Objective To investigate the change characteristics of brain natriuretic peptide(BNP) after offpump coronary artery bypass grafting (OPCAB), and observe the relationship of BNP with atrial fibrillation, intensive care unit(ICU) stay time, time of withdrawing trachea tube, and usage of intraaortic balloon pump(IABP). Methods We retrospectively analyzed the clinical data of 168 consecutive patients with coronary artery diseases who underwent OPCAB in Beijing Anzhen Hospital from September 2009 to March 2010. There were 133 males and 35 females with an age of 60.77±9.32 years. BNP was determined before operation, on the operative day just after operation, and day 1, 2 and 3 after operation. At the same time, the relationship between BNP and ICU stay time, time of withdrawing trachea tube, occurrence of atrial fibrillation, and usage of IABP were also recorded. Results There were two inhospital deaths, due to low cardiac output syndrome, infection and circulatory failure respectively. BNP increased significantly after operation with the peak level occurring 1 day after operation, after which it decreased gradually. BNP level in patients with their left ventricular ejection fraction(LVEF) under 50% was significantly higher than that in patients with LVEF equal to or above 50% before and after operation(the median BNP level at the second postoperative day: 2 198.20 pg/ml vs. 531.65 pg/ml, Plt;0.05). BNP in patients using IABP was significantly higher than that in patients without using IABP before and after operation(the median BNP level at the first postoperative day: 5 066.75 pg/ml vs. 745.20 pg/ml, Plt;0.05). The ROC value was 0.834 when perioperative BNP was used to predict the possibility of using IABP. BNP in patients with postoperative atrial fibrillation was also significantly higher than that in patients without atrial fibrillation(the median BNP level at the first postoperative day: 1 070.60 pg/ml vs. 747.80 pg/ml, Plt;0.05). BNP was positively correlated with using IABP(at the third postoperative day: r=0.437, Plt;0.05), prognosis(at the first postoperative day:r=0.224, Plt;0.05), time of withdrawing trachea tube(at the third postoperative day: r=0.440, Plt;0.05), ICU stay time(at the third postoperative day: r=0.477, Plt;0.05). Conclusion BNP can be considered as one of the diagnostic criteria for ventricular dysfunction, and preoperative high BNP level is a risk factor for using IABP and ICU stay time equal to or longer than 3 days.
Aortic dissection is a life-threatening cardiovascular disease with devastating complications and high mortality. It requires rapid and accurate diagnosis and a focus on prognosis. Many laboratory tests are routinely performed in patients with aortic dissection including D-dimer, brain natriuretic peptide, cardiac troponin I, C-reactive protein, and procalcitonin. D-dimer shows vital performance in the diagnosis of aortic dissection, and brain natriuretic peptide, cardiac troponin I, C-reactive protein, and procalcitonin exhibits important value in risk stratification and prognostic effect in aortic dissection patients. Our review summarized the clinical utility of these laboratory tests in patients with aortic dissection, aiming to provide advanced and comprehensive evidence for clinicians to better understand these laboratory tests and help their clinical practice.
