Biomarker changes during acute heart failure treatment.
Biomarker changes during acute heart failure treatment.
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DOI：
10.1111/j.1751-7133.2011.00256.x
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发表时间：
2012-03-01
期刊：
影响因子：
--
通讯作者：
Collins, Sean P
中科院分区：
文献类型：
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作者：
Boyer, Brent;Hart, Kimberly W;Collins, Sean P
生物标志物变化可为医生提供急性失代偿性心力衰竭（ADHF）患者治疗疗效的客观证据，并促进患者早日出院。作者假设，在ADHF治疗的前24小时内，中区肾上腺髓质素原（MR-proADM）、C末端内皮素原-1（CT-pro-ET-1）和中区心钠素原（MR-proANP）发生变化。符合条件的患者在急诊科诊断为ADHF，并符合改良的Fragrance标准。在入组时、治疗后2 - 4小时和12 - 24小时收集临床数据、血清和血浆值。计算从基线至2 - 4小时、基线至12 - 24小时和2 - 4 - 12 - 24小时的生物标志物浓度变化。Fisher精确检验和Kruskal-Wallis检验用于比较。纳入48例患者。中位年龄为62岁（范围40-88岁），54%为男性，50%为白色。与MR-proADM或CT-pro-ET-1相比，更多患者在ADHF治疗后的前2至4小时内MR-pro-ANP水平发生变化（36% vs 16%和24%）。然而，在治疗后12至24小时，相似比例的患者的MR-proANP、MR-proADM和CT-proET-1水平发生变化（47%、41%和49%）。在这项初步研究中，ADHF患者在初始治疗后24小时，MR-proANP、MR-proADM和CT-pro-ET-1发生了可测量的变化。一项与临床过程和结果相关的研究，以确定这些标志物在风险分层中的作用是必要的。
Biomarker changes may provide physicians with objective evidence of treatment efficacy in patients with acute decompensated heart failure (ADHF) and facilitate early hospital discharge. The authors hypothesize that mid-regional-pro-adrenomedullin (MR-proADM), C-terminal-pro-endothelin-1 (CT-pro-ET-1), and mid-regional-pro-atrial natriuretic peptide (MR-proANP) change during the first 24 hours of ADHF therapy. Eligible patients had an emergency department diagnosis of ADHF and fulfilled modified Framingham criteria. Clinical data, serum, and plasma values were collected at enrollment, 2 to 4 hours, and 12 to 24 hours after treatment. Changes in biomarker concentrations from baseline to 2 to 4 hours, baseline to 12 to 24 hours, and 2 to 4 to 12 to 24 hours were calculated. Fisher exact and Kruskal-Wallis tests were used for comparisons. Forty-eight patients were included. The median age was 62 years (range 40-88), 54% were men and 50% were white. More patients had changes in MR-pro-ANP levels in the first 2 to 4 hours after ADHF therapy compared with MR-proADM or CT-pro-ET-1 (36% vs 16% and 24%). However, 12 to 24 hours after therapy, similar proportions of patients had changes in MR-proANP, MR-proADM, and CT-proET-1 levels (47%, 41%, and 49%). In this preliminary study, patients with ADHF had measurable changes in MR-proANP, MR-proADM, and CT-pro-ET-1 24 hours after initial therapy. A study of association with clinical course and outcomes to determine the role of these markers in risk-stratification is warranted.