Handa T, Nagai S, Ueda S, Chin K, Ito Y, Watanabe K, Tanizawa K, Tamaya M, Mishima M, Izumi T
Department of Rehabilitation Medicine, Kyoto University Hospital, Kyoto, Japan.
Sarcoidosis Vasc Diffuse Lung Dis. 2010 Jul;27(1):27-35.
Cardiac involvement and pulmonary hypertension (PH) are life-threatening complications in sarcoidosis.
This study aimed to investigate the utility of plasma NT-proBNP in the assessment of these conditions in sarcoidosis patients.
A prospective, observational study was performed on 150 consecutive Japanese sarcoidosis patients. Doppler echocardiography was performed in all subjects, and those who were successfully evaluated for PH status were included in the analysis. Cardiac sarcoidosis was diagnosed based on Japanese guidelines, and PH was defined as estimated systolic pulmonary artery pressure (sPAP) > or = 35 mmHg. The diagnostic accuracy of NT-proBNP according to the presence of cardiac sarcoidosis and PH was assessed based on receiver-operator characteristic (ROC) curves.
130 subjects were successfully evaluated for PH status. Of these, 29 met the diagnostic criteria of cardiac sarcoidosis, and 21 were diagnosed with PH. Plasma NT-proBNP levels were significantly higher in patients with cardiac sarcoidosis (p < 0.0001). Stepwise regression analysis showed that presence of cardiac sarcoidosis, decreased ejection fraction and increased sPAP were all independently associated with higher plasma NT-proBNP levels. Plasma NT-proBNP showed good accuracy in identifying patients with cardiac sarcoidosis (area under the ROC curve; AURC = 0.913). However, even when patients with cardiac sarcoidosis were excluded, plasma NT-proBNP levels could not be used reliably to identify patients with PH (AURC = 0.681).
In patients with sarcoidosis, plasma NT-proBNP levels are a useful biomarker to identify cardiac involvement, but not to identify PH.
心脏受累和肺动脉高压（PH）是结节病中危及生命的并发症。
本研究旨在探讨血浆N末端脑钠肽前体（NT-proBNP）在评估结节病患者这些情况中的效用。
对150例连续的日本结节病患者进行了一项前瞻性观察研究。所有受试者均接受了多普勒超声心动图检查，成功评估了PH状态的患者纳入分析。根据日本指南诊断心脏结节病，PH定义为估计收缩期肺动脉压（sPAP）≥35 mmHg。根据心脏结节病和PH的存在情况，基于受试者工作特征（ROC）曲线评估NT-proBNP的诊断准确性。
130例受试者成功评估了PH状态。其中，29例符合心脏结节病的诊断标准，21例被诊断为PH。心脏结节病患者的血浆NT-proBNP水平显著更高（p<0.0001）。逐步回归分析表明，心脏结节病的存在、射血分数降低和sPAP升高均与较高的血浆NT-proBNP水平独立相关。血浆NT-proBNP在识别心脏结节病患者方面显示出良好的准确性（ROC曲线下面积；AURC = 0.913）。然而，即使排除心脏结节病患者，血浆NT-proBNP水平也不能可靠地用于识别PH患者（AURC = 0.681）。
在结节病患者中，血浆NT-proBNP水平是识别心脏受累的有用生物标志物，但不是识别PH的有用生物标志物。
