High intraindividual variation of B-type natriuretic peptide (BNP) and amino-terminal proBNP in patients with stable chronic heart failure
High intraindividual variation of B-type natriuretic peptide (BNP) and amino-terminal proBNP in patients with stable chronic heart failure
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DOI：
10.1373/clinchem.2004.038752
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发表时间：
2004-11-01
影响因子：
9.3
通讯作者：
Muskiet, FAJ
中科院分区：
文献类型：
--
作者：
Bruins, S;Fokkema, MR;Muskiet, FAJ
背景：血浆B型利钠肽（BNP）和N末端前体BNP（NT - proBNP）是心力衰竭诊断、预后及治疗中有前景的标志物。关于BNP和NT - proBNP个体内生物学变异（CVi）的数据不足，阻碍了对疾病进展或治疗优化过程中浓度变化的解读。因此我们对稳定型心力衰竭患者的CVi值进行了研究。
方法：我们招募了43名生活在库拉索岛的稳定型慢性心力衰竭患者（22名男性，21名女性；中位年龄63岁；范围20 - 86岁；纽约心脏协会心功能分级I - III级）。采集样本用于日内CVi（n = 6；从08：00开始每2小时一次）、日间CVi（n = 5；连续5天在08：00 - 10：00之间采集样本）和周间CVi（n = 6；连续6周在每周同一天的08：00 - 10：00之间采集样本）检测。采用免疫分析法测定NT - proBNP（罗氏）和BNP（雅培）。
结果：中位（范围）浓度分别为134（16 - 30）ng/L（BNP）和570（17 - 5048）ng/L（NT - proBNP）。分析变异、周间CVi和参考变化值分别为8.4%、40%和113%（BNP），以及3.0%、35%和98%（NT - proBNP）。周间CVi与BNP中位浓度呈负相关。BNP的周间CVi分别为44%（BNP≤350 ng/L）和30%（BNP＞350 ng/L）。BNP和NT - proBNP在08：00 - 10：00之间均升高。NT - proBNP/BNP中位比值与BNP中位浓度呈负相关。
结论：较高的CVi阻碍了对BNP和NT - proBNP浓度变化的解读，并可能部分解释了它们在慢性心力衰竭中诊断价值不佳的原因。尚未确定可降低CVi的易于改变的决定因素。BNP和NT - proBNP在慢性心力衰竭诊断中的价值，尤其是在个体随访和治疗优化方面的价值，在很大程度上仍有待确定。（C）2004年美国临床化学协会
Background: Plasma B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are promising markers for heart failure diagnosis, prognosis, and treatment. Insufficient data on the intraindividual biological variation (CVi) of BNP and NT-proBNP hamper interpretation of changes in concentration on disease progression or treatment optimization. We therefore investigated CVi values in stable heart failure patients.Methods: We recruited 43 patients with stable chronic heart failure living in Curacao (22 males, 21 females; median age, 63 years; range, 20-86 years; New York Heart Association classes I-III). Samples were collected for within-day CVi (n = 6; every 2 h starting at 0800), day-to-day CVi (n = 5; samples collected between 0800 and 1000 on 5 consecutive days), and week-to-week CVi (n = 6; samples collected between 0800 and 1000 on the same day of the week for 6 consecutive weeks). NT-proBNP (Roche) and BNP (Abbott) were measured by immunoassay.Results: Median (range) concentrations were 134 (01630) ng/L (BNP) and 570 (17-5048) ng/L (NT-proBNP). Analytical variation, week-to-week CVi, and reference change values were 8.4%, 40%, and 113% (BNP), and 3.0%, 35%, and 98% (NT-proBNP). Week-to week CV(i)s were inversely related to median BNP concentrations. Week-to week CVis for BNP were 44% (BNP less than or equal to350 ng/L) and 30% (BNP >350 ng/L). Both BNP and NT-proBNP increased between 0800 and 1000. Median NT-proBNP/BNP ratios were inversely related to median BNP concentrations.Conclusions: The high CV(i)s hamper interpretation of changes in BNP and NT-proBNP concentrations and may partly explain their poor diagnostic values in chronic heart failure. Easily modifiable determinants to lower CVi have not been identified. The value of BNP and NT-proBNP for chronic heart failure diagnosis, and especially for follow-up and treatment optimization of individuals, remains largely to be established. (C) 2004 American Association for Clinical Chemistry.