Bratisl Lek Listy. 2021;122(1):28-33. doi: 10.4149/BLL_2021_002.
In addition to the recent success of neprilysin inhibition in treatment of heart failure, elevated soluble neprilysin (sNEP) in circulation has been suggested to be a prognostic biomarker in heart failure with a reduced ejection fraction (HFrEF). However, the diagnostic performance of sNEP is nebulous and its levels in HFrEF have not been compared with controls. For the purpose of this study, we determined the role of sNEP levels as a biomarker in routine ambulatory care of HFrEF patients, when compared to the control subjects.
Ambulant patients with chronic HFrEF (n = 18) were included. Apparently healthy volunteers - hospital physicians (n = 9) were included as the controls. Besides standard diagnostic tools (echocardiographic examination and laboratory biochemical diagnostic tests including NT-proBNP assessment), we analysed serum levels of neprilysin with a commercially available human soluble neprilysin ultrasensitive ELISA kit (Aviscera Bioscience, USA).
Concentrations of sNEP were significantly reduced in HFrEF patients (average ± S.E.M.=1038 ± 464 pg/ml) when compared to the controls (1947 ± 613 pg/ml; p < 0.05). Two of eighteen HFrEF samples were below, while two of ten control samples were above the detection limit of the immunoassay. We documented a lack of significant correlation between sNEP and left ventricular ejection fraction (LVEF) and other echocardiographic features as well as NT-proBNP. However, sNEP significantly negatively correlated to serum natrium levels (Spearman r = ‒0.6112, p < 0.05) and to systolic blood pressure (Spearman r = ‒0.4746, p < 0.05) in HFrEF.
Levels of sNEP were significantly reduced in HFrEF, when compared to the controls, with absent correlations to relevant HF-related features (e.g. LVEF). These findings might contribute to clarification of the diagnostic value of sNEP in HF (Tab. 2, Fig. 2, Ref. 30) Keywords: soluble neprilysin, heart failure, reduced ejection fraction, pharmacotherapy.
除了最近神经肽酶抑制剂在心力衰竭治疗方面的成功，循环中可溶性神经肽酶（sNEP）升高已被认为是射血分数降低的心力衰竭（HFrEF）的预后生物标志物。然而，sNEP 的诊断性能尚不清楚，其在 HFrEF 中的水平尚未与对照进行比较。 为此，我们确定了 sNEP 水平作为 HFrEF 患者常规门诊护理中的生物标志物的作用，并与对照进行了比较。
纳入慢性 HFrEF 门诊患者（n=18）。将体格检查正常的医院医生（n=9）纳入对照组。除了标准诊断工具（超声心动图检查和包括 NT-proBNP 评估在内的实验室生化诊断测试）外，我们还使用市售的人可溶性神经肽酶超敏 ELISA 试剂盒（美国 Aviscera Bioscience）分析血清中神经肽酶的水平。
与对照组（1947±613pg/ml；p<0.05）相比，HFrEF 患者的 sNEP 浓度明显降低（平均值±S.E.M.=1038±464pg/ml）。18 例 HFrEF 样本中有 2 例低于检测限，10 例对照组样本中有 2 例高于检测限。我们记录到 sNEP 与左心室射血分数（LVEF）和其他超声心动图特征以及 NT-proBNP 之间没有显著相关性。然而，sNEP 与 HFrEF 患者的血清钠水平呈显著负相关（Spearman r=-0.6112，p<0.05），与收缩压呈显著负相关（Spearman r=-0.4746，p<0.05）。
与对照组相比，HFrEF 患者的 sNEP 水平显著降低，与相关 HF 相关特征（如 LVEF）无相关性。这些发现可能有助于澄清 sNEP 在 HF 中的诊断价值（表 2，图 2，参考文献 30）关键词：可溶性神经肽酶，心力衰竭，射血分数降低，药物治疗。
