among NYHA classes in left ventricular dysfunction group(NYHAⅡ:189.46±161.47pg/ml,NYHAⅢ:770.43±727.69pg/ml,NYHAⅣ:2782.69±2470.11pg/ml),(P=0.001).4.There were significant differences of ET levels among NYHA classes in left ventricular dysfunction group(NYHAⅡ:31.42±20.57ng/L,NYHAⅢ:45.18±21.41ng/L,NYHAⅣ:60.38±38.64ng/L),(P=0.013).5.In the left ventricular dysfunction group,the concentration of NT-proBNP was positively correlated with ET(r=0.407,P=0.001),and negatively correlated with LVEF(r=-0.430,P=0.000),and positively correlated with LVEDD(r=0.451,P=0.000).The concentration of ET negatively correlated with LVEF(r=-0.272,P=0.033),and positively correlated with LVEDD(r=0.256,P=0.045)
Conclusion:1.NT-proBNP and ET could diagnose heart failure.2.The concentration of NT-proBNP in patients with left ventricular dysfunction was much higher than that with right ventricular dysfunction,the concentrations of NT-proBNP and ET in patients with left ventricular systolic dysfunction were much higher than that in left ventricular diastolic dysfunction.3.NT-proBNP and ET were positively correlated with NYHA classification,they could predict severity of heart failure.4.NT-proBNP in patients with left ventricular dysfunction was positively correlated with ET,NT-proBNP and ET might possess important significance in development of CHF.5.NT-proBNP had good correlation with UCG.
方法:选取中南大学湘雅医院心血管内科的门诊和住院患者共96例,分为左心室功能不全组62例(其中左室收缩功能不全组31例,左室舒张功能不全组31例),右心室功能不全组14例,对照组心功能正常者20例。采集入选病例所有临床资料,并对左心室功能不全患者心功能进行NYHA分级。入院或就诊24小时内行超声心动图检查,对所有患者抽静脉血测定血浆中NT-proBNP和ET水平。
结果:(1)左室收缩功能不全组、左室舒张功能不全组、右心室功能不全组和对照组四组间比较,以左室收缩功能不全组中NT-proBNP水平(2743.47±2276.52pg/ml)最高,其次为左室舒张功能不全组(446.94±415.76pg/ml),而右心室功能不全组NT-proBNP水平(387.24±333.46pg/ml)较低,但均高于对照组(97.60±84.43pg/ml),各组间差异有统计学意义(p=0.000)。(2)四组间比较,ET水平在左室舒张功能不全组(39.17±24.49ng/L)较左室收缩功能不全组(55.31±33.62ng/L)和右心室功能不全组(54.04±38.15ng/L)低,但高于对照组(15.98±12.37ng/L),各组间差异有统计学意义(P=0.000)。(3)NT-proBNP水平随着NYHA心功能分级的逐级增加而升高(NYHAⅡ级:189.46±161.47pg/ml,NYHAⅢ级:770.43±727.69pg/ml,NYHAⅣ级:2782.69±2470.11pg/ml),各级间差异有统计学意义(P=0.001)。(4)ET水平随着NYHA心功能分级的逐级增加而升高(NYHAⅡ级:31.42±20.57ng/L,NYHAⅢ级:45.18±21.41ng/L,NYHAⅣ级:60.38±38.64ng/L),各级间差异有统计学意义(P=0.013)。(5)在左心室功能不全组中,NT-proBNP与ET呈正相关,(r=0.407,P=0.001),与左室射血分数呈负相关(r=-0.430,P=0.000),与左室舒张末期内径呈正相关,(r=0.451,p=0.000);ET与左室射血分数呈弱负相关(r=-0.272,P=0.033),与左室舒张末期内径呈弱正相关(r=0.256,P=0.045)。
结论:(1)NT-proBNP与ET是诊断心力衰竭的重要指标。(2)左心室功能不全患者NT-proBNP水平明显较右心室功能不全患者高,左室收缩功能不全患者NT-proBNP和ET水平明显较左室舒张功能不全患者高。(3)NT-proBNP与ET水平均随着NYHA心功能分级的逐级增加而升高,可以预测心力衰竭的严重程度。(4)左心室功能不全患者NT-proBNP与ET呈正相关性,提示二者在心力衰竭的发生、发展中起重要作用。(5)NT-proBNP与超声心动图评价左心室功能的方法具有良好的相关性。
Objective:To investigate the concentrations of N-terminal pro-brain natriuretic peptide(NT-proBNP)、endothelin(ET) and the indexes of ventricular function examed by ultrasonic cardiogram(UCG) in patients with heart failure.To study the roles of NT-proBNP and ET on cardiac function evaluation and diagnosis of heart failure.To compare NT-proBNP and ET levels in patients between left and right ventricular dysfunction.The relationship between NT-proBNP and ET was also studied.
Methods:Ninety-six patients were included in the study.The patients were divided into 4 groups:the left ventricular systolic dysfunction group,the left ventricular diastolic dysfunction group,the right ventricular dysfunction group,and the control group.The left ventricular dysfunction group were divided into 3 groups:NYHAⅡ,NYHAⅢ,NYHAⅣ.NT-proBNP and ET were measured in all subjects.
