Luchner Andreas, Hengstenberg Christian, Löwel Hannelore, Riegger Günter A J, Schunkert Heribert, Holmer Stephan
Klinik und Poliklinik für Innere Medizin II, University of Regensburg, Germany.
Hypertension. 2005 Jul;46(1):118-23. doi: 10.1161/01.HYP.0000170140.36633.8f. Epub 2005 Jun 6.
Brain natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) are markers of heart failure. Although renal dysfunction may increase plasma concentrations, the magnitude of this effect has not been assessed in a head-to-head comparison between the clinically approved tests. We assessed the effect of compensated renal dysfunction on BNP (Triage BNP; Biosite) and NT-proBNP (elecsys proBNP; Roche) in 469 randomly selected stable outpatients after myocardial infarction (MI; Monitoring Trends and Determinants in Cardiovascular Diseases [MONICA] register Augsburg) who were characterized with respect to renal function (glomerular filtration rate [GFR]; Cockroft method) and left ventricular (LV) ejection fraction (EF) and mass (2D echocardiography). BNP and NT-proBNP were elevated in MI patients with LV dysfunction (LVD; EF <35%) compared with MI patients with preserved EF ( >45%; BNP 139+/-27 pg/mL versus 75+/-6; NT-proBNP 816+/-237 pg/mL versus 243+/-20; both P <0.03). Among all MI patients, the prevalence of renal dysfunction (GFR <85 mL/min) was 24%. BNP and NT-proBNP were significantly elevated in MI patients with renal dysfunction (BNP 132+/-17 pg/mL versus 68+/-4 without renal dysfunction; NT-proBNP 535+/-80 pg/mL versus 232+/-19; both P <0.05), and both markers were correlated with GFR in univariate and multivariate analyses (all P <0.01). When binary cut-off values were stratified according to the absence or presence of renal dysfunction (BNP 75 pg/mL and 125 pg/mL, respectively; NT-proBNP 100 pg/mL and 350 pg/mL, respectively), the predictive power of both markers for the detection of LVD increased substantially. BNP and NT-proBNP are almost similarly influenced by mild-to-moderate renal dysfunction. Renal dysfunction is a potential cause of elevated marker concentrations in the absence of LVD, and cut-off concentrations should be stratified according to renal function.
脑钠肽（BNP）和N末端脑钠肽原（NT-proBNP）是心力衰竭的标志物。虽然肾功能不全可能会使血浆浓度升高，但尚未在临床上认可的检测方法之间进行直接比较来评估这种影响的程度。我们评估了469例随机选取的心肌梗死（MI；奥格斯堡心血管疾病监测趋势和决定因素[MONICA]登记处）后病情稳定的门诊患者中，代偿性肾功能不全对BNP（Triage BNP；Biosite公司）和NT-proBNP（elecsys proBNP；罗氏公司）的影响，这些患者的肾功能（肾小球滤过率[GFR]；Cockcroft法）、左心室（LV）射血分数（EF）和质量（二维超声心动图）均已明确。与EF保留（>45%）的MI患者相比，左心室功能不全（LVD；EF<35%）的MI患者中BNP和NT-proBNP升高（BNP：139±27 pg/mL对75±6；NT-proBNP：816±237 pg/mL对243±20；P均<0.03）。在所有MI患者中，肾功能不全（GFR<85 mL/min）的患病率为24%。肾功能不全的MI患者中BNP和NT-proBNP显著升高（BNP：132±17 pg/mL对无肾功能不全者的68±4；NT-proBNP：535±80 pg/mL对232±19；P均<0.05），在单变量和多变量分析中，这两种标志物均与GFR相关（所有P<0.01）。当根据肾功能不全的有无对二元临界值进行分层时（BNP分别为75 pg/mL和125 pg/mL；NT-proBNP分别为100 pg/mL和350 pg/mL），两种标志物检测LVD的预测能力均显著提高。轻度至中度肾功能不全对BNP和NT-proBNP的影响几乎相似。肾功能不全是在无LVD情况下标志物浓度升高的一个潜在原因，临界浓度应根据肾功能进行分层。
