Cavasi Adriana, Cavasi Eduard, Grigorescu Mircea, Sitar-Taut Adela
Regional Institute of Gastroenterology and Hepatology Prof. Dr. Octavian Fodor;3rd Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Integrated Ambulatory of the Clinical Hospital of Infectious Diseases, Cluj-Napoca, Romania.
J Gastrointestin Liver Dis. 2014 Mar;23(1):51-6. doi: 10.1007/s11749-013-0341-7.
BACKGROUND & AIMS: ProBNP is a sensitive marker of cardiac dysfunction. We assessed the concentration of circulating NT-proBNP in patients with liver cirrhosis in various stages of the disease and its correlation with markers of cardiac and renal dysfunction and with markers of liver disease severity.
A number of 88 patients with liver cirrhosis were included in the study, divided into 3 groups: group 1--18 control patients without ascites; group 2--35 non-azotemic patients with ascites; group 3--35 patients with hepatorenal syndrome. The cardiac dysfunction was assessed by measuring the NT-proBNP serum levels and the QTc interval. The markers of renal dysfunction were the estimated glomerular filtration rates--formulas involving creatinine and serum cystatin C. The Child-Pugh score was used to assess the liver disease severity.
The median NT-proBNP serum levels significantly increased in patients with advanced liver cirrhosis (group 3: 960 fmol/ml and group 2: 660 fmol/ml) as compared to group 1 (435 fmol/ml) (p<0.05). A significant direct correlation was found between the NT-proBNP concentration and the QTc interval (r=0.540, p<0.001). The NT-proBNP levels also correlated with the Child-Pugh score (r=0.501, p<0.01), proving the link between the cardiac dysfunction and the liver disease severity. The cardio-renal interrelation is supported by the relationship between the NT-proBNP concentration and the estimated clearances.
The high NT-proBNP levels in patients with advanced cirrhosis indicate the presence of cardiac dysfunction, which has a role in the pathogenesis of the hepatorenal syndrome.
脑钠肽前体（ProBNP）是心脏功能障碍的敏感标志物。我们评估了不同疾病阶段肝硬化患者循环中N末端脑钠肽前体（NT-proBNP）的浓度，及其与心脏和肾脏功能障碍标志物以及肝病严重程度标志物之间的相关性。
本研究纳入了88例肝硬化患者，分为3组：第1组——18例无腹水的对照患者；第2组——35例无氮质血症的腹水患者；第3组——35例肝肾综合征患者。通过测量NT-proBNP血清水平和QTc间期评估心脏功能障碍。肾功能障碍的标志物是估算的肾小球滤过率——涉及肌酐和血清胱抑素C的公式。采用Child-Pugh评分评估肝病严重程度。
与第1组（435 fmol/ml）相比，晚期肝硬化患者（第3组：960 fmol/ml，第2组：660 fmol/ml）的NT-proBNP血清水平中位数显著升高（p<0.05）。NT-proBNP浓度与QTc间期之间存在显著的正相关（r=0.540，p<0.001）。NT-proBNP水平也与Child-Pugh评分相关（r=0.501，p<0.01），证明了心脏功能障碍与肝病严重程度之间的联系。NT-proBNP浓度与估算清除率之间的关系支持了心肾相互关系。
晚期肝硬化患者NT-proBNP水平升高表明存在心脏功能障碍，这在肝肾综合征的发病机制中起作用。
