Tsutamoto Takayoshi, Wada Atsuyuki, Sakai Hiroshi, Ishikawa Chitose, Tanaka Toshinari, Hayashi Masaru, Fujii Masanori, Yamamoto Takashi, Dohke Tomohiro, Ohnishi Masato, Takashima Hiroyuki, Kinoshita Masahiko, Horie Minoru
Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan.
J Am Coll Cardiol. 2006 Feb 7;47(3):582-6. doi: 10.1016/j.jacc.2005.10.038. Epub 2006 Jan 18.
This study sought to evaluate the relationship between brain natriuretic peptide (BNP), renal function, and the severity of congestive heart failure (CHF).
Both BNP and renal function are prognostic predictors in CHF patients.
We measured the plasma BNP level in the aortic root and coronary sinus in 366 consecutive patients with CHF. Estimated glomerular filtration rate (eGFR) by the Cockcroft-Gault equation was used as an indicator of renal function.
By stepwise multivariate analyses, hemodynamic parameters such as left ventricular ejection fraction (LVEF) and left ventricular end-diastolic pressure (LVEDP) but not eGFR were independent predictors of a transcardiac increase (coronary sinus-aortic root) in BNP. Regarding the plasma level of BNP in the aortic root, not only LVEF (p < 0.0001) and LVEDP (p < 0.0001) but also eGFR (p < 0.0001) were independent predictors. Patients were divided into two groups, patients with an eGFR > or =60 ml/min (group 1, n = 229) and patients with an eGFR <60 ml/min (group 2, n = 137). There was no difference in LVEF, LVEDP, or the transcardiac gradient of BNP between the two groups, but the plasma level of BNP in the aortic root was approximately two-fold greater in group 2 than in the group 1.
These findings suggest that decreased clearance from the kidney contributes to the elevated BNP in CHF patients with renal dysfunction, especially in patients with an eGFR <60 ml/min.
本研究旨在评估脑钠肽（BNP）、肾功能与充血性心力衰竭（CHF）严重程度之间的关系。
BNP和肾功能都是CHF患者的预后预测指标。
我们对366例连续性CHF患者测量了主动脉根部和冠状窦的血浆BNP水平。采用Cockcroft-Gault方程估算的肾小球滤过率（eGFR）作为肾功能指标。
通过逐步多因素分析，左心室射血分数（LVEF）和左心室舒张末期压力（LVEDP）等血流动力学参数而非eGFR是BNP跨心脏升高（冠状窦-主动脉根部）的独立预测因素。关于主动脉根部的BNP血浆水平，不仅LVEF（p<0.0001）和LVEDP（p<0.0001），而且eGFR（p<0.0001）都是独立预测因素。患者被分为两组，eGFR≥60 ml/min的患者（第1组，n = 229）和eGFR<60 ml/min的患者（第2组，n = 137）。两组之间LVEF、LVEDP或BNP的跨心脏梯度无差异，但第2组主动脉根部的BNP血浆水平比第1组高约两倍。
这些发现表明，肾脏清除率降低导致肾功能不全的CHF患者BNP升高，尤其是eGFR<60 ml/min的患者。
