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Title:: Relationship between cardiac function and brain natriuretic peptide and Insulinlike growth factorI

作者:: 孙卫红¹; 戴向东¹; 陶金华¹; 刘玮¹; 宋建平¹ ; 程绪杰²; 1.昆山市第二人民医院心内科, 江苏昆山 215300; 2.苏州大学附属第一人民医院心内科, 江苏苏州 215000

Author(s):: SUN Weihong; DAI Xiangdong; TAO Jinhua; LIU Wei; SONG Jianping; CHENG Xujie; Department of Cardiology,Second Hospital of Kunshan,Kunshan,Jiangsu 215300,China

关键词:: 脑钠尿肽; 胰岛素样生长因子I; 心力衰竭; 充血性; 超声心动描记术

Keywords:: Btype natriuretic peptide; insulinlike growth factorI; congestive heart failure; echocardiography

分类号:: R512.6

DOI:: -

文献标识码:: A

摘要:: 目的研究心力衰竭患者血浆胰岛素样生长因子I（IGFI）、脑钠尿肽（BNP）水平及其与心功能（NYHA）分级、心脏超声特征之间的关系。方法心力衰竭患者78例，健康对照组18例。使用美国博适Triage干式快速定量心力衰竭/心肌梗死诊断仪定量快速（15 min）检测全血中BNP含量。用ELISA法检测血清中IGFI水平。并测量左心室收缩末期内径（LVESd）、左心室舒张末期内径（LVEDd）、左室后壁厚度（LVPWT）及左心室射血分数（LVEF）。结果对照组、心功能Ⅰ，Ⅱ，Ⅲ，Ⅳ级组BNP值分别为41.3±11.4，156.3±15.1，338.4±23.4，596.4±33.2，972.4±25.4 ng/L，随着心功能分级加重，BNP呈上升趋势，呈正相关。LVEF分别为0.65±0.09，0.62±0.09，0.60±0.08，0.58±0.11，0.35±0.10，与BNP值呈负相关（r=-0.90，P<0.05）。IGFI值分别为166.7±62.5，158.2±55.3，203.5±63.7，240.7±67.3，107.8±66.4 μg/L。心功能Ⅱ级与Ⅰ级，Ⅲ级比较，差异有显著性（P<0.05）；而心功能Ⅳ级患者的IGFⅠ水平降低，差异非常显著（P<0.01）。相关性分析显示IGFⅠ值与LVPWT呈正相关（r=0.75，P<0.05）。结论左室功能不全的患者BNP值升高并与NYHA分级相关，可作为诊断心力衰竭的指标，心功能Ⅱ，Ⅲ级者IGFI水平明显上升，但Ⅳ级者明显降低，如结合BNP浓度可对心力衰竭的预后作出评价。IGFⅠ水平与左室后壁厚度呈正相关，在心功能Ⅳ级组IGFⅠ水平、室壁厚度及EF值均明显降低，提示IGFⅠ水平可能与心室重构有关。

Abstract:: AIM To investigate how brain natriuretic peptide and insulinlike growth factorI related with the class of cardiac function, feature of transthoracic echocardiography. METHODS Our study included 78 patients with heart failure and 18 healthy people as the control group. Patients were divided into different groups according to the classification of cardiac function. The level of brain natriuretic peptide was measured by fluorescence immunoassay (15 min) and the serum level of IGFI was measured by ELISA. All patients received routine transthoracic echocardiography. Left ventricular end systolic diameter, left ventricular end diastolic diameter, left ventricular posterior wall thickness and left ventricular ejection fraction were measured. RESULTS The levels of BNP in normal control group, grade I, grade II, grade Ⅲ and grade Ⅳ were 41.3±11.4，156.3±15.1，338.4±23.4，596.4±33.2 and 972.4±25.4 ng/L，respectively (P<0.01). BNP level was positively correlated with the grade of cardiac function，while it was negatively correlated with LVEF （r=-0.90，P<0.05）. But IGFI levels in normal control group and grade Ⅰ-Ⅳ were 166.7±62.5，158.2±55.3，203.5±63.7，240.7±67.3，107.8±66.4 μg/L，respectively. There was significant difference between grade Ⅱ and gradeⅠ, grade Ⅲ and grade Ⅱ(P<0.05). IGFI decreased significantly in grade Ⅳ and showed statistical difference comparing with normal control group, gradeⅠ-Ⅲ and grade Ⅳ.The level of IGFI was positively correlated with the LVPWT（r=0.75，P<0.05）. CONCLUSION BNP level is elevated in patients with left ventricular dysfunction and correlating with cardiac function and therefore it might be helpful in the diagnosis of heart failure. The level of IGFI is different in accordance with cardiac function. It increases significantly in grade Ⅱ,Ⅲ but decreases significantly in grade Ⅳ. IGFI combined with BNP level can be used to evaluate the prognosis of heart failure. The level of IGFI is positively correlated with the LVPWT and the levels of IGFI, LVPWT and LVEF decreases significantly in grade Ⅳ, indicating that IGFI level may be involved in left ventricular remodeling.

参考文献/References

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胰岛素样生长因子I,脑钠尿肽与心功能分级关系(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

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