方臻飞,李丽,黄亿源,胡信群,沈向前,唐建军,李江,吕晓玲,赵延恕,周胜华

• 1:长沙市中南大学湘雅二医院心内科

摘要(Abstract)：

目的通过检测成人房间隔缺损患者血浆氨基末端脑钠肽前体(NT-proBNP)浓度,研究NT-proBNP与肺动脉高压的(PAH)关系,为临床评价先天性心脏病(CHD)相关性肺动脉高压(PAH)的程度提供参考。方法房间隔缺损患者80例为试验组,依据平均肺动脉压(mPAP)分为正常PAH组、轻度PAH组、中度PAH组及重度PAH组各20例;另选20例健康正常人作为对照组。所有患者均行右心导管检查,测右心房、右心室压力、肺动脉收缩压(sPAP)、mPAP与全肺阻力(PVR)。测定患者术前血浆NT-proBNP浓度,分析其与肺动脉压力的相关性。结果房间隔缺损各PAH组血浆NT-proBNP水平明显高于正常对照组,重度PAH组>中度PAH组>轻度PAH组>正常PAH组>对照组(P<0.01)。mPAP与NT-proBNP水平呈正相关(r=0.889,P=0.000),sPAP与NT-proBNP水平呈正相关(r=0.923,P=0.000),PVR与NT-proBNP水平呈正相关(r=0.835,P=0.000)。血浆NT-proBNP浓度67.53 pg/ml对轻度PAH组有较高的诊断价值;血浆NT-proBNP浓度146.80 pg/ml对中度PAH组、血浆NT-proBNP浓度235.90 pg/ml对重度PAH组有一定的诊断价值。结论房间隔缺损患者血浆NT-proBNP水平随肺动脉压力升高而逐渐增加,可作为评价PAH程度的一项指标。

关键词(KeyWords)： 氮末端脑钠肽前体;房间隔缺损;肺动脉高压

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 方臻飞,李丽,黄亿源,胡信群,沈向前,唐建军,李江,吕晓玲,赵延恕,周胜华

参考文献(References)：

• [1]Inglessis I,Landzberg MJ.Interventional catheterization in adult congenital heart disease.Circulation,2007,115:1622-1633.
• [2]Mair J.Biochemistry of B-type natriuretic peptide--where are we now?Clin Chem Lab Med,2008,46:1507-1514.
• [3]Badesch DB,Champion HC,Sanchez MA,et al.Diagnosis and assessment of pulmonary arterial hypertension.J Am Coll Cardiol,2009,54(1 Suppl):S55-S66.
• [4]Cracowski JL,Leuchte HH.The potential of biomarkers in pulmonary arterial hypertension.Am J Cardiol,2012,110(6Suppl):32S-38S.
• [5]Bagnoli F,Rossetti A,Casucci M,et al.Aminoterminal B-type natriuretic peptide(NT-proBNP)in the therapy of patent ductus arteriosus.Minerva Pediatr,2010,62(3 Suppl 1):67-70.
• [6]Vogel M,Berger F,Kramer A,et al.Incidence of secondary pulmonary hypertension in adults with atrial septal or sinus venosus defects.Heart,1999,82:30-33.
• [7]GalièN,Hoeper MM,Humbert M,et al.Guidelines for the diagnosis and treatment of pulmonary hypertension:the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology(ESC)and the European Respiratory Society(ERS),endorsed by the International Society of Heart and Lung Transplantation(ISHLT).Eur Heart J,2009,30:2493-2537.
• [8]MagrìD,Agostoni P,Ricotta A,et al.NT-proatrial natriuretic peptide as a possible biomarker of cardiopulmonary involvement in sarcoidosis.Eur J Intern Med,2013,24:278-284.
• [9]Giannakoulas G,Dimopoulos K,Bolger AP,et al.Usefulness of natriuretic peptide levels to predict mortality in adults with congenital heart disease.Am J Cardiol,2010,105:869-873.
• [10]Cantinotti M,Vittorini S,Storti S,et al.Diagnostic accuracy and clinical relevance of brain natriuretic peptide assay in pediatric patients with congenital heart diseases.J Cardiovasc Med(Hagerstown),2009,10:706-713.
• [11]李运泉,李淑娟,朱玲,等.N端脑利钠肽前体在儿童左向右分流先天性心脏病中评价肺动脉高压的价值.中华临床医师杂志(电子版),2012,6:4485-4487.
• [12]Li ZF,Zhou DX,Wang QB,et al.Plasma N-terminal pro-brain natriuretic peptide levels are positively correlated with pulmonary arterial pressure in atrial septal defect patients.Regul Pept,2013,183C:13-16.
• [13]Miura Y,Fukumoto Y,Sugimura K,et al.Identification of new prognostic factors of pulmonary hypertension.Circulation,2010,74:1965-1971.
• [14]Handa T,Nagai S,Ueda S,et al.Significance of plasma NTproBNP levels as a biomarker in the assessment of cardiac involvement and pulmonary hypertension in patients with sarcoidosis.Sarcoidosis Vasc Diffuse Lung Dis,2010,27:27-35.