Kashiwagi S, Akaike M, Kawai H, Adachi K, Saito S
First Department of Internal Medicine, School of Medicine, University of Tokushima.
Rinsho Shinkeigaku. 1996 Jan;36(1):7-11.
We investigated the usefulness of the plasma concentration of brain natriuretic peptide (BNP) for evaluating cardiac function in patients with Duchenne muscular dystrophy (DMD). The plasma BNP concentration was measured by immunoradiometric assay in 55 patients with DMD and in 34 healthy subjects. Cardiac function was evaluated by the cardiothoracic ratio (CTR) on chest roentgenogram, left ventricular end-diastolic dimension (LVDd) and fractional shortening (FS) on echocardiogram, and the ratio of ejection time to pre-ejection period (ET/PEP) on mechanocardiogram. The function of skeletal muscle was evaluated in terms of the disability of lower limb function, serum creatine kinase (CK) activity and % vital capacity (% VC). The plasma concentration of BNP was increased in patients with DMD (32.7 +/- 14.8 pg/ml, mean +/- SEM) compared with that in normal subjects (4.3 +/- 0.5 pg/ml). Two of the DMD patients had symptoms of heart failure, with markedly increased plasma BNP concentrations. The other DMD patients with increased plasma BNP concentrations showed abnormal cardiac function but no symptoms of heart failure. In addition, in patients with DMD, the plasma BNP concentration showed significant positive correlations with CTR and LVDd (p < 0.01), and negative correlations with ET/PEP and FS (p < 0.01). In severe DMD patients who had advanced disability and decreased CK activity, the plasma BNP concentration tended to be elevated. There was no significant correlation between the plasma BNP concentration and % VC. These findings suggest that the plasma BNP concentration is useful for evaluating cardiac dysfunction, whether manifest or latent, in patients with DMD, in whom accurate evaluation of cardiac function by conventional methods is difficult due to severe muscle atrophy and deformity of the thorax.
我们研究了脑钠肽（BNP）血浆浓度在评估杜氏肌营养不良症（DMD）患者心功能方面的作用。采用免疫放射分析法测定了55例DMD患者和34名健康受试者的血浆BNP浓度。通过胸部X线片上的心胸比率（CTR）、超声心动图上的左心室舒张末期内径（LVDd）和缩短分数（FS）以及心机械图上的射血时间与射血前期比值（ET/PEP）来评估心功能。根据下肢功能障碍、血清肌酸激酶（CK）活性和肺活量百分比（%VC）来评估骨骼肌功能。与正常受试者（4.3±0.5 pg/ml）相比，DMD患者的血浆BNP浓度升高（32.7±14.8 pg/ml，平均值±标准误）。2例DMD患者出现心力衰竭症状，血浆BNP浓度显著升高。其他血浆BNP浓度升高的DMD患者心功能异常，但无心力衰竭症状。此外，在DMD患者中，血浆BNP浓度与CTR和LVDd呈显著正相关（p<0.01），与ET/PEP和FS呈负相关（p<0.01）。在残疾程度严重且CK活性降低的重度DMD患者中，血浆BNP浓度往往升高。血浆BNP浓度与%VC之间无显著相关性。这些发现表明，血浆BNP浓度有助于评估DMD患者的心脏功能障碍，无论是显性还是隐性，由于严重的肌肉萎缩和胸廓畸形，通过传统方法准确评估这些患者的心脏功能较为困难。