Objective To explore the pulmonary arterial pressure level in patients with predialysis chronic kidney disease ( CKD) and its relationship to cardiac structure and function. Methods 397 patients with predialysis CKD and 50 healthy subjects were enrolled. Cardiac structure was evaluated by Doppler echocardiography. Glomerular filtration rate ( GFR ) were assessed by radiant 99mTc-DTPA.Differences of PAP, BNP, LA, IVST, LVDd, LVDs, LVEF, LVMI and the correlation of PAP with cardiac structure and function were examined. Results The PAP level in the predialysis CKD patients was much higher than that in the healthy subjects [ ( 33. 13 ±9. 00) mm Hg vs. ( 29. 43 ±3. 71) mmHg, P lt;0. 01] .18. 9% of the CKD patients were complicated with pulmonary hypertension. PAP was higher in the CKD patients in stages 4-5 than those CKD patients in stages 1-3 [ ( 35. 90 ±9. 34) mmHg vs. ( 32. 08 ±8. 62)mmHg, P lt;0. 01) ] , so as to the prevalene of pulmonary hypertension ( 21. 60% vs. 13. 47% , P lt;0. 01) .Compared with the healthy, the level of lnBNP [ ( 3. 59 ±1. 63) pg/mL vs. ( 2. 88 ±1. 51) pg/mL, P lt;0. 01] , LA [ ( 40. 42 ±6. 77) mmvs. ( 36. 75 ±4. 94) mm, P lt; 0. 01) ] , LVPW [ ( 9. 55 ±1. 96) mm vs.( 8. 54 ±0. 88) mm, P lt; 0. 01) ] , IVST [ ( 9. 76 ±1. 75) mm vs. ( 8. 71 ±0. 90) mm, P lt; 0. 01) ] , LVMI[ ( 105. 61 ±36. 47) g/m2 vs. ( 87. 41 ±17. 08) g/m2 , P lt; 0. 01) ] were all much higher. There was a negative correlation between PAP and GFR( r = - 0. 461, P lt;0. 01) , and positive correlations between PAP and LA ( r=0. 491, P lt; 0. 01) , LVPW ( r =0. 298, P lt;0. 01) , IVST ( r = 0. 613, P lt;0. 01) , lnBNP ( r =0. 536, P lt;0. 01) , LVMI ( r = 0. 382, P lt;0. 01) . LVMI and lnBNP were both independent risk factors of PAP. The regression equation: y = 16. 447 + 0. 105x1 + 1. 724x2 ( F = 23. 482, P = 0. 000) , y: PAP( mm Hg) , x1 : LVMI( g/m2 ) , x2 : lnBNP( pg/mL) . Conclusions Pulmonary hypertension is a common morbidity of predialysis CKD patients, and deteriorates with degression of renal function. PAP is related to indexes of cardiac structure ( LVMI, LA, LVPW, IVST) and index of cardiac function ( lnBNP) . LnBNP and LVMI are independent risk factors of PAP.
【摘要】目的探讨B型脑钠肽(BNP)与慢性充血性心力衰竭预后的关系。方法2008年1月10月收治的慢性充血性心力衰竭患者100例,均符合美国心脏病协会分级标准(NYHA)Ⅲ~Ⅳ级,快速检测BNP,观察心血管事件发生组与未发生组患者血浆BNP浓度差异。结果发生心血管事件患者血浆BNP浓度显著升高,未发生心血管事件患者血浆BNP浓度下降。血浆BNP浓度与心血管事件发生有密切关系结论BNP水平可以指导心力衰竭患者的治疗,并可以预测失代偿期充血性心力衰竭患者的预后。
目的 探讨血浆脑钠肽（BNP）及血清肌钙蛋白I（cTNI）含量改变在老年患者发生充血性心力衰竭时的临床意义。 方法 选择2010年7月－2012年8月住院的各种老年心脏病患者117例，根据纽约心功能分级分为4组（心功能Ⅰ级组、Ⅱ级组、Ⅲ级组、Ⅳ级组），分别检测血浆BNP、血清cTNI及心肌酶[肌酸磷酸激酶（CK）、肌酸磷酸激酶同工酶（CK-MB）]进行组间比较，同时与健康老年组进行对比。 结果 ① 老年慢性充血性心力衰竭各组（心功能Ⅱ～Ⅳ级）血浆BNP水平均高于健康对照组及心功能正常组（心功能Ⅰ级组）；且心功能Ⅳ级组BNP水平＞心功能Ⅲ级组＞心功能Ⅱ级组。各组之间比较差异有统计学意义，但心功能Ⅰ级组与健康对照组血浆BNP水平无明显差异。② 各组之间CK及CK-MB水平差异均无统计学意义。③ 充血性心力衰竭各组（心功能Ⅱ～Ⅳ级组血清cTNI水平均高于健康对照组及心功能正常组（心功能Ⅰ级组）；且心功能Ⅳ级组cTNI水平＞心功能Ⅲ级组＞心功能Ⅱ级组。各组之间比较差异有统计学意义，而心功能Ⅰ级组及健康对照组血清cTNI水平差异无统计学意义。 结论 血浆BNP水平及血清cTNI水平在老年患者发生心力衰竭时随心力衰竭程度加重而逐渐升高，两者均对慢性充血性心力衰竭的临床诊断具有重要参考意义。
Brain natriuretic peptide (BNP) and amino-terminal pro-brain natriuretic peptide (NT-proBNP) were the main members of the natriuretic peptide family. BNP has the effects of diuretic sodium, reducing sympathetic nervous system activity, dilating blood vessels, and improving the pathological remodeling of heart. Plasma BNP/NT-proBNP levels have been widely used in the diagnosis, severity assessment, prognosis prediction and treatment guidance of heart failure. In recent years, BNP/NT-proBNP has become a research hotspot in the diagnosis and and prognosis judgment of atrial fibrillation, recurrence of atrial fibrillation after radiofrequency ablation and cardioversion and congenital heart disease in infants and children, prediction of postoperative complications, and drug development. This article reviews the latest advances in clinical application and research progress on BNP/NT-proBNP.
