Department of Internal Medicine, University of Pisa School of Medicine , Pisa, Italy.
J Interferon Cytokine Res. 2010 May;30(5):359-63. doi: 10.1089/jir.2009.0059.
Many patients with hepatitis C chronic infection (HCV+ patients) experience symptoms (fatigue, dyspnea) not proportional to the liver involvement and resemble symptoms of heart failure (HF). To our knowledge, no study evaluated at the same time serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and tumor necrosis factor alpha (TNF-alpha) in HCV+ patients. Circulating NT-proBNP and TNF-alpha were assayed in 60 HCV+ patients, and in 60 sex- and age-matched controls. HCV+ patients showed significantly higher mean NT-proBNP and TNF-alpha levels than controls (P < 0.003). By defining high NT-proBNP level as a value higher than 125 pg/mL (the single cutoff point for outpatients under 75 years of age), 28% of HCV+ and 7% controls had high NT-proBNP (chi-square; P < 0.002). With a cutoff point of 900 pg/mL (that should be used for ruling in HF in patients age 50-75; such as the patients in our study), 3% HCV+ and 0 controls had high NT-proBNP. In conclusion, the study demonstrates high levels of circulating NT-proBNP and TNF-alpha in HCV+ patients. The increase of NT-proBNP may indicate the presence of a subclinical cardiac dysfunction. Further prospective studies quantifying symptoms and correlating these with echocardiographic parameters are needed to confirm this association.
许多慢性丙型肝炎感染患者（HCV+ 患者）出现的症状（疲劳、呼吸困难）与肝脏受累不成比例，类似于心力衰竭（HF）的症状。据我们所知，尚无研究同时评估 HCV+ 患者的血清 N 末端脑利钠肽前体（NT-proBNP）和肿瘤坏死因子 alpha（TNF-alpha）水平。我们检测了 60 名 HCV+ 患者和 60 名性别和年龄匹配的对照者的循环 NT-proBNP 和 TNF-alpha 水平。HCV+ 患者的平均 NT-proBNP 和 TNF-alpha 水平明显高于对照组（P<0.003）。将高 NT-proBNP 水平定义为高于 125 pg/mL（75 岁以下门诊患者的单一截断值），28%的 HCV+患者和 7%的对照组有高 NT-proBNP（卡方检验；P<0.002）。使用 900 pg/mL 的截断值（用于诊断 50-75 岁患者的 HF；如本研究中的患者），3%的 HCV+患者和 0 对照组有高 NT-proBNP。总之，该研究表明 HCV+ 患者循环 NT-proBNP 和 TNF-alpha 水平升高。NT-proBNP 的增加可能表明存在亚临床心脏功能障碍。需要进一步的前瞻性研究来量化症状，并将其与超声心动图参数相关联，以证实这种关联。
