Inoue Terumasa, Kawai Makoto, Nakane Tokiko, Nojiri Ayumi, Minai Kosuke, Komukai Kimiaki, Ogawa Takayuki, Hongo Kenichi, Matsushima Masato, Yoshimura Michihiro
Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo.
Intern Med. 2010;49(24):2659-68. doi: 10.2169/internalmedicine.49.4211. Epub 2010 Dec 15.
B-type natriuretic peptide (BNP) is a cardiac hormone. The results of previous in vitro studies suggest that neurohumoral factors, and not only hemodynamic factors, may cause BNP secretion. In this study, we examined the impact of serum C-reactive protein (CRP) levels on the relationship between echocardiographic parameters and plasma BNP levels in patients with cardiovascular diseases.
The study population comprised 417 patients who visited our cardiovascular unit with a problem. Both blood sampling and echocardiography were performed within one month.
Multiple regression analysis showed that plasma BNP levels were negatively correlated with male gender, body mass index, and estimated glomerular filtration rate, and positively correlated with serum CRP levels and left ventricular end-systolic dimension (LVDs). The study population was divided into two groups based on the 75th percentile of the serum CRP levels. Single regression analysis showed that a regression line between LVDs and plasma BNP levels was steeper in the group of patients with CRP levels above the 75th percentile. Multiple regression analysis revealed that the interaction term (LVDs×CRP) was significant, which means LVDs had more impact on plasma BNP levels at higher CRP levels.
Plasma BNP levels increased with respect to the severity of cardiac dysfunction and serum CRP levels, and should therefore be considered a collective or total marker for life-threatening conditions including systemic inflammation, and not simply as a marker of cardiac dysfunction in patients with cardiovascular diseases.
B型利钠肽（BNP）是一种心脏激素。以往的体外研究结果表明，神经体液因素而非仅仅血流动力学因素可能导致BNP分泌。在本研究中，我们检测了血清C反应蛋白（CRP）水平对心血管疾病患者超声心动图参数与血浆BNP水平之间关系的影响。
研究人群包括417名因问题前来我们心血管科就诊的患者。在1个月内进行了血液采样和超声心动图检查。
多元回归分析显示，血浆BNP水平与男性、体重指数和估计肾小球滤过率呈负相关，与血清CRP水平和左心室收缩末期内径（LVDs）呈正相关。根据血清CRP水平的第75百分位数将研究人群分为两组。单因素回归分析显示，在CRP水平高于第75百分位数的患者组中，LVDs与血浆BNP水平之间的回归线更陡。多元回归分析显示交互项（LVDs×CRP）具有显著性，这意味着在较高的CRP水平下，LVDs对血浆BNP水平的影响更大。
血浆BNP水平随心脏功能障碍的严重程度和血清CRP水平升高，因此应被视为包括全身炎症在内的危及生命状况的一个综合或总体标志物，而不仅仅是心血管疾病患者心脏功能障碍的标志物。
