李美蘭 張佩生 梁雪

腦利鈉肽和CA125在老年舒張性心力衰竭診治中的評(píng)價(jià)

李美蘭 張佩生 梁雪

目的測(cè)定老年舒張性心力衰竭(DHF)患者治療前、后血漿腦利鈉肽(BNP)和糖類(lèi)抗原125(CA125)的水平, 探討老年DHF時(shí)BNP和CA125的變化及其意義。方法60例老年DHF患者為老年DHF組, 60例心功能正常者作為對(duì)照組。檢測(cè)老年DHF組患者治療前后和對(duì)照組的血漿BNP和CA125濃度。結(jié)果①老年DHF組血漿BNP和CA125濃度明顯高于對(duì)照組, 差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。②老年DHF組治療后血漿BNP和CA125濃度均顯著下降, 差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。結(jié)論血漿BNP和CA125在老年DHF患者中明顯升高, 對(duì)療效觀察和病情轉(zhuǎn)歸有一定臨床指導(dǎo)意義。

老年舒張性心力衰竭；腦利鈉肽；糖類(lèi)抗原125

隨著人口的老齡化, 舒張性心力衰竭的發(fā)病率及死亡率不斷上升, 現(xiàn)已成為一種獨(dú)立的臨床疾病, 日益受到人們的重視。血清CA125于1981年被發(fā)現(xiàn), 隨著研究的進(jìn)展, 人們發(fā)現(xiàn)其不僅在卵巢癌患者血清中表達(dá)升高, 而且在許多其他疾病中表達(dá)也升高[1]。1999年Nagele等[2]首先闡述了CA125與心力衰竭的關(guān)系。BNP是一種心臟神經(jīng)激素, 主要反映心室功能, 左心室功能不全時(shí)血漿BNP水平增高, 且增高程度與心功能不全程度相關(guān)。但對(duì)老年DHF治療前后BNP和CA125的變化意義的報(bào)道較少, 因此本研究通過(guò)對(duì)老年DHF患者血漿中BNP和CA125水平變化進(jìn)行研究, 探討其臨床意義?，F(xiàn)報(bào)告如下。

1 資料與方法

1.1 一般資料 選擇2014年1～12月在本院心內(nèi)科住院確診并治療好轉(zhuǎn)的老年DHF患者60例(老年DHF組), 年齡70～90歲, 男40例, 女20例。其中冠心病患者30例, 高血壓心臟病患者27例, 肥厚型心肌病患者3例。老年DHF組患者均符合歐洲心臟病學(xué)會(huì)(ESC) 提出的DHF診斷標(biāo)準(zhǔn), 即同時(shí)存在下述3項(xiàng)指標(biāo)者DHF診斷成立：①有慢性心力衰竭(臨床)依據(jù)；②正?；蜉p微左心室收縮功能異常；③有左心室舒張、左心室充盈擴(kuò)張功能異?；蚴鎻埥┯惨罁?jù)。老年DHF組治療包括: 利尿劑、β受體阻滯劑、血管緊張素轉(zhuǎn)化酶抑制劑(ACEI)/血管緊張素受體拮抗劑(ARB)、醛固酮受體拮抗劑等。檢測(cè)治療前、臨床心力衰竭癥狀好轉(zhuǎn)(2～3周左右)后患者血漿BNP和CA125濃度。選取60例心功能正常者作為對(duì)照組, 年齡70～89歲, 男43例, 女17例。所有入選者均排除急性冠狀動(dòng)脈綜合征、腎功能不全、慢性肝病、免疫系統(tǒng)疾病、急性腦血管病、甲狀腺疾病、腫瘤、感染性疾病。兩組一般資料比較, 差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05),具有可比性。

1.2 方法

1.2.1 BNP濃度測(cè)定 所有患者均清晨空腹采肘靜脈血2 ml,用100 g/L EDTA抗凝, 并加入抑肽酶, 離心后分離血漿, 采用雙抗夾心酶聯(lián)免疫吸附實(shí)驗(yàn)(ELISA)測(cè)定血漿BNP濃度,正常值范圍0～100 pg/ml。