Results:1.In the left ventricular systolic dysfunction group,the left ventricular diastolic dysfuncton group and the right ventricular dysfunction group,the concentrations of NT-proBNP and ET were much higher than that of control group(97.60±84.43pg/ml),(P=0.000).Among the four groups,the concentration of NT-proBNP was highest in the left ventricular systolic dysfunction group(2743.47±2276.52pg/ml),second in the left ventricular diastolic dysfunction group(446.94±415.76pg/ml),third in the right ventricular dysfunction group(387.24±333.46pg/ml).2.Among the four groups,the concentration of ET in the left ventricular diastolic dysfunction group(39.17±24.49ng/L) was much lower than that of left ventricular systolic dysfunction group(55.31±33.62ng/L) or right ventricular dysfunction group(54.04±38.15ng/L),but showed higher concentration than that in the control group(15.98±12.37ng/L),(P=0.000).3.There were significant differences of NT-proBNP levels among NYHA classes in left ventricular dysfunction group(NYHAⅡ:189.46±161.47pg/ml,NYHAⅢ:770.43±727.69pg/ml,NYHAⅣ:2782.69±2470.11pg/ml),(P=0.001).4.There were significant differences of ET levels among NYHA classes in left ventricular dysfunction group(NYHAⅡ:31.42±20.57ng/L,NYHAⅢ:45.18±21.41ng/L,NYHAⅣ:60.38±38.64ng/L),(P=0.013).5.In the left ventricular dysfunction group,the concentration of NT-proBNP was positively correlated with ET(r=0.407,P=0.001),and negatively correlated with LVEF(r=-0.430,P=0.000),and positively correlated with LVEDD(r=0.451,P=0.000).The concentration of ET negatively correlated with LVEF(r=-0.272,P=0.033),and positively correlated with LVEDD(r=0.256,P=0.045)
Conclusion:1.NT-proBNP and ET could diagnose heart failure.2.The concentration of NT-proBNP in patients with left ventricular dysfunction was much higher than that with right ventricular dysfunction,the concentrations of NT-proBNP and ET in patients with left ventricular systolic dysfunction were much higher than that in left ventricular diastolic dysfunction.3.NT-proBNP and ET were positively correlated with NYHA classification,they could predict severity of heart failure.4.NT-proBNP in patients with left ventricular dysfunction was positively correlated with ET,NT-proBNP and ET might possess important significance in development of CHF.5.NT-proBNP had good correlation with UCG.
引文
[1]Moe GW.B-type natriuretic peptide in heart failure[J].Curr Op in Cardiol,2006,21(3):208-214.
[2]Sudoh T,Kangawa K,Minamino N,et al.A natriuretic peptide in porcine brain[J].Nature.1988,322:78.
[3]Zhang Guo-hua,Hu Yun,Shi Xiao-min,et al.The biological characteristic of B-type natriuretic peptide and the clinical application progress in heart disease[J].Chinese Journal of Laboratory Medicine,2004,27(4):262-265.
[4]Mueller T,Gegenhuber A,Poelz W,et al.Head-to-head comparison of the diagnostic utility of BNP and NT-proBNP in symptomatic and assymptomatic structural heart disease[J].Clin Chim Acta,2004,341(1-2):41-48.
[5]Losonezy G,Kriston T,Szsho A.Male gender predisposes development of endotoxie shock inthe rat[J].Cardiotmse Res,2000,47(1):183-191.
[6]Cheng JW.Bosentan[J].HeartDis,2003,5:161-169.
[7]Muller DN,Mervaala EM,Schmidt F,etal.Effect of bosentan on NF-Kb,inflamm-ation,and tissue factor in angiotensin-induced and organ damage[J].Hypertension,2000,36:282-290.
[8]PiacentiniL,Honda M,Saida K,et al.Endotholin-lStimulates Cardiac fibroblast proliferation through activation of protein kinaseC[J].J Mol Cell Cardiol,2000,32:565-576.
[9]Bauer M,Wilkens H,Langer CF,et al.elective upregulation of endothelin B receptor gene expressionin severe pulmonary hypertension[J].Circulation,2002,105:1034-1036.
[10]Yamamoto K,lkeda U,Mito H,et al.Endothelin production in pulmonary circulation of patient with mitral stenesis[J].Circulation,1994,89(5):2093-2098
[11]Rubin LJ,Badesch DB,Barst RJ,etal.Bosentan therapy for pulmonary arterial hypertension[J].Neng 1 J Med,2002,346(12):896-903.
[12]祝烨.B一型尿钠肤(BNP)在左、右心室功能不全心力衰竭患者血液中水平的比较及与严重心衰患者近期死亡关系的初步观察[D].四川大学,2003.
[13]丁连芹,李明,牟春平,等.心梗塞患者血浆脑钠素N端前体肽与内皮素含量的相关性[J].心血管康复医学杂志,2006,15(6):540-541.
[14]ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008[J].European Heart Journal,2008,29:2388-2442.
[15]林培林.N-端B型钠利尿肽(NT-proBNP)与心力衰竭的相关性研究[D].青岛大学,2007.
[16]黄水明,方玉才,钱健,等.B型钠尿肽检测对心力衰竭的早期诊断价值[J].心脑血管病防治,2005,5(1):32-34.
[17]赵世军,郑世良,张学臻,等.心血通对充血性心力衰竭患者血浆内皮素的影响[J].临床荟萃,2003,18(3):149-150.
[18]Hunt SA,Abraham W T,Chin MH,et a 1.ACC/AHA 2005 guideline update for the dignosis and management of chronic heart in the adult-summary article[J].Circulation,2005,112(12):1825-1852.
[19]Piepho RW.Overview of the angiotensin-converting-enzyme inhibitors[J].Am J Health Syst Pharm,2000,57:S3-7.
[20]张天泰.内皮素系统在慢性心力衰竭中作用的研究进展[J].国外医学药学分册,2002,29(4):213-217.
