Goetze Jens Peter, Rehfeld Jens F, Carlsen Jørn, Videbaek Regitze, Andersen Claus B, Boesgaard Soeren, Friis-Hansen Lennart
Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, 9 Blegdamsvej, DK-2100, Copenhagen, Denmark.
Regul Pept. 2006 Jan 15;133(1-3):134-8. doi: 10.1016/j.regpep.2005.09.032. Epub 2005 Nov 2.
Dyspnea is a major symptom of both parenchymal lung disease and chronic heart failure. Underlying cardiac dysfunction can be assessed by measurement of cardiac-derived B-type natriuretic peptide or its precursor in plasma. However, no specific endocrine marker of the lung parenchyma has so far been identified. We therefore examined whether plasma concentrations of apelin, a novel inotropic hormone, is affected in patients with chronic parenchymal lung disease without cardiac dysfunction.
Patients with severe chronic parenchymal lung disease and normal cardiac function (n=53), idiopathic pulmonary hypertension with increased right ventricular pressure (n=10), and patients with severe left ventricular systolic dysfunction (n=22) were enrolled. Plasma apelin-36 and proBNP concentrations were measured with radioimmunoassays. While proBNP plasma concentrations were unaffected in chronic parenchymal lung disease patients compared to normal subjects, the apelin-36 concentration was reduced 3.3-fold (median 35 pmol/l (0-162 pmol/l) vs. 117 pmol/l (55-232 pmol/l), P<0.001). Moreover, the apelin-36 concentration was decreased in chronic heart failure patients (2.1-fold, P<0.01) and in patients with idiopathic pulmonary hypertension (4.0-fold, P<0.001). In contrast, the proBNP concentration was highly increased in both chronic heart failure and idiopathic pulmonary hypertension patients.
Plasma concentrations of apelin-36, a novel inotropic peptide, are decreased in patients with chronic parenchymal lung disease and preserved cardiac function. Combined measurement of apelin-36 and proBNP may be a new diagnostic approach in distinguishing pulmonary from cardiovascular causes of dyspnea.
呼吸困难是实质性肺疾病和慢性心力衰竭的主要症状。可通过测量血浆中心脏源性B型利钠肽或其前体来评估潜在的心功能不全。然而，迄今为止尚未发现肺实质的特异性内分泌标志物。因此，我们研究了新型正性肌力激素apelin的血浆浓度在无心脏功能障碍的慢性实质性肺疾病患者中是否受到影响。
纳入患有严重慢性实质性肺疾病且心功能正常的患者（n = 53）、右心室压力升高的特发性肺动脉高压患者（n = 10）以及严重左心室收缩功能不全的患者（n = 22）。采用放射免疫分析法测量血浆apelin - 36和proBNP浓度。与正常受试者相比，慢性实质性肺疾病患者的proBNP血浆浓度未受影响，但apelin - 36浓度降低了3.3倍（中位数35 pmol/l（0 - 162 pmol/l）对117 pmol/l（55 - 232 pmol/l），P < 0.001）。此外，慢性心力衰竭患者（降低2.1倍，P < 0.01）和特发性肺动脉高压患者（降低4.0倍，P < 0.001）的apelin - 36浓度也降低。相比之下，慢性心力衰竭和特发性肺动脉高压患者的proBNP浓度均显著升高。
新型正性肌力肽apelin - 36的血浆浓度在慢性实质性肺疾病且心功能保留的患者中降低。联合测量apelin - 36和proBNP可能是区分呼吸困难的肺部与心血管病因的一种新的诊断方法。
