1 Health of Ministry, Şanlıurfa Children's Hospital Pediatric Hematooncology Clinic, Şanlıurfa, Turkey ; 2 Health of Ministry, Şanlıurfa Children's Hospital Pediatric Cardiology Clinic, Şanlıurfa, Turkey ; 3 Harran University, Pediatric Hematology Department, Şanlıurfa, Turkey ; 4 Ankalab laboratory, Ankara, Turkey.
Transl Pediatr. 2014 Oct;3(4):287-92. doi: 10.3978/j.issn.2224-4336.2014.06.02.
It has been reported that N-terminal pro-brain natriuretic peptide (NT-proBNP) is early biomarker of iron- induced cardiomyopathy in β-thalassemia major (β-TM). In this study, we aimed to assess the Doppler echocardiographic, tissue Doppler velocity datas and clinical characteristics in β-TM patients with high and normal NT-proBNP levels who have normal systolic function.
Fifty-eight β-TM patients who were on regular transfusion in every 3-4 weeks for more than one year and 20 healthy children were included into the study. According to NT-proBNP levels, β-TM patients are divided in two groups. Group I: the patients with high NT-proBNP levels; Group II: the patients with normal NT-proBNP levels.
The mean serum NT-proBNP levels were significantly increased in patients with β-TM compared to control group (P<0.05). The serum ferritin levels were ranged between 676-9,476 ng/mL (mean: 3,716±2,003 ng/mL) in β-TM. No correlation was found between ferritin and NT-pro BNP in patients with β-TM. The mean age and body surface area (BSA) were significantly low in group with high NT-proBNP compared to group with normal NT-proBNP (P<0.01). The mean heart rate, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were elevated, but not significantly in group with high NT-proBNP. Also, the mean ferritin and hemoglobin levels were decreased in this group compared to group with normal NT-proBNP, but statistically not significant. The left ventricular end diastole (LVED) diameters and left ventricular mass index (LVMI) values were found significantly decreased in group with high NT-proBNP compared to other group respectively (P<0.001, P<0,05). Right ventricular early diastolic tricuspid inflow velocity/early diastolic tissue Doppler indices (TDI) tricuspid annular velocity (RV E/E') were found increased in group with high NT-proBNP levels and difference was statistically significant (P<0.05). In addition, NT-pro BNP was found correlated with RV E/E' (r: 0.320).
According to our result, elevated NT-proBNP level was correlated with RVE/E', but it was not associated with ferritin level. The serum NT-proBNP level may be increased as a response to increased myocardial workload and decreased hemoglobin level in patients who have an increased need for transfusion.
已有报道称，N 端脑利钠肽前体（NT-proBNP）是β-地中海贫血（β-TM）患者铁诱导性心肌病的早期生物标志物。本研究旨在评估多普勒超声心动图、组织多普勒速度数据和临床特征，以比较高和正常 NT-proBNP 水平且左心室收缩功能正常的β-TM 患者。
将 58 名接受规律输血（每 3-4 周 1 次）治疗超过 1 年的β-TM 患者和 20 名健康儿童纳入研究。根据 NT-proBNP 水平，将β-TM 患者分为两组。组 I：NT-proBNP 水平升高的患者；组 II：NT-proBNP 水平正常的患者。
与对照组相比，β-TM 患者的血清 NT-proBNP 水平显著升高（P<0.05）。β-TM 患者的血清铁蛋白水平为 676-9476ng/mL（均值：3716±2003ng/mL）。β-TM 患者的铁蛋白与 NT-proBNP 之间无相关性。与 NT-proBNP 正常组相比，NT-proBNP 升高组的平均年龄和体表面积（BSA）显著降低（P<0.01）。NT-proBNP 升高组的平均心率、收缩压（SBP）和舒张压（DBP）升高，但无统计学意义。与 NT-proBNP 正常组相比，该组的平均铁蛋白和血红蛋白水平降低，但无统计学意义。与其他组相比，NT-proBNP 升高组的左心室舒张末期直径（LVED）和左心室质量指数（LVMI）值明显降低（P<0.001，P<0.05）。NT-proBNP 升高组的右心室早期舒张三尖瓣流入速度/早期舒张组织多普勒指数（TDI）三尖瓣环速度（RV E/E'）升高，差异有统计学意义（P<0.05）。此外，NT-proBNP 与 RV E/E'呈正相关（r：0.320）。
根据我们的结果，升高的 NT-proBNP 水平与 RVE/E'相关，但与铁蛋白水平无关。血清 NT-proBNP 水平可能会升高，以应对增加的心肌工作量和增加输血需求导致的血红蛋白水平降低。