[21]Eryonucu B,Koldas L,Ayan F,et al.Comparison of the first dose response of fosinopril and captopril in congestive heart failure:a randomized,double-blind,placebo controlled study[J].Jpn Heart J,2001,42:185-191.
[22]龚兰生,施仲伟,于金德.充血性心力衰竭[M].第一版.上海:上海科学技术出版社,2002,44.
[23]吴彦.Bnp的基础医学部分[M]//胡大一,杨振华.B型钠尿肽的临床应用和最新进展.北京:科学技术出版社,2006:14-22.
[24]Dokainish H,Zoghbi WA,Lakkis NM,et al.Optimal noninvasive assessment of left ventricular filling pressures:a comparison of tissue Doppler echocardiography and B-type natriuretic peptide in patients with pulmonary artery catheters[J].Circulation,2004,25:2432-2439.
[25]Jenny AD,Paul PG,Eva P,et al.A systematic review of the diagnostic accuracy of natriuretic peptides for heart failure[J].Arch Intern Med,2004,164:1978-1984.
[26]Angeja BG,Grossman W.Evaluation and management of diastolic heart failure[J].Circulation,2003,107:659-663.
[27]Mottram PM,Leano R,Marwick TH.Usefulness of B-type natriuretic peptide in hypertensive patients with exertional dyspnea and normal left ventricular ejection fraction and correlation with new echocardiographic indexes of systolic and diastolic function[J].Am J Cardiol,2003,92:1434-1438.
[28]Carsten T,Mario K,Dirk W,et al.The role of NT-proBNP in the diagnostics of isolated diastolic dysfunction:correlation with echocardiographic and invasive measurements[J].Eur Heart J,2005,26:2277-2284.
[29]蔡琳.《2007 ESC心力衰竭和超声协会对诊断左室射血分数正常心力衰竭的共识如何诊断舒张性心力衰竭[J].心血管病学进展,2008,29(1):17-20.
[30]Mccullough PA,Nowak RM,Mccord J,et al.B-type natriuretic peptide and clinical judgment in emergency diagnosis ofheart failure:analysis from breathing not properly(BNP) multinational study[J].Circulation,2002,106(4):416-422.
[31]史晓敏,林箐,徐国宾,等.血清N末端B型钠尿肽原在心功能评价及慢性充血性心力衰竭诊断中的初步应用[J].中华检验医学杂志,2005,28(1):37-41.
[32]LeeSC,StevensTL,SandbergSM,et al.The Potential of brain natriuretic peptide as a biomarker for New York Heart Association class during the outpatient treatment of heartfailure[J].J Card Fail,2002,Jun;8(3):149-154.
[33]KusterGM,Tan-nerH,PrintzenG,et al.B-type natriuretic peptide for diagnosis and treatment of congestive heartfailure[J].Swiss Med Wkly,2002 Dec 14;132(43-44):623-628.
[34]Tjeerdsma G,deBoerRA,BoomsmaF,et al.Rapid bedside measurement of brain natriuretic peptide in patients with chronic heart failure[J].Int J Cardiol,2002Dee:86(2-3):143-149.
[35]Davis M,EsPiner E,Riehards G,et al.Plasma brain natriuretic peptide in assessment of acute dyspnoea[J].Laneet,1994 Feb 19;343(8895):440-444.
[36]赵丽,吴学思,韩智红,等.B-型利钠肽检测在心衰患者的临床应用价值[J].第7次全国心血管病学术会议论文集,2002,262-263.
[37]刘敏,徐岩,史学功,等.慢性心衰患者血浆心钠素、脑钠素浓度与心衰程度及左室功能的关系[J].第7次全国心血管病学术会议论文集,2002,515-516.
[1]Mir T S,Marohn S,Laer S,et al.Plasm concentrations of N-terminal pro-brain natriuretic peptide in control children from the neonatal to adolescent period and in children with congestive heartfailure[J].Pediatrics,2002,110:E76.
[2]WIECZOREK S J,WU A H,CHRISTENSON R,et al.A rapid B-type natriuretic peptide assay accurately diagnoses left ventricular dysfunction and heart failure:a multicenter evaluation[J].Am Heart J,2002,144:834-839.
[3]CUSHING S D,BERLINER J A,VALENTE A J,et al.Minimally modified low density lipoprotein induces monocyte chemotactic protein 1 in human endothelial cells and smoth muscle cells[J].Proc Natl Acad Sci,1990,87:5134-5138.
[4]OISHI Y,WAKATSUKI T,NISHIKADO A,et al.Circulating adhesion molecules and severity of coronary atherosclerosis[J].Coron Artery Dis,2000,11:77-81.
[5]MAISELA S,KRISHNASWAMY P,NOWAK R M,et al.Rapid measurement of B2 tipe natriuretic peptide in the emergency diagnosis of heart failure[J].N Eng J Med,2002,347:161-167.
[6]GALLS ZS,SOKHOVA G K,LARK M W,et al.Increased expression of matrix metalloproteinases and matrix degrading activity in vulnerable regions of human atherosclerotic plaqus[J].J Clin Invest,1994,94:2493-2503.
[7]PENG H B,LIBBY P,LIAO J K.Induction and stabilization of 1 kappa B alpha by nitric oxide mediates inhibition of NF-kappa B[J].J Biol Chem,1995,270:14214-14219.
[8]周珊珊,蔡智荣.N末端BNP前体对老年人不典型心力衰竭诊断价值[J].青岛大学医学院学报,2008,44(6):481-482.
[9]JANUZZI J L J R,CAMARGO C A,ANWARUDDIN S,et al.The N-terminal pro-BNP investiation of dyspnea in the emerency department(PRIDE) study [J].Am J Cardiol,2005,95(8):948-954.
