稳定型心力衰竭患者NT-proBNP血浆和尿液水平的变异性：一项为期2年的随访研究。
Variability of NT-proBNP plasma and urine levels in patients with stable heart failure: a 2-year follow-up study.
作者信息
Cortés Raquel, Rivera Miguel, Salvador Antonio, Bertomeu Vicente, de Burgos Fernando García, Roselló-Lletí Esther, Portolés Manuel, Payá Rafael, Martínez-Dolz Luis, Climent Vicente
机构信息
Cardiology Unit, Research Centre, Hospital Universitario La Fe, Valencia, Spain.
出版信息
Heart. 2007 Aug;93(8):957-62. doi: 10.1136/hrt.2006.096891. Epub 2007 May 8.
OBJECTIVES
To examine N-terminal pro-brain natriuretic peptide (NT-proBNP) variability in plasma and urine samples of patients with stable heart failure (HF) during a 24-month follow-up.
DESIGN
Prospective study.
SETTING
Teaching hospital based study.
PATIENTS
74 clinically and functionally stable patients (NYHA class 2+/-0.5) out of 114 patients diagnosed with HF were followed up, and NT-proBNP plasma and urine levels were measured at baseline, 12 and 24 months.
RESULTS
Significant differences in mean urinary levels (p<0.01) were found during follow-up, but no changes were found in plasma. Bland-Altman plots showed few variations in plasma percentages in the three intervals (stage I-basal; stage II-stage I; stage II-basal) with a coefficient of reproducibility (CR) of 22%, 21% and 25%, respectively. Changes in NT-proBNP urinary levels had a CR of 7.1%, 6.8% and 9.4% at the three intervals, respectively. A good correlation was found between plasma and urinary levels of NT-proBNP (p<0.001) and between the different NT-proBNP plasma (p<0.001) and urine measurements (p<0.001).
CONCLUSIONS
NT-proBNP plasma and urine levels show good stability in a 24-month follow-up of patients with stable heart failure. Thus, assessment of urinary and plasma NT-proBNP concentrations may be a useful tool for monitoring patients with HF during follow-up. The results suggest that variations in peptide concentrations exceeding 22% in plasma and 7% in urine in a 12-month follow-up and 25% and 9% in a 24-month follow-up may indicate pathophysiological changes.
目的
在24个月的随访期间，检测稳定型心力衰竭（HF）患者血浆和尿液样本中N末端脑钠肽前体（NT-proBNP）的变异性。
设计
前瞻性研究。
地点
基于教学医院的研究。
患者
在114例诊断为HF的患者中，对74例临床和功能稳定的患者（纽约心脏协会心功能分级2级±0.5）进行随访，并在基线、12个月和24个月时测量NT-proBNP的血浆和尿液水平。
结果
随访期间尿中平均水平存在显著差异（p<0.01），但血浆中未发现变化。布兰德-奥特曼图显示，在三个时间段（阶段I-基线；阶段II-阶段I；阶段II-基线）血浆百分比变化较小，重现性系数（CR）分别为22%、21%和25%。NT-proBNP尿水平在三个时间段的CR分别为7.1%、6.8%和9.4%。NT-proBNP的血浆和尿液水平之间（p<0.001）以及不同的NT-proBNP血浆测量值之间（p<0.001）和尿液测量值之间（p<0.001）均发现良好的相关性。
结论
在对稳定型心力衰竭患者进行24个月的随访中，NT-proBNP的血浆和尿液水平显示出良好的稳定性。因此，评估尿液和血浆中NT-proBNP的浓度可能是随访期间监测HF患者的有用工具。结果表明，在12个月的随访中，血浆中肽浓度变化超过22%，尿液中超过7%，以及在24个月的随访中超过25%和9%，可能表明存在病理生理变化。
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