Objective To determine whether B-type natriuretic peptide （BNP） levels combined with Spontaneous breathing trial (SBT) could improve the weaning outcome. Methods Eighty-three patients who were ready to undergo a 90-minute weaning trial （low-pressure support level） were enrolled .Weaning was considered to be successful if the patient passed the trial and sustained spontaneous breathing for more than 48 h after extubation. Plasma BNP was measured just before and at the end of the trial. All patients were divided into a weaning success group and a weaning failure group according to the outcomes of weaning. Categorical variables，expressed as percentages，were analyzed with a chi-square test or a Fisher’s exact test. Continuous variables were expressed as median （25th-75th percentile） and were compared using the Wilcoxon paired test （for related samples） or the Kolgomorov-Smirnov test （for independent samples）. A two-tailed p value of less than 0.05 was taken to indicate statistical significance. Receiver operating characteristic （ROC） curve analysis was performed to assess plasma BNP’s ability to discriminate the subjects who weaned succesfully or failed. Results Overall，13 patients （16.7%） failed the weaning process （6 patients passed the trial but failed extubation）. At the end of SBT，the BNP levels of the weaning failure group were significantly higher than the weaning success group. The BNP levels of the weaning failure group were significantly higher than the weaning success group （Plt;0.001）. The area under cure （AUC） of the ROC curve of BNP to predict the failure of weaning was 0.94±0.03 （Plt;0.001）.At a cut-off level of 123 pg/mL,BNP had a predictive efficiency in weaning outcome as Yourdon’s index of 0.837，sensitivity of 92.3%，and specificity of 91.4%. Conclusion Monitoring the change of BNP during a SBT may improve weaning outcome.
Objective To explore and compare the diagnostic value of blood pressure, brain natriuretic peptide (BNP), pulmonary artery systolic pressure (PASP) in evaluating right ventricular dysfunction (RVD) in patients with acute pulmonary embolism (APE). Methods A retrospective study was conducted on 84 APE patients who were diagnosed by computed tomographic pulmonary angiography. The patients were divided into a RVD group and a non-RVD group by echocardiography. Eighteen clinical and auxiliary examination variables were used as the research factors and RVD as the related factor. The relationship between these research factors and RVD were evaluated by logistic regression model, the diagnostic value of BNP and PASP to predict RVD was analyzed by receiver-operating characteristic (ROC) curve analysis. Results The patients with RVD had more rapid heart rate, higher diastolic blood pressure, higher mean arterial pressure, higher incidence of BNP>100 pg/ml and higher incidence of PASP>40 mm Hg (allP<0 05="" upon="" logistic="" regression="" model="" bnp="">100 pg/ml (OR=4.904, 95%CI 1.431–16.806, P=0.011) and PASP>40 mm Hg (OR=6.415, 95%CI 1.509–27.261, P=0.012) were independent predictors of RVD. The areas under the ROC curve to predict RVD were 0.823 (95%CI 0.729–0.917) for BNP, and 0.798 (95%CI 0.700–0.896) for PASP. Conclusions Blood pressure related parameters can not serve as a predictor of RVD. Combined monitoring of BNP level and PASP is helpful for accurate prediction of RVD in patients with APE.
ObjectiveTo investigate the correlation between brain natriuretic peptide (BNP) and cardiopulmonary function, as well as explore prognostic value of BNP in patients with interstitial lung disease(ILD). MethodsThe clinical data of ILD patients admitted between February 2010 and April 2013 were retrospectively analyzed.The relationship between serum BNP level and cardiopulmonary function was analyzed by Pearson's or Spearman's rank correlation test.Meanwhile, the patients were divided into a survivor group and a death group, as well as a pulmonary hypertention (PH) group and a normal group respectively.Clinical data were compared between two groups. ResultsThere were 38 patients included in the study.BNP concentration was correlated with echocardiographic indices of right heart function, including systolic pressure of pulmonary artery, right atrial inlet diameter, right ventricular inlet diameter, and right ventricular end-diastollc diameter (P < 0.05), but not correlated with echocardiographic parameters of left heart function (P > 0.05).BNP was also correlated with DLCO%pred.BNP and right heart function parameters except right atrial inlet diameter were significantly higher, and DLCO%pred, were significantly lower in the death group and the PH group than those in the survivor group and the normal group (P < 0.05). ConclusionsSerum BNP concentration can reflect right heart function appropriately, suggesting pulmonary vascular impairment in ILD patients contributes to increased pulmonary vascular resistance.Elevated BNP levels are associated with increased mortality and poor prognosis in patients with ILD.