[10]赵世平,曹秀华,张丽娜.NT-proBNP在急性冠脉综合征中的研究[J].放射免疫学杂志,2008,21(1):79-82.
[11]SerdarMA,Tokgoz S,MetinyurtG,et al.Effectofmacro-creatine kinase and increased creatine kinase BB on the rapid diagnosis of patients with suspected acute myocardial infarction in the emergency department.MilMed.2005,170(8):648.
[12]GalvaniM,OttaniF,Oltrona L,et al.N-terminal pro-brain natriuretic peptide on admission has prognostic value across the whole spectrum of acute coronary syndromes.Circulation.2004,110:128.
[13]de Lemos JA,Morrow DA,etal.Brain natriuretic peptide measurements in acute coronary syndromes:Ready for clinical application? Circulation.2002,106:2868.
[14]Goetze JP,GoreA,MollerCH,etal.Acutemyocardial hypoxia increases BNP gene expression.FASEB J.2004,18:1928.
[15]孙国华,孙芹敏,肖熙凡.N末端脑钠肽在鉴别心源性和肺源性呼吸困难中的应用研究[J].大连医科大学学报,2008,30(4):378-380.
[16]HuntPJ,RichardsAM,NichollsMG,et al.Immunoreactive aminoterminal pro-brain natriuretic peptide(NT-proBNP):A new marker for cardiac impairment[J].ClinEndocrino,1 1997,47:287-296.
[17]Mccullough PA,Nowak RM,Mccord J,et al.B-type natriuretic peptide and clinical judgment in emergency diagnosis ofheart failure:analysis from breathing notproperly(BNP) multinational study[J].Circulation,2002,106(4):416-422.
[18]史晓敏,林箐,徐国宾,等.血清N末端B型钠尿肽原在心功能评价及慢性充血性心力衰竭诊断中的初步应用[J].中华检验医学杂志,2005,28(1):37-41.
[19]RichardsAM,NichollsMG,YandleTG,eta.l Plasma N- terminal pro -brain natriureitc peptide and adrenomedullin:new neurohormonal predictors of left ventriculation function and prognosis after myocardial infarction[J].Circulation,1998,97:1921-1929.
[20]陈玉成,刘兴斌,吕均,等.氨基末端脑钠素前体在风心病合并心力衰竭患者中检测的临床意义[J].四川医学,2005,26(5):491-493.
[21]Logeart D,Saudubray C,Beyne P,et al.Comparative value of Doppler echocardiography and B-type natriuretic peptide assay in the etiologic diagnosis of acute dyspnea[J].J Am Coll Cardiol,2002,40(10):1794-1800
[22]Golbasy Z,Ucar O,Yuksel AG,et al.Plasma brain natriuretic peptide levels in patients with rheumatic heart disease[J].Eur J Heart Fail,2004,6(6):757-760
[23]Eimer MJ,Ekery DL,Rigolin VH,et al.Elevated B-type natriuretic peptide in asymptomatic men with chronic aortic regurgitation and preserved left ventricular systolic function[J].Am JCardiol,2004,94(5):676-678.
[24]高晓峰,李占荣,王希章,等.血浆N末端脑钠肽原与高血压的关系[J].中西医结合心脑血管病杂志,2009,7(2):223-224.
[25]Ford CM,Pruitt R,Parker V,et al.CHF:Effects of cardiac rehabilitation and brain natriuretic peptide[J].Nurse Practitioner,2004,29(3):36-39.
[26]Inoue S,Mnrakami T,Sano K,et al.Atrium as a source of brain natriuretic poly peptide in patients with atrial fibrillation.J Card Fail,2000,6(2):92-96.
[27]Kurosaki K,Tada H,Hashimoto T,et al.Plasma natriuretic peptide concentrations as a predictor for successful catheter ablation in patients with drugrefractory atrial fibrillation.Cir J,2007,71:313-320.
[28]Helge M,Michael W,Albrecht E.Nt-proBNP predicts rhythm stability after cardioversion of lone atrial fibrillation.Circ J,2008,72:921-925.
[29]刘清娥.口服胺碘酮普罗帕酮治疗阵发性心房颤动疗效的对比[J].山西医药杂志,2007,3(1):56.
[30]Dao Q,Krishnasway P,Kenenagra R.Utility of b-type natriuretic peptide in diagnosis of CHF in an urgent care setting.JAM CollCardio,1 2001,37:379-385.
[31]王林海,夏熙郑,邵润霞.N-端脑钠肽前体与慢性阻塞性肺疾病的相关性分析[J].中国实用医药.2008,3(33):31-33.
[32]KuroseM,YoshimuraM,YasueH.Raised plasma BNP in a patient with acute pulmonery embolism.Hear,1997,78:320-321.
[33]KucherN,PrintzenG,GoldhaberSZ.Prognostic Role of Brain Natriuretic Peptide in Acute Pulmonary Embolism.Circulation,2003,107:2545-2547.
[34]刘雅,肖茜,王超,等.脑钠肽的研究现状和进展[J].陕西医学杂志,2008,37(1):116-118.
[35]陈铃,朱红枫.氨基末端脑钠尿肽激素原对小儿心功能的评估[J].中国妇幼健康研究.2006,17(3):202-205.
[36]Nir A,Bar O B,Perles Z,et al.N-terminal pro-B-type natriuretic peptide:reference plasma levels from birth to adolescence:Elevated levels at birth and in infants and children with heart diseases[J].Acta Paediatr,2004,93(5):603-607.
