Yin Geng, Mao Lei, Cen Xiao-Min, Yang Min, Xie Qi-Bing
Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu 610041, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2011 Sep;42(5):646-8, 660.
To explore the application value of combining brain natriuretic peptide (BNP), creatine phosphokinase (CPK) and echocardiogram in the evaluation of olymyositis-related chronic heart failure (CHF).
Twenty-five polymyositis (PM) patients with CHF (NYHA grade II-IV) were evaluated with New York Heart Association (NYHA) criteria for heart failure. Serum concentration of BNP and CPK were detected by the methods of enzyme linked immunosorbent assay and automatic biochemistry analyzer respectively. Echocardiogram was used to calculate left ventricular ejection fraction (LVEF). Thirty PM patients without CHF were also investiaged as control.
Serum concentrations of BNP, CPK in PM with CHF were significantly higher than those in PM without CHF (P < 0.01). Compared with the level before intervention, BNP concentration in PM with CHF decreased sharply after 14 days therapy (P < 0.05), while the decrease of BNP concentration was not statistically significant (P > 0.05) in PM without CHF after the therapy. The concentration of CPK was much lower in PM patients either with or without CHF after therapy (P < 0.05). Among each group of NYHA grade II-IV, there was statistical significant difference of BNP concentration (P < 0.05). Statistical significant difference of CPK concentration was only found between grade II and grade IV patients. The difference of BNP was not statistical significant between PM patients without CHF but CPK > 2 000 IU/L and PM with grade II CHF. BNP concentration was significantly different between PM patients with LVEF > 40% and those with LVEF < or = 40% (P < 0.05).
BNP is a good marker for PM with CHF and correlates well with LVEF and NYHA grades. In addition, it plays a suggestive role in diagnosing CHF in PM with CPK > 2 000 IU/L.
探讨脑钠肽（BNP）、肌酸磷酸激酶（CPK）及超声心动图联合应用在评估多发性肌炎相关慢性心力衰竭（CHF）中的应用价值。
对25例纽约心脏病协会（NYHA）心功能分级为II-IV级的多发性肌炎（PM）合并CHF患者，采用NYHA心力衰竭标准进行评估。分别采用酶联免疫吸附测定法和自动生化分析仪检测血清BNP和CPK浓度。用超声心动图计算左心室射血分数（LVEF）。另选取30例无CHF的PM患者作为对照。
合并CHF的PM患者血清BNP、CPK浓度显著高于无CHF的PM患者（P<0.01）。与干预前水平相比，合并CHF的PM患者治疗14天后BNP浓度急剧下降（P<0.05），而未合并CHF的PM患者治疗后BNP浓度下降无统计学意义（P>0.05）。治疗后，无论是否合并CHF的PM患者CPK浓度均显著降低（P<0.05）。在NYHA II-IV级的每组中，BNP浓度存在统计学差异（P<0.05）。仅在II级和IV级患者之间发现CPK浓度有统计学差异。无CHF但CPK>2000 IU/L的PM患者与II级CHF的PM患者之间BNP差异无统计学意义。LVEF>40%的PM患者与LVEF≤40%的患者之间BNP浓度有显著差异（P<0.05）。
BNP是合并CHF的PM的良好标志物，与LVEF和NYHA分级密切相关。此外，对于CPK>2000 IU/L的PM患者，BNP在诊断CHF方面具有提示作用。
