Montagnana Martina, Lippi Giuseppe, Fava Cristiano, Minuz Pietro, Santonastaso Clara Lechi, Arosio Enrico, Guidi Gian Cesare
Istituto di Chimica e Microscopia Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università degli Studi di Verona, Verona, Italy.
Clin Chem Lab Med. 2006;44(2):207-12. doi: 10.1515/CCLM.2006.038.
Cardiovascular disease is the leading cause of mortality and morbidity in Western countries. Despite its remarkable medical and social consequences, the prevalence of peripheral arterial disease (PAD) is often underestimated among atherosclerotic disorders. So far, little is known about the behavior of traditional and emerging markers of ischemic heart disease that should allow the reliable identification of PAD patients at increased risk of developing myocardial ischemia and heart failure or dysfunction. To investigate this topic, we measured cardiac troponin T (cTnT), ischemia-modified albumin (IMA) and NT-prohormone-brain natriuretic peptide (NT-proBNP) in 35 consecutive patients with clinically ascertained PAD (stage 2-4, according to Lériche-Fontaine) asymptomatic for chest pain and current heart failure, and 20 controls displaying moderate to high cardiovascular risk factors (hypertension, diabetes, hyperlipidemia), but with no clinical evidence of PAD. Although the concentrations of cTnT and IMA were not statistically increased in PAD patients, NT-pro-BNP values were substantially higher in PAD patients than in controls (62.6 vs. 7.4 pmol/L, p<0.0001). The percentage of subjects displaying values exceeding the specific NT-proBNP diagnostic threshold (>14.8 pmol/L) was also significantly different between PAD patients and controls (74% vs. 10%, p<0.001). After excluding PAD patients exceeding the 0.01 ng/mL cTnT cutoff value indicative of current ischemic cardiac involvement, the median concentration of NT-proBNP remained statistically increased (28.0 vs. 5.8 pmol/L, p<0.0001). Taken together, these results indicate that NT-proBNP, but not IMA, is substantially increased in PAD patients. This finding suggests that such patients, even though asymptomatic, might develop myocardial dysfunction, and thus warrant further investigation.
心血管疾病是西方国家死亡率和发病率的主要原因。尽管其具有显著的医学和社会影响，但在动脉粥样硬化疾病中，外周动脉疾病（PAD）的患病率常常被低估。到目前为止，关于缺血性心脏病的传统和新兴标志物的行为了解甚少，而这些标志物应能可靠地识别出有发生心肌缺血、心力衰竭或功能障碍风险增加的PAD患者。为了研究这个课题，我们对35例临床确诊为PAD（根据勒里什 - 方丹分期为2 - 4期）且无胸痛症状和当前心力衰竭症状的连续患者，以及20例有中度至高度心血管危险因素（高血压、糖尿病、高脂血症）但无PAD临床证据的对照组进行了心肌肌钙蛋白T（cTnT）、缺血修饰白蛋白（IMA）和N末端脑钠肽前体（NT-proBNP）的检测。尽管PAD患者中cTnT和IMA的浓度没有统计学上的升高，但PAD患者的NT-pro-BNP值显著高于对照组（62.6对7.4 pmol/L，p<0.0001）。PAD患者和对照组中NT-proBNP值超过特定诊断阈值（>14.8 pmol/L）的受试者百分比也有显著差异（74%对10%，p<0.001）。在排除cTnT超过0.01 ng/mL临界值（表明当前存在缺血性心脏受累）的PAD患者后，NT-proBNP的中位数浓度仍有统计学上的升高（28.0对5.8 pmol/L，p<0.0001）。综上所述，这些结果表明PAD患者中NT-proBNP显著升高，而IMA没有。这一发现表明，这类患者即使无症状，也可能发生心肌功能障碍，因此值得进一步研究。
