Goetze Jens Peter, Videbaek Regitze, Boesgaard Soren, Aldershvile Jan, Rehfeld Jens F, Carlsen Jorn
Medical Department B, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
J Heart Lung Transplant. 2004 Jan;23(1):80-7. doi: 10.1016/s1053-2498(03)00060-3.
Increased plasma concentrations of pro-atrial natriuretic peptide (proANP) and pro-brain natriuretic peptide (proBNP) are features of left ventricular impairment. However, concentrations of proANP and proBNP in patients with isolated terminal parenchymal lung disease are not known. Therefore, we measured the plasma concentrations of natriuretic precursor peptides in patients with terminal parenchymal lung disease who had normal left ventricular function and who were referred for evaluation for lung transplantation.
We measured plasma N-terminal proANP and proBNP in patients undergoing right heart catheterization (n = 50) and related results to hemodynamic variables obtained during catheterization.
Plasma proBNP concentrations were unaffected in patients with terminal parenchymal lung disease and normal left ventricular function (median, 2.5 pmol/liter; range, 0-22; upper reference limit, 15 pmol/liter). In contrast, patients with primary pulmonary hypertension displayed more than a 40-fold increase in plasma proBNP concentrations (median, 107 pmol/liter vs 2.5 pmol/liter, p < 0.0001). Plasma N-terminal proANP increased moderately (median, 664 pmol/liter; range, 36-1620; upper reference limit, 600 pmol/liter) but correlated to plasma proBNP concentrations (r = 0.47, p < 0.0001). Finally, regional vascular proBNP concentrations revealed the heart as the secretory site.
Our findings strongly support the contention that natriuretic peptide measurements are efficient markers for cardiovascular causes of dyspnea. Moreover, our results eliminate natriuretic peptides as markers of moderate pulmonary hypertension in patients with terminal parenchymal lung disease.
血浆中前心钠素（proANP）和前脑钠素（proBNP）浓度升高是左心室功能损害的特征。然而，孤立性终末期实质性肺病患者的proANP和proBNP浓度尚不清楚。因此，我们测量了左心室功能正常且因肺移植评估而转诊的终末期实质性肺病患者的血浆利钠肽前体肽浓度。
我们测量了接受右心导管检查的患者（n = 50）的血浆N端proANP和proBNP，并将结果与导管检查期间获得的血流动力学变量相关联。
终末期实质性肺病且左心室功能正常的患者血浆proBNP浓度未受影响（中位数，2.5 pmol/升；范围，0 - 22；参考上限，15 pmol/升）。相比之下，原发性肺动脉高压患者的血浆proBNP浓度增加了40多倍（中位数，107 pmol/升对2.5 pmol/升，p < 0.0001）。血浆N端proANP适度增加（中位数，664 pmol/升；范围，36 - 1620；参考上限，600 pmol/升），但与血浆proBNP浓度相关（r = 0.47，p < 0.0001）。最后，局部血管proBNP浓度显示心脏为分泌部位。
我们的研究结果有力地支持了利钠肽测量是呼吸困难心血管病因有效标志物的观点。此外，我们的结果排除了利钠肽作为终末期实质性肺病患者中度肺动脉高压标志物的可能性。