[37]Westerlind A,Wahlander H,Lindstedt G,et al.Clinical signs of heart failure are associated with increased levels of natriuretic peptide types B and A in children with congenital heart defects or cardiomyopathy[J].Acta Paediatr,2004,93(3):340-345.
[38]Nasser N,Perles Z,Rein A J,et al.NT-proBNP as a marker for persistent cardiac disease in children with history of dilated cardiomyopathy and myocarditis[J].Pediatr Cardiol,2006,27(1):87-90.
[39]Cohen S,Springer C,Avital A,et al.Amino-terminal pro-brain-type natriuretic peptide:heart or lung disease in pediatric respiratory distress[J]Pediatrics,2005,115(5):1347-1350.
[40]Soker M,Kervancioglu M.Plasma concentrations of NT-pro-BNP and cardiac troponin-I in relation to doxorubicin-induced cardiomyopathy and cardiac function in childhood malignancy[J].Audi Med J,2005,26(8):1197-1202.
[41]Germanakis I,Kalmanti M,Parthenakis F,et al.Correlation of plasma N-terminal pro-brain natriuretic peptide levels with left ventricle mass in children treated with anthracyclines[J].Int J Cardiol,2006,108(2):212-215.
[42]Fleming S M,O'Gorman T,O'Byrne L,et al.Cardiac troponin I and N-terminal pro-brain natriuretic peptide in umbilical artery blood in relation to fetal heart rate abnormalities during labor[J].Pediatr Cardiol,2001,22(5):393-396.
[43]Friesewinkel O,Furrer M,Hanggi G,et al.Severe heart failure:treatment optimisation and monitoring using plasma NT-proBNP levels-an useful tool in clinical practice[J].Schweiz Rundsch Med Prax,2004,93(12):476-480.
[44]Kohno M,Horio T,Yasunari K,et a l.Stimulation of brain natriuretic pep tide release from the heart by thyroid hormone.Metabolism.1993,Aug,42(8):1059.
[45]L iang F,W ebb P,Marimuthu A,et a l.Triiodothyronine increases brain natriuretic peptide(BNP) gene transcription and amplifies endothelia-dependent BNP gene transcription and hypertrophy in neonatal rat ventricular myocytes.J B iol Chem.2003 Ap r 25,278(17):15073.
[46]Marchant C,B rown L,Sernia C,et a l.Renin-angiotensin system in thyroid dysfunction in rats.J Cardiovasc Pharmacol.1993,Sep,22(3):449.
[47]Klein I,O jamaa K.Thyroid hormone and the cardiovascular system.New England Journal of Medicine.2001,344:501.
[48]陶莉,张延军,张欣,等.甲亢患者血清NT-proBNP水平的变化[J].放射免疫学杂志,2007,20(6):563-566.
[49]Christ-Crain M,Morgenthaler NG,Meier C,et al.Pro-A-type and N-term inal pro-B-type natriuretic peptides in different thyroid function states.Swiss Med W kly.2005 Sep 17,135(37-38):549.
[50]SchultzM,Faber J,Kistorp C,et al.N-terminal pro-B-type natriuretic peptide(NTproBNP)in different thyroid function states.Clin Endocrinol(Oxf).2004Jan,60(1):54.
[51]Hammerer-Lercher A,Neubauer E,Pachinger O,et al.Head-to -head comparison of N-term inal p ro-brain natriuretic pep tide,brain natriuretic pep tide,and N-term inal p ro-atrial natriuretic pep tide in diagnosing left ventricular dysfunction.Clinica Chm ica Acta.2001,310:193.
[52]Helfand M.Screening for subclinical thyroid dysfunction in nonp regnant adults:a summary of the evidence for the U.S.Preventive Services Task Force.Ann Intern Med.2004,140:128.
[53]郭江平,王秀文,孙涛.NT-Pro-BNP评价肥厚型心肌病预后的临床研究[J].长治医学院学报,2007,21(4):261-262.
[2]Sudoh T,Kangawa K,Minamino N,et al.A natriuretic peptide in porcine brain[J].Nature.1988,322:78.
[3]Zhang Guo-hua,Hu Yun,Shi Xiao-min,et al.The biological characteristic of B-type natriuretic peptide and the clinical application progress in heart disease[J].Chinese Journal of Laboratory Medicine,2004,27(4):262-265.
[4]Mueller T,Gegenhuber A,Poelz W,et al.Head-to-head comparison of the diagnostic utility of BNP and NT-proBNP in symptomatic and assymptomatic structural heart disease[J].Clin Chim Acta,2004,341(1-2):41-48.
[5]Losonezy G,Kriston T,Szsho A.Male gender predisposes development of endotoxie shock inthe rat[J].Cardiotmse Res,2000,47(1):183-191.
[6]Cheng JW.Bosentan[J].HeartDis,2003,5:161-169.
[7]Muller DN,Mervaala EM,Schmidt F,etal.Effect of bosentan on NF-Kb,inflamm-ation,and tissue factor in angiotensin-induced and organ damage[J].Hypertension,2000,36:282-290.
[8]PiacentiniL,Honda M,Saida K,et al.Endotholin-lStimulates Cardiac fibroblast proliferation through activation of protein kinaseC[J].J Mol Cell Cardiol,2000,32:565-576.
[9]Bauer M,Wilkens H,Langer CF,et al.elective upregulation of endothelin B receptor gene expressionin severe pulmonary hypertension[J].Circulation,2002,105:1034-1036.
