Department of Hematology and Oncology, Cell Therapy and Transplantation Medicine, Graduate School of Medicine, University of Tokyo, 7–3–1 Hongo, Bunkyo-ku, Tokyo, Japan.
Bone Marrow Transplant. 2010 Nov;45(11):1631-7. doi: 10.1038/bmt.2010.26. Epub 2010 Feb 22.
Fluid retention is characteristic of veno-occlusive disease (VOD). We hypothesized that plasma brain natriuretic peptide (BNP), a neurohormone secreted in response to volume expansion, may be associated with VOD after hematopoietic stem cell transplantation (HSCT). BNP was measured before and weekly after HSCT in 46 recipients. Sixteen patients developed VOD. BNP concentrations were similar before and on day 0 in patients with and without VOD, but were significantly higher on day 7 and later in those with VOD. Patients with VOD had significantly higher peak BNP concentrations before engraftment than those without VOD (median, 634.4 versus 80.9 pg ml⁻¹; P=0.01). Multivariate analysis showed that VOD was independently associated with BNP elevation (odds ratio, 50.1; 95% CI: 5.2-478.4; P<0.01). Landmark analysis at day 7 showed that patients with peak BNP concentration of ≥ 180 pg ml⁻¹ had significantly worse 100-day survival than patients with peak BNP <180 pg ml⁻¹ (54 versus 91%; P<0.01). In multivariate analysis, BNP elevation before day 7 significantly predicted 100-day survival (hazard ratio 5.3; 95% CI: 1.1-24.3; P=0.03). These findings suggest that plasma BNP may serve as a diagnostic and prognostic marker of VOD.
液体潴留是静脉阻塞性疾病（VOD）的特征。我们假设，作为对容量扩张的反应而分泌的神经激素——血浆脑利钠肽（BNP），可能与造血干细胞移植（HSCT）后 VOD 相关。在 46 名接受者中，我们在 HSCT 前和每周测量一次 BNP。16 名患者发生了 VOD。在有或没有 VOD 的患者中，BNP 浓度在 HSCT 前和第 0 天相似，但在 VOD 患者中，第 7 天及以后明显升高。在发生 VOD 的患者中，植入前的峰值 BNP 浓度明显高于没有 VOD 的患者（中位数分别为 634.4 与 80.9 pg/ml；P=0.01）。多变量分析显示，VOD 与 BNP 升高独立相关（优势比，50.1；95%CI：5.2-478.4；P<0.01）。第 7 天的时间点分析显示，峰值 BNP 浓度≥180 pg/ml 的患者 100 天生存率明显低于峰值 BNP<180 pg/ml 的患者（54%与 91%；P<0.01）。在多变量分析中，第 7 天前的 BNP 升高显著预测 100 天生存率（风险比 5.3；95%CI：1.1-24.3；P=0.03）。这些发现表明，血浆 BNP 可能是 VOD 的诊断和预后标志物。
