Vila Greisa, Resl Michael, Stelzeneder David, Struck Joachim, Maier Christina, Riedl Michaela, Hülsmann Martin, Pacher Richard, Luger Anton, Clodi Martin
Dept. of Medicine III, Medical Univ. of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
J Appl Physiol (1985). 2008 Dec;105(6):1741-5. doi: 10.1152/japplphysiol.90442.2008. Epub 2008 Oct 9.
Circulating levels of B-type natriuretic peptide (BNP) and NH(2)-terminal-proBNP (NT-proBNP) increase in response to volume overload and help in the differential diagnosis of acute heart failure. Elevated plasma BNP levels are observed also in sepsis and do not always correspond to left ventricular dysfunction. Here, we investigated plasma NT-proBNP fluctuations in response to human bacterial endotoxinemia, an experimental model of systemic infection and inflammation. Escherichia coli endotoxin (LPS) (2 ng/kg) was administered to 10 healthy volunteers in a randomized, placebo-controlled, cross-over design. Plasma NT-proBNP, C-reactive protein (CRP), COOH terminal pro-endothelin-1 (CT-proET-1), and midregional-pro-adrenomedullin (MR-proADM) were measured at hourly intervals for 6 h. LPS administration induced a continuous increase in plasma NT-proBNP that reached peak values after 6 h (40.7 +/- 7.9 vs. 16.1 +/- 3.2 pg/ml in placebo days, mean +/- SE; P = 0.023). The profile of changes in NT-proBNP correlated to changes in body temperature (P < 0.001), heart rate (P = 0.005), CRP (P < 0.001), and CT-proET-1 (P = 0.008), but not to blood pressure values. Our results demonstrate that plasma NT-proBNP increases in a model of systemic infection/inflammation in healthy men with normal heart function. This finding emphasizes the necessity to consider concomitant infections when interpreting elevated circulating NT-proBNP concentrations.
B型利钠肽（BNP）和氨基末端前BNP（NT-proBNP）的循环水平会因容量超负荷而升高，并有助于急性心力衰竭的鉴别诊断。脓毒症时也可观察到血浆BNP水平升高，且并不总是与左心室功能障碍相对应。在此，我们研究了在人类细菌内毒素血症（一种全身感染和炎症的实验模型）中血浆NT-proBNP的波动情况。采用随机、安慰剂对照、交叉设计，对10名健康志愿者给予大肠杆菌内毒素（LPS）（2 ng/kg）。每小时测量一次血浆NT-proBNP、C反应蛋白（CRP）、羧基末端前内皮素-1（CT-proET-1）和中段肾上腺髓质素（MR-proADM），共持续6小时。给予LPS后，血浆NT-proBNP持续升高，6小时后达到峰值（安慰剂日为40.7±7.9 vs. 16.1±3.2 pg/ml，均值±标准误；P = 0.023）。NT-proBNP的变化曲线与体温变化（P < 0.001）、心率（P = 0.005）、CRP（P < 0.001）和CT-proET-1（P = 0.008）相关，但与血压值无关。我们的结果表明，在心脏功能正常的健康男性全身感染/炎症模型中，血浆NT-proBNP会升高。这一发现强调了在解释循环NT-proBNP浓度升高时考虑合并感染的必要性。
