Zuetenhorst J M, Korse C M, Bonfrer J M G, Bakker R H, Taal B G
Department of Gastroenterology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
Br J Cancer. 2004 Jun 1;90(11):2073-9. doi: 10.1038/sj.bjc.6601816.
Carcinoid heart disease (CHD) occurs in 20-70% of the patients with metastatic well-differentiated neuroendocrine tumours (NET). We evaluated whether natriuretic peptides (ANP or NT-proBNP) are useful in early detection of CHD. Blood samples from 32 patients with NET were compared with cardiac ultrasound follow-up. CHD was defined as thickening of the tricuspid valve in the presence of grade III-IV/IV tricuspid valve regurgitation. CHD was found in nine out of 32 patients (28%), all with symptoms of the carcinoid syndrome compared to 65% in the 23 patients without CHD (P=0.04). Median levels of NT-proBNP and 5-HIAA were significantly higher in patients with CHD (894 ng l(-1) and 815 micromol 24 h(-1)) compared to those without (89 and 206 ng l(-1), P<0.001 and P=0.007). No significant differences were detected in ANP levels (P=0.11). Dilatation of the right atrium and ventricle as well as thickening of the tricuspid valve and degree of regurgitation were statistically significant correlated with NT-proBNP levels. The accuracy of NT-proBNP in the diagnosis of CHD was higher than that of ANP. A significantly better survival was observed in case of normal NT-proBNP values. In conclusion, NT-proBNP is helpful as a simple marker in the diagnosis of CHD. Survival is better in patients with normal levels of NT-proBNP.
类癌性心脏病（CHD）发生于20%至70%的转移性高分化神经内分泌肿瘤（NET）患者中。我们评估了利钠肽（心房钠尿肽或N末端B型利钠肽原）在CHD早期检测中是否有用。将32例NET患者的血样与心脏超声随访结果进行比较。CHD定义为存在III-IV/IV级三尖瓣反流时三尖瓣增厚。32例患者中有9例（28%）发现患有CHD，所有患者均有类癌综合征症状，而23例无CHD患者中的这一比例为65%（P=0.04）。与无CHD患者相比，CHD患者的N末端B型利钠肽原和5-羟吲哚乙酸的中位数水平显著更高（分别为894 ng l⁻¹和815 μmol 24 h⁻¹，而无CHD患者分别为89和206 ng l⁻¹，P<0.001和P=0.007）。心房钠尿肽水平未检测到显著差异（P=0.11）。右心房和右心室扩张、三尖瓣增厚以及反流程度与N末端B型利钠肽原水平在统计学上显著相关。N末端B型利钠肽原在CHD诊断中的准确性高于心房钠尿肽。N末端B型利钠肽原值正常的患者观察到显著更好的生存率。总之，N末端B型利钠肽原作为CHD诊断中的一个简单标志物很有帮助。N末端B型利钠肽原水平正常的患者生存率更好。
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