Kube Jennifer, Ebner Nicole, Jankowska Ewa A, Rozentryt Piotr, Cicoira Mariantonietta, Filippatos Gerasimos S, Ponikowski Piotr, Doehner Wolfram, Anker Stefan D, von Haehling Stephan
Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany.
Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.
Int J Cardiol. 2016 Sep 15;219:84-91. doi: 10.1016/j.ijcard.2016.05.006. Epub 2016 May 14.
Natriuretic peptides play an important role in the diagnosis and risk stratification of patients with acute and chronic heart failure. Multiple studies have shown that these peptides are liable to the influence of individual factors. For N-terminal-pro-B-type natriuretic peptide (NT-proBNP) some of these confounding factors have been evaluated over the years such as age, gender, New York Heart Association (NYHA) class and body mass index (BMI). The aim of this study was to establish confounding factors of mid-regional pro-atrial natriuretic peptide (MR-proANP) assessment.
We studied 684 patients (94% male, age 61.2±11.2, left ventricular ejection fraction [LVEF]<35%-45%, NYHA class (I/II/III/IV: 8.4/45.8/39.5/6.3%), ischaemic aetiology 71%, body mass index [BMI] 26.5±4.3kg/m(2), mean MR-proANP 296.0±281.0pmol/L, mean NT-proBNP 2792.0±5328.6pg/mL, mean creatinine level 110.2±38.0μmol/L and mean haemoglobin 13.9±1.5g/dL) with clinically stable chronic heart failure. MR-proANP levels increased with increasing NYHA class (p<0.0001) and an increasing BMI category was associated with decreasing values of MR-proANP (p<0.0001). We found MR-proANP to be independently associated with BMI, creatinine, ischaemic aetiology, LVEF and NYHA class. Meanwhile, NT-proBNP was independently associated with BMI, creatinine, haemoglobin, LVEF and NYHA class.
MR-proANP is subject to the almost identical influencing factors like NT-proBNP. The effects of anaemia warrant further study.
利钠肽在急慢性心力衰竭患者的诊断及风险分层中发挥重要作用。多项研究表明，这些肽易受个体因素影响。多年来，针对N末端B型利钠肽原（NT-proBNP），已对其中一些混杂因素进行了评估，如年龄、性别、纽约心脏协会（NYHA）心功能分级及体重指数（BMI）。本研究旨在确定中部心房利钠肽原（MR-proANP）评估的混杂因素。
我们研究了684例临床稳定的慢性心力衰竭患者（男性占94%，年龄61.2±11.2岁，左心室射血分数[LVEF]<35%-45%，NYHA心功能分级（I/II/III/IV：8.4/45.8/39.5/6.3%），缺血性病因占71%，体重指数[BMI]26.5±4.3kg/m²，平均MR-proANP 296.0±281.0pmol/L，平均NT-proBNP 2792.0±5328.6pg/mL，平均肌酐水平110.2±38.0μmol/L，平均血红蛋白13.9±1.5g/dL）。MR-proANP水平随NYHA心功能分级升高而升高（p<0.0001），且BMI类别增加与MR-proANP值降低相关（p<0.0001）。我们发现MR-proANP与BMI、肌酐、缺血性病因、LVEF及NYHA心功能分级独立相关。同时，NT-proBNP与BMI、肌酐、血红蛋白、LVEF及NYHA心功能分级独立相关。
MR-proANP受与NT-proBNP几乎相同的影响因素作用。贫血的影响值得进一步研究。