[10]Yamamoto K,lkeda U,Mito H,et al.Endothelin production in pulmonary circulation of patient with mitral stenesis[J].Circulation,1994,89(5):2093-2098
[11]Rubin LJ,Badesch DB,Barst RJ,etal.Bosentan therapy for pulmonary arterial hypertension[J].Neng 1 J Med,2002,346(12):896-903.
[12]祝烨.B一型尿钠肤(BNP)在左、右心室功能不全心力衰竭患者血液中水平的比较及与严重心衰患者近期死亡关系的初步观察[D].四川大学,2003.
[13]丁连芹,李明,牟春平,等.心梗塞患者血浆脑钠素N端前体肽与内皮素含量的相关性[J].心血管康复医学杂志,2006,15(6):540-541.
[14]ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008[J].European Heart Journal,2008,29:2388-2442.
[15]林培林.N-端B型钠利尿肽(NT-proBNP)与心力衰竭的相关性研究[D].青岛大学,2007.
[16]黄水明,方玉才,钱健,等.B型钠尿肽检测对心力衰竭的早期诊断价值[J].心脑血管病防治,2005,5(1):32-34.
[17]赵世军,郑世良,张学臻,等.心血通对充血性心力衰竭患者血浆内皮素的影响[J].临床荟萃,2003,18(3):149-150.
[18]Hunt SA,Abraham W T,Chin MH,et a 1.ACC/AHA 2005 guideline update for the dignosis and management of chronic heart in the adult-summary article[J].Circulation,2005,112(12):1825-1852.
[19]Piepho RW.Overview of the angiotensin-converting-enzyme inhibitors[J].Am J Health Syst Pharm,2000,57:S3-7.
[20]张天泰.内皮素系统在慢性心力衰竭中作用的研究进展[J].国外医学药学分册,2002,29(4):213-217.
[21]Eryonucu B,Koldas L,Ayan F,et al.Comparison of the first dose response of fosinopril and captopril in congestive heart failure:a randomized,double-blind,placebo controlled study[J].Jpn Heart J,2001,42:185-191.
[22]龚兰生,施仲伟,于金德.充血性心力衰竭[M].第一版.上海:上海科学技术出版社,2002,44.
[23]吴彦.Bnp的基础医学部分[M]//胡大一,杨振华.B型钠尿肽的临床应用和最新进展.北京:科学技术出版社,2006:14-22.
[24]Dokainish H,Zoghbi WA,Lakkis NM,et al.Optimal noninvasive assessment of left ventricular filling pressures:a comparison of tissue Doppler echocardiography and B-type natriuretic peptide in patients with pulmonary artery catheters[J].Circulation,2004,25:2432-2439.
[25]Jenny AD,Paul PG,Eva P,et al.A systematic review of the diagnostic accuracy of natriuretic peptides for heart failure[J].Arch Intern Med,2004,164:1978-1984.
[26]Angeja BG,Grossman W.Evaluation and management of diastolic heart failure[J].Circulation,2003,107:659-663.
[27]Mottram PM,Leano R,Marwick TH.Usefulness of B-type natriuretic peptide in hypertensive patients with exertional dyspnea and normal left ventricular ejection fraction and correlation with new echocardiographic indexes of systolic and diastolic function[J].Am J Cardiol,2003,92:1434-1438.
[28]Carsten T,Mario K,Dirk W,et al.The role of NT-proBNP in the diagnostics of isolated diastolic dysfunction:correlation with echocardiographic and invasive measurements[J].Eur Heart J,2005,26:2277-2284.
[29]蔡琳.《2007 ESC心力衰竭和超声协会对诊断左室射血分数正常心力衰竭的共识如何诊断舒张性心力衰竭[J].心血管病学进展,2008,29(1):17-20.
[30]Mccullough PA,Nowak RM,Mccord J,et al.B-type natriuretic peptide and clinical judgment in emergency diagnosis ofheart failure:analysis from breathing not properly(BNP) multinational study[J].Circulation,2002,106(4):416-422.
[31]史晓敏,林箐,徐国宾,等.血清N末端B型钠尿肽原在心功能评价及慢性充血性心力衰竭诊断中的初步应用[J].中华检验医学杂志,2005,28(1):37-41.
[32]LeeSC,StevensTL,SandbergSM,et al.The Potential of brain natriuretic peptide as a biomarker for New York Heart Association class during the outpatient treatment of heartfailure[J].J Card Fail,2002,Jun;8(3):149-154.
[33]KusterGM,Tan-nerH,PrintzenG,et al.B-type natriuretic peptide for diagnosis and treatment of congestive heartfailure[J].Swiss Med Wkly,2002 Dec 14;132(43-44):623-628.
[34]Tjeerdsma G,deBoerRA,BoomsmaF,et al.Rapid bedside measurement of brain natriuretic peptide in patients with chronic heart failure[J].Int J Cardiol,2002Dee:86(2-3):143-149.
[35]Davis M,EsPiner E,Riehards G,et al.Plasma brain natriuretic peptide in assessment of acute dyspnoea[J].Laneet,1994 Feb 19;343(8895):440-444.
[36]赵丽,吴学思,韩智红,等.B-型利钠肽检测在心衰患者的临床应用价值[J].第7次全国心血管病学术会议论文集,2002,262-263.
[37]刘敏,徐岩,史学功,等.慢性心衰患者血浆心钠素、脑钠素浓度与心衰程度及左室功能的关系[J].第7次全国心血管病学术会议论文集,2002,515-516.
[1]Mir T S,Marohn S,Laer S,et al.Plasm concentrations of N-terminal pro-brain natriuretic peptide in control children from the neonatal to adolescent period and in children with congestive heartfailure[J].Pediatrics,2002,110:E76.
