Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan.
J Card Fail. 2011 Oct;17(10):819-26. doi: 10.1016/j.cardfail.2011.05.011. Epub 2011 Jul 8.
Pregnancy-associated plasma protein A (PAPP-A) proteolyzes insulin-like growth factor (IGF)-binding proteins and thus increases IGF-1 bioactivity. PAPP-A has been reported to be involved in various pathophysiologic abnormalities; however, the clinical significance of PAPP-A has not been examined in cases of heart failure (HF). We hypothesized that PAPP-A levels might be correlated with the severity of HF.
PAPP-A and B-type natriuretic peptide (BNP) levels were measured in 262 subjects (182 HF patients and 80 control subjects). PAPP-A levels were higher in patients with HF than in control subjects and increased with advancing New York Heart Association functional class. There were 53 cardiac events during a mean follow-up period of 796 days. PAPP-A levels were higher in patients with cardiac events than in event-free patients. Patients were divided into 3 groups on the basis of their PAPP-A and BNP levels. Kaplan-Meier analysis demonstrated that the group with both high BNP with high PAPP-A had a significantly higher cardiac event rate than other groups.
Serum PAPP-A levels were related to the severity of HF and associated with a high risk for adverse cardiac events in HF patients, suggesting that PAPP-A might be involved in the pathogenesis of HF.
妊娠相关血浆蛋白 A（PAPP-A）可使胰岛素样生长因子（IGF）结合蛋白发生蛋白水解，从而增加 IGF-1 的生物活性。已有报道称，PAPP-A 与各种病理生理异常有关；然而，心力衰竭（HF）患者中尚未检查 PAPP-A 的临床意义。我们假设 PAPP-A 水平可能与 HF 的严重程度相关。
在 262 名受试者（182 名 HF 患者和 80 名对照组）中测量了 PAPP-A 和 B 型利钠肽（BNP）水平。HF 患者的 PAPP-A 水平高于对照组，并随着纽约心脏协会功能分级的提高而增加。在平均 796 天的随访期间发生了 53 例心脏事件。发生心脏事件的患者的 PAPP-A 水平高于无事件患者。根据 PAPP-A 和 BNP 水平将患者分为 3 组。Kaplan-Meier 分析表明，同时具有高 BNP 和高 PAPP-A 的组的心脏事件发生率明显高于其他组。
血清 PAPP-A 水平与 HF 的严重程度相关，并与 HF 患者不良心脏事件的高风险相关，提示 PAPP-A 可能参与 HF 的发病机制。
