Rubinsztajn R
Zakład Farmakologii Klinicznej IMW WAM w łodzi.
Pol Arch Med Wewn. 2001 Mar;105(3):217-24.
The sympathetic nervous system is markedly activated in patients with chronic heart disease. This activation can be evaluated by assessing the serum levels of chromogranin A (CgA), the protein which is present in the all neuroendocrine cells. The main human source of CgA are adrenal medullary and sympathetic nerve endings. The aim of the study was to demonstrate if serum concentration of chromogranin A correlated to severity of chronic heart failure and it can be usefulness for clinical diagnosis.
The serum levels of CgA were measured in 123 patients. Patients with chronic heart disease (n = 100) were divided into four groups depending of the severity of heart failure--NYHA classification (B1--NYHA I, B2--NYHA II, B3--NYHA III, B4--NYHA IV). The control group consisted of 23 persons without heart disease. The patients in both groups were examined and had performed tests: electrocardiography, echocardiography, blood morphology and the blood concentrations of creatinine, glucose, electrolytes, lipids. The serum concentration of chromogranin A was assessed by specific and immunoenzymatic sandwich ELISA test.
The mean serum concentration of CgA in the control group was 48.43 +/- 2.97 micrograms/L. In the chronic heart disease group the concentrations of CoA increased with the degree of NYHA heart failure and in four groups (B1, B2, B3, B4) the CgA levels were: 42.10 +/- 19.52; 49.84 +/- 22.63; 73.64 +/- 34.08; 106.66 +/- 87.54 micrograms/L respectively. The concentrations in groups B3 and B4 were significantly higher than in control group. The LV ejection fraction was reduced in groups B1-B4 (mean +/- SD): 60.12 +/- 9.20; 47.45 +/- 11.10; 40.28 +/- 9.52%. The CgA concentration was significantly negatively correlated with LV ejection fraction (r = -28). The left atrium was in group B1-B4:--32.94 +/- 4.35, 38.73 +/- 7.87, 42.57 +/- 7.98, 46.32 +/- 10.67 mm. The heart rate rised with the NYHA class (the control group (mean +/- SD): 72.96 +/- 9.15/min) and in the groups B1-B4 (mean +/- SD): 78.15 +/- 14.35, 79.90 +/- 14.67; 85.40 +/- 14.11; 93.74 +/- 16.29/min. The heart rate was significantly higher in B3 and B4 groups.
慢性心脏病患者的交感神经系统明显激活。这种激活可通过评估嗜铬粒蛋白A（CgA）的血清水平来评估，CgA是存在于所有神经内分泌细胞中的一种蛋白质。CgA的主要人体来源是肾上腺髓质和交感神经末梢。本研究的目的是证明嗜铬粒蛋白A的血清浓度是否与慢性心力衰竭的严重程度相关，以及它对临床诊断是否有用。
测定了123例患者的CgA血清水平。慢性心脏病患者（n = 100）根据心力衰竭的严重程度分为四组——纽约心脏协会（NYHA）分级（B1——NYHA I级，B2——NYHA II级，B3——NYHA III级，B4——NYHA IV级）。对照组由23名无心脏病的人组成。对两组患者进行了检查并进行了测试：心电图、超声心动图、血液形态学以及肌酐、葡萄糖、电解质、脂质的血液浓度。嗜铬粒蛋白A的血清浓度通过特异性免疫酶联夹心ELISA试验进行评估。
对照组中CgA的平均血清浓度为48.43±2.97微克/升。在慢性心脏病组中，CgA的浓度随NYHA心力衰竭程度的增加而升高，在四组（B1、B2、B3、B4）中CgA水平分别为：42.10±19.52；49.84±22.63；73.64±34.08；106.66±87.54微克/升。B3组和B4组的浓度显著高于对照组。B1 - B4组的左心室射血分数降低（平均值±标准差）：60.12±9.20；47.45±11.10；40.28±9.52%。CgA浓度与左心室射血分数显著负相关（r = -28）。B1 - B4组的左心房内径分别为：32.94±4.35、38.73±7.87、42.57±7.98、46.32±10.67毫米。心率随NYHA分级升高（对照组（平均值±标准差）：72.96±9.15次/分钟），B1 - B4组（平均值±标准差）分别为：78.15±14.35、79.90±14.67；85.40±14.11；93.74±16.29次/分钟。B3组和B4组的心率显著更高。
