Sezione di Gastroenterologia, Dipartimento Biomedico di Medicina Interna e Specialistica, DI.BI.M.I.S, University of Palermo, Palermo, Italy.
PLoS One. 2013 Aug 5;8(8):e68364. doi: 10.1371/journal.pone.0068364. Print 2013.
Plasma levels of NT-pro-BNP, a natriuretic peptide precursor, are raised in the presence of fluid retention of cardiac origin and can be used as markers of cardiac dysfunction. Recent studies showed high levels of NT pro BNP in patients with cirrhosis. We assessed NT pro-BNP and other parameters of cardiac dysfunction in patients with cirrhosis, with or without ascites, in order to determine whether the behaviour of NT pro BNP is linked to the stage of liver disease or to secondary cardiac dysfunction.
Fifty eight consecutive hospitalized patients mostly with viral or NAFLD-related cirrhosis were studied. All underwent abdominal ultrasound and upper GI endoscopy. Cardiac morpho-functional changes were evaluated by echocardiography and NT-pro-BNP plasma levels determined upon admission. Twenty-eight hypertensive patients, without evidence of liver disease served as controls.
Fifty eight cirrhotic patients (72% men) with a median age of 62 years (11% with mild arterial hypertension and 31% with type 2 diabetes) had a normal renal function (mean creatinine 0.9 mg/dl, range 0.7-1.06). As compared to controls, cirrhotic patients had higher NT pro-BNP plasma levels (365.2±365.2 vs 70.8±70.6 pg/ml; p<0.001). Left atrial volume (LAV) (61.8±26.3 vs 43.5±14.1 ml; p = 0.001), and left ventricular ejection fraction (62.7±6.9 vs. 65.5±4%,; p = 0.05) were also altered in cirrhotic patients that in controls. Patients with F2-F3 oesophageal varices as compared to F0/F1, showed higher e' velocity (0.91±0.23 vs 0.66±0.19 m/s, p<0.001), and accordingly a higher E/A ratio (1.21±0.46 vs 0.89±0.33 m/s., p = 0.006).
NT-pro-BNP plasma levels are increased proportionally to the stage of chronic liver disease. Advanced cirrhosis and high NT-pro-BNP levels are significantly associated to increased LAV and to signs of cardiac diastolic dysfunction. NT pro-BNP levels could hence be an useful prognostic indicators of early decompensation of cirrhosis.
血浆 NT-pro-BNP 水平（一种利钠肽前体）在心脏源性液体潴留时升高，可作为心功能障碍的标志物。最近的研究表明，肝硬化患者的 NT pro BNP 水平较高。我们评估了肝硬化患者（伴或不伴腹水）的 NT pro-BNP 和其他心功能障碍参数，以确定 NT pro-BNP 的行为是否与肝病的阶段或继发性心功能障碍有关。
研究了 58 例连续住院的患者，大多数患有病毒性或非酒精性脂肪性肝病相关的肝硬化。所有患者均行腹部超声和上消化道内镜检查。通过超声心动图评估心形态和功能变化，并在入院时测定 NT-pro-BNP 血浆水平。28 例高血压患者，无肝脏疾病证据作为对照。
58 例肝硬化患者（72%为男性），中位年龄 62 岁（11%为轻度动脉高血压，31%为 2 型糖尿病），肾功能正常（平均肌酐 0.9mg/dl，范围 0.7-1.06）。与对照组相比，肝硬化患者的 NT pro-BNP 血浆水平更高（365.2±365.2 比 70.8±70.6pg/ml；p<0.001）。左心房容积（LAV）（61.8±26.3 比 43.5±14.1ml；p=0.001）和左心室射血分数（62.7±6.9 比 65.5±4%；p=0.05）也在肝硬化患者中发生改变。与 F0/F1 相比，F2-F3 食管静脉曲张患者的 e' 速度更高（0.91±0.23 比 0.66±0.19m/s，p<0.001），E/A 比值更高（1.21±0.46 比 0.89±0.33m/s，p=0.006）。
NT-pro-BNP 血浆水平与慢性肝病的阶段成正比。晚期肝硬化和高 NT pro-BNP 水平与左心房容积增加和舒张功能障碍的迹象显著相关。NT pro-BNP 水平可能是早期肝硬化失代偿的有用预后指标。
