BMP and AMP as diagnostic and predictive markers in heart failure with left ventricular systolic dysfunction
BMP and AMP as diagnostic and predictive markers in heart failure with left ventricular systolic dysfunction
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DOI：
10.3317/jraas.2004.028
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发表时间：
2004-09-01
影响因子：
2.9
通讯作者：
van Zwieten, PA
中科院分区：
文献类型：
--
作者：
Falcao, L;Pinto, F;van Zwieten, PA
背景慢性心力衰竭（CHF）合并收缩功能障碍的患病率日益增加.血浆利钠肽（BNP）已被认为是诊断和预测CHF的重要指标，目的探讨CHF患者血浆BNP和ANP水平与临床和心功能指标的关系。在一项随机对照试验中，发现接受血管紧张素转换酶（ACE）抑制剂、卡托普利或血管紧张素受体阻滞剂（ARB）治疗的患者之间的差异，厄贝沙坦。方法测定68例高血压伴扩张型心肌病、NYHA Ⅲ ~ Ⅳ级、射血分数（EF）≤ 40%的患者和26例正常对照者血浆BNP（pmol/L）和ANP（pmol/L）水平。BNP和ANP的统计学分析通过Student t检验进行。患者组被随机分为两个亚组，每组34例，分别接受ARB（厄贝沙坦）或ACE抑制剂（ACE-I）（卡托普利）治疗。BNP和ANP在两个子样本中进行测量，并与临床，功能和神经激素参数在整个随访期间的6个月，在第六month.ResultsThe平均EF在患者样本为33.43 +/- 6.52%，在对照组为61.96 +/- 3.53%（p=0.000）。患者的平均BNP（pmol/L）为44.78 ± 54.36，对照组为7.12 ± 8.28（p=0.000），患者的平均ANP（pmol/L）为30.32 ± 25.97，对照组为11.18 ± 7.92（p=0.000）。患者和健康对照组之间存在统计学显著差异。利钠肽与EF之间存在显著相关性。ARB组BNP和ANP在基线期和6个月之间显著降低。第6个月时，ARB组BNP和ANP均较低。在6个月内，ARB或ACE-I治疗均发现了临床获益的证据，患者从III级和IV级变为II级NYHA。EF也有所改善，EF较低的患者（甚至
BackgroundThe prevalence of chronic heart failure (CHF) with systolic dysfunction is increasing. Plasma natriuretic peptides have been envisaged as diagnostic and predictive markers.AimsTo investigate the relationship between the levels of B-type natriuretic peptide (BNP) and A-type natriuretic peptide (ANP) and the clinical and functional parameters of CHF in outpatients with CHF at baseline, compared with normal healthy controls; to find out the differences in a randomised controlled trial between patients treated with an angiotensin-converting enzyme (ACE) inhibitor, captopril, or an angiotensin receptor blocker (ARB), irbesartan. These differences were assessed throughout the six-month treatment period and at the sixth month.MethodsPlasma BNP (pmol/L) and ANP (pmol/L) were determined in 68 hypertensive patients with dilated cardiomyopathy, NYHA class III-IV and ejection fraction (EF) less than or equal to40%, and in 26 normal controls. Statistical analysis for BNP and ANP was done by Student's t-test. The patient group was randomly subdivided into two subgroups of 34 patients, each treated with either an ARB, irbesartan, or an ACE inhibitor (ACE-I), captopril. BNP and ANP were measured in both subsamples and correlated with clinical, functional and neurohormonal parameters throughout a follow-up period of six months and at the sixth month.ResultsThe mean EF in the patient sample was 33.43 +/- 6.52% and in the controls was 61.96 +/- 3.53% (p=0.000). The mean BNP (pmol/L) in patients was 44.78 +/- 54.36 and in the controls was 7.12 +/- 8.28 (p=0.000) and the mean ANP (pmol/L) was 30.32 +/- 25.97 in patients and 11.18 +/- 7.92 in controls (p=0.000). A statistically significant difference was found between patients and healthy controls. Significant correlations were found between natriuretic peptides and EF. Between the baseline phase and the sixth month, BNP and ANP decreased significantly in the ARB group. At the sixth month, both BNP and ANP were lower in the ARB group. Evidence of clinical benefit was found with both ARB or ACE-I treatment throughout the six months, with patients moving from classes III and IV to class II NYHA. Improvement of EF was also found, with transition of patients with lower EF (even