富路; 陈叶萍

Clinical study on changes of chromogranin A, brain natriuretic peptide and noradrenaline in patients with chronic heart failure

摘要

摘要: 目的:探讨不同程度心力衰竭患者血浆嗜铬粒蛋白A(CgA)、脑钠尿肽(BNP)及去甲肾上腺素(NE)水平的变化及其临床意义。方法：慢性心力衰竭（CHF）患者50（男35，女15）例，年龄在37～79（60±12）岁；其中扩张性心肌病27例，缺血性心肌病23例；健康对照组30（男22，女8）例，年龄在45～68（56±10）岁。采用ELISA法检测CgA、NE。采用放免法测定BNP。所有入选者行超声心动图检查, 测量左室射血分数(LVEF)及左室舒张末期内径(LVEDD) 。比较CHF患者血浆CgA、BNP、NE水平与对照组之间的差异；血浆CgA、 BNP、NE水平与心功能及LVEF以及3种激素之间的相关性；CHF组治疗前及治疗后CgA、BNP、NE水平的变化。结果： CHF患者血浆CgA、BNP、NE水平与对照组相比明显升高［CgA(124±79) μg/L vs.(24±10)μg/L；BNP (262±111)n/L vs.(78±29)ng/L；NE (504±356)ng/L vs.(102±68)ng/L,均P<0.05)。血浆CgA、BNP、NE水平分别随心功能NYHA分级程度的加重而显著增高,并与LVEF呈负相关。患者血浆CgA分别与BNP、LVEDD正相关。CHF组治疗前、后比较，血浆BNP、NE水平明显下降，而CgA水平无变化。结论： CHF患者血浆CgA、BNP及NE水平的变化与心衰的发生和发展有关。

Abstract: AIM:To investigate the changes of plasma chromogranin A (CgA), brain natriuretic peptide (BNP) and noradrenaline (NE) levels in patients with chronic heart failure (CHF) of different severities and their clinical signification. METHODS: Plasma BNP was measured by radioimmunoassay and CgA and NE by enzyme-linked immunosorbent assay, respectively, in 50 CHF patients and 30 control subjects. LVEF and LVEDD were measured by echocardiography. RESULTS: Plasma CgA, BNP and NE were significantly higher in CHF patients than in control subjects ［CgA (124.2±79.4)vs. (3.7±9.5) g/L; BNP (62.1±110.7) vs. (78.2±28.7) ng/L; NE (503.5±355.7) vs. (102.5±68.4) ng/L; P<0.05］. The increased CgA, BNP and NE were parallel with the severity of CHF. CgA, BNP and NE were negatively correlated with LVEF correspondingly and the level of CgA was positively related to BNP and LVEDD, respectively. A week of treatment significantly reduced the concentrations of BNP and NE, whereas the value of CgA was relatively unvaried. CONCLUSION: CgA, BNP and NE levels may be involved in the occurrence and development of CHF.

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