[2]WIECZOREK S J,WU A H,CHRISTENSON R,et al.A rapid B-type natriuretic peptide assay accurately diagnoses left ventricular dysfunction and heart failure:a multicenter evaluation[J].Am Heart J,2002,144:834-839.
[3]CUSHING S D,BERLINER J A,VALENTE A J,et al.Minimally modified low density lipoprotein induces monocyte chemotactic protein 1 in human endothelial cells and smoth muscle cells[J].Proc Natl Acad Sci,1990,87:5134-5138.
[4]OISHI Y,WAKATSUKI T,NISHIKADO A,et al.Circulating adhesion molecules and severity of coronary atherosclerosis[J].Coron Artery Dis,2000,11:77-81.
[5]MAISELA S,KRISHNASWAMY P,NOWAK R M,et al.Rapid measurement of B2 tipe natriuretic peptide in the emergency diagnosis of heart failure[J].N Eng J Med,2002,347:161-167.
[6]GALLS ZS,SOKHOVA G K,LARK M W,et al.Increased expression of matrix metalloproteinases and matrix degrading activity in vulnerable regions of human atherosclerotic plaqus[J].J Clin Invest,1994,94:2493-2503.
[7]PENG H B,LIBBY P,LIAO J K.Induction and stabilization of 1 kappa B alpha by nitric oxide mediates inhibition of NF-kappa B[J].J Biol Chem,1995,270:14214-14219.
[8]周珊珊,蔡智荣.N末端BNP前体对老年人不典型心力衰竭诊断价值[J].青岛大学医学院学报,2008,44(6):481-482.
[9]JANUZZI J L J R,CAMARGO C A,ANWARUDDIN S,et al.The N-terminal pro-BNP investiation of dyspnea in the emerency department(PRIDE) study [J].Am J Cardiol,2005,95(8):948-954.
[10]赵世平,曹秀华,张丽娜.NT-proBNP在急性冠脉综合征中的研究[J].放射免疫学杂志,2008,21(1):79-82.
[11]SerdarMA,Tokgoz S,MetinyurtG,et al.Effectofmacro-creatine kinase and increased creatine kinase BB on the rapid diagnosis of patients with suspected acute myocardial infarction in the emergency department.MilMed.2005,170(8):648.
[12]GalvaniM,OttaniF,Oltrona L,et al.N-terminal pro-brain natriuretic peptide on admission has prognostic value across the whole spectrum of acute coronary syndromes.Circulation.2004,110:128.
[13]de Lemos JA,Morrow DA,etal.Brain natriuretic peptide measurements in acute coronary syndromes:Ready for clinical application? Circulation.2002,106:2868.
[14]Goetze JP,GoreA,MollerCH,etal.Acutemyocardial hypoxia increases BNP gene expression.FASEB J.2004,18:1928.
[15]孙国华,孙芹敏,肖熙凡.N末端脑钠肽在鉴别心源性和肺源性呼吸困难中的应用研究[J].大连医科大学学报,2008,30(4):378-380.
[16]HuntPJ,RichardsAM,NichollsMG,et al.Immunoreactive aminoterminal pro-brain natriuretic peptide(NT-proBNP):A new marker for cardiac impairment[J].ClinEndocrino,1 1997,47:287-296.
[17]Mccullough PA,Nowak RM,Mccord J,et al.B-type natriuretic peptide and clinical judgment in emergency diagnosis ofheart failure:analysis from breathing notproperly(BNP) multinational study[J].Circulation,2002,106(4):416-422.
[18]史晓敏,林箐,徐国宾,等.血清N末端B型钠尿肽原在心功能评价及慢性充血性心力衰竭诊断中的初步应用[J].中华检验医学杂志,2005,28(1):37-41.
[19]RichardsAM,NichollsMG,YandleTG,eta.l Plasma N- terminal pro -brain natriureitc peptide and adrenomedullin:new neurohormonal predictors of left ventriculation function and prognosis after myocardial infarction[J].Circulation,1998,97:1921-1929.
[20]陈玉成,刘兴斌,吕均,等.氨基末端脑钠素前体在风心病合并心力衰竭患者中检测的临床意义[J].四川医学,2005,26(5):491-493.
[21]Logeart D,Saudubray C,Beyne P,et al.Comparative value of Doppler echocardiography and B-type natriuretic peptide assay in the etiologic diagnosis of acute dyspnea[J].J Am Coll Cardiol,2002,40(10):1794-1800
[22]Golbasy Z,Ucar O,Yuksel AG,et al.Plasma brain natriuretic peptide levels in patients with rheumatic heart disease[J].Eur J Heart Fail,2004,6(6):757-760
[23]Eimer MJ,Ekery DL,Rigolin VH,et al.Elevated B-type natriuretic peptide in asymptomatic men with chronic aortic regurgitation and preserved left ventricular systolic function[J].Am JCardiol,2004,94(5):676-678.
[24]高晓峰,李占荣,王希章,等.血浆N末端脑钠肽原与高血压的关系[J].中西医结合心脑血管病杂志,2009,7(2):223-224.
[25]Ford CM,Pruitt R,Parker V,et al.CHF:Effects of cardiac rehabilitation and brain natriuretic peptide[J].Nurse Practitioner,2004,29(3):36-39.
[26]Inoue S,Mnrakami T,Sano K,et al.Atrium as a source of brain natriuretic poly peptide in patients with atrial fibrillation.J Card Fail,2000,6(2):92-96.
[27]Kurosaki K,Tada H,Hashimoto T,et al.Plasma natriuretic peptide concentrations as a predictor for successful catheter ablation in patients with drugrefractory atrial fibrillation.Cir J,2007,71:313-320.
[28]Helge M,Michael W,Albrecht E.Nt-proBNP predicts rhythm stability after cardioversion of lone atrial fibrillation.Circ J,2008,72:921-925.
[29]刘清娥.口服胺碘酮普罗帕酮治疗阵发性心房颤动疗效的对比[J].山西医药杂志,2007,3(1):56.
[30]Dao Q,Krishnasway P,Kenenagra R.Utility of b-type natriuretic peptide in diagnosis of CHF in an urgent care setting.JAM CollCardio,1 2001,37:379-385.
[31]王林海,夏熙郑,邵润霞.N-端脑钠肽前体与慢性阻塞性肺疾病的相关性分析[J].中国实用医药.2008,3(33):31-33.
[32]KuroseM,YoshimuraM,YasueH.Raised plasma BNP in a patient with acute pulmonery embolism.Hear,1997,78:320-321.
[33]KucherN,PrintzenG,GoldhaberSZ.Prognostic Role of Brain Natriuretic Peptide in Acute Pulmonary Embolism.Circulation,2003,107:2545-2547.
[34]刘雅,肖茜,王超,等.脑钠肽的研究现状和进展[J].陕西医学杂志,2008,37(1):116-118.
[35]陈铃,朱红枫.氨基末端脑钠尿肽激素原对小儿心功能的评估[J].中国妇幼健康研究.2006,17(3):202-205.
[36]Nir A,Bar O B,Perles Z,et al.N-terminal pro-B-type natriuretic peptide:reference plasma levels from birth to adolescence:Elevated levels at birth and in infants and children with heart diseases[J].Acta Paediatr,2004,93(5):603-607.
[37]Westerlind A,Wahlander H,Lindstedt G,et al.Clinical signs of heart failure are associated with increased levels of natriuretic peptide types B and A in children with congenital heart defects or cardiomyopathy[J].Acta Paediatr,2004,93(3):340-345.
[38]Nasser N,Perles Z,Rein A J,et al.NT-proBNP as a marker for persistent cardiac disease in children with history of dilated cardiomyopathy and myocarditis[J].Pediatr Cardiol,2006,27(1):87-90.
[39]Cohen S,Springer C,Avital A,et al.Amino-terminal pro-brain-type natriuretic peptide:heart or lung disease in pediatric respiratory distress[J]Pediatrics,2005,115(5):1347-1350.
[40]Soker M,Kervancioglu M.Plasma concentrations of NT-pro-BNP and cardiac troponin-I in relation to doxorubicin-induced cardiomyopathy and cardiac function in childhood malignancy[J].Audi Med J,2005,26(8):1197-1202.
[41]Germanakis I,Kalmanti M,Parthenakis F,et al.Correlation of plasma N-terminal pro-brain natriuretic peptide levels with left ventricle mass in children treated with anthracyclines[J].Int J Cardiol,2006,108(2):212-215.
[42]Fleming S M,O'Gorman T,O'Byrne L,et al.Cardiac troponin I and N-terminal pro-brain natriuretic peptide in umbilical artery blood in relation to fetal heart rate abnormalities during labor[J].Pediatr Cardiol,2001,22(5):393-396.
[43]Friesewinkel O,Furrer M,Hanggi G,et al.Severe heart failure:treatment optimisation and monitoring using plasma NT-proBNP levels-an useful tool in clinical practice[J].Schweiz Rundsch Med Prax,2004,93(12):476-480.
[44]Kohno M,Horio T,Yasunari K,et a l.Stimulation of brain natriuretic pep tide release from the heart by thyroid hormone.Metabolism.1993,Aug,42(8):1059.
[45]L iang F,W ebb P,Marimuthu A,et a l.Triiodothyronine increases brain natriuretic peptide(BNP) gene transcription and amplifies endothelia-dependent BNP gene transcription and hypertrophy in neonatal rat ventricular myocytes.J B iol Chem.2003 Ap r 25,278(17):15073.
[46]Marchant C,B rown L,Sernia C,et a l.Renin-angiotensin system in thyroid dysfunction in rats.J Cardiovasc Pharmacol.1993,Sep,22(3):449.
[47]Klein I,O jamaa K.Thyroid hormone and the cardiovascular system.New England Journal of Medicine.2001,344:501.
[48]陶莉,张延军,张欣,等.甲亢患者血清NT-proBNP水平的变化[J].放射免疫学杂志,2007,20(6):563-566.
[49]Christ-Crain M,Morgenthaler NG,Meier C,et al.Pro-A-type and N-term inal pro-B-type natriuretic peptides in different thyroid function states.Swiss Med W kly.2005 Sep 17,135(37-38):549.
[50]SchultzM,Faber J,Kistorp C,et al.N-terminal pro-B-type natriuretic peptide(NTproBNP)in different thyroid function states.Clin Endocrinol(Oxf).2004Jan,60(1):54.
[51]Hammerer-Lercher A,Neubauer E,Pachinger O,et al.Head-to -head comparison of N-term inal p ro-brain natriuretic pep tide,brain natriuretic pep tide,and N-term inal p ro-atrial natriuretic pep tide in diagnosing left ventricular dysfunction.Clinica Chm ica Acta.2001,310:193.
[52]Helfand M.Screening for subclinical thyroid dysfunction in nonp regnant adults:a summary of the evidence for the U.S.Preventive Services Task Force.Ann Intern Med.2004,140:128.
[53]郭江平,王秀文,孙涛.NT-Pro-BNP评价肥厚型心肌病预后的临床研究[J].长治医学院学报,2007,21(4):261-262.