1.2.2 CA125濃度測(cè)定 所有對(duì)象均清晨空腹采肘靜脈血2 ml, 離心取上清液, 采用ELISA法測(cè)定CA125濃度, 正常值＜35 U/ml。

1.3 統(tǒng)計(jì)學(xué)方法 采用SPSS17.0統(tǒng)計(jì)學(xué)軟件對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析。計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(±s)表示, 采用t檢驗(yàn)；計(jì)數(shù)資料以率(%)表示, 采用χ2檢驗(yàn)。P＜0.05表示差異具有統(tǒng)計(jì)學(xué)意義。

2 結(jié)果

2.1 治療前兩組BNP、CA125比較 治療前老年BNP、CA125水平均高于對(duì)照組(P＜0.05)。見(jiàn)表1。

表1 治療前兩組BNP、CA125水平比較(±s)

表1 治療前兩組BNP、CA125水平比較(±s)

注：與對(duì)照組比較, P＜0.05

組別 例數(shù) BNP(pg/ml) CA125(U/ml)對(duì)照組 60 42.67±18.25 14.30±7.70老年DHF組 60 631.18±437.51 88.30±43.74

2.2 老年DHF組治療前后BNP、CA125比較 治療后老年DHF組BNP、CA125水平均低于治療前(P＜0.05)。見(jiàn)表2。

表2 老年DHF組治療前后BNP、CA125水平的比較(±s, n=60)

表2 老年DHF組治療前后BNP、CA125水平的比較(±s, n=60)

注：與治療前比較, P＜0.05

時(shí)間 BNP(pg/ml) CA125(U/ml)治療前 631.18±437.51 88.30±43.74治療后 263.20±163.82 38.20±8.35

3 討論

BNP是一種多肽, 主要在心室分泌, 含32個(gè)氨基酸, 心室容量負(fù)荷和壓力增高時(shí)其分泌增多, 目前已成為反映心室功能的重要指標(biāo)之一。DHF因舒張期充盈壓增高和室壁應(yīng)力增加導(dǎo)致心室肌合成和釋放BNP增加[3]。目前認(rèn)為CA125是一種高分子糖蛋白, 其糖類(lèi)主要是半乳糖、N-乙酰氨基葡萄糖和N-乙酰氨基半乳糖鏈, 蛋白部分主要是絲氨酸。近年來(lái)多項(xiàng)研究表明, 無(wú)論是急性失代償心力衰竭(HF)還是慢性穩(wěn)定性HF[4], 無(wú)論是輕中度還是重度HF[5], 血清CA125水平在某種程度上是獨(dú)立于生化指標(biāo)、BNP和超聲心動(dòng)圖有助于評(píng)價(jià)充血性HF的一種新指標(biāo)[6,7]。CA125在心力衰竭過(guò)程中表達(dá)升高的可能機(jī)制：容量擴(kuò)張、間皮細(xì)胞承受壓力等物理因素引發(fā)的間皮細(xì)胞刺激或漿膜滲出最終激發(fā)CA125水平升高[8]；較為活躍的背景炎癥狀態(tài)刺激間皮細(xì)胞過(guò)度表達(dá)CA125[9-11]。

本研究結(jié)果顯示, 老年DHF患者血BNP和CA125濃度較對(duì)照組升高, 治療后血BNP和CA125濃度均顯著下降, 由此可見(jiàn), 血BNP和CA125濃度對(duì)老年DHF患者的療效觀察和病情轉(zhuǎn)歸有一定臨床指導(dǎo)意義。

[1]Miralles C, Orea M, Espana P, et al. Cancer antigen 125 associated with multiple benign and malignant pathologies. Ann Surg Oncol, 2003, 10(2):150-154.

[2]Nagele H, Bahlo M, Klapdor R, et al. CA125 and its relation to cardiac function. Am Heart J, 1999, 137(6):1044-1049.

[3]Iwanaga Y, Nishi I, Furuichi S, et al. B-type natriuretic peptide strongly reflects diastolic wall stress in patients with chronic heart failure: comparison between systolic and diastolic heart failure. Am Coll Cardiol, 2006, 47(4):742-748.

[4]Mansour IN, Napan S, Tarek Alahdab M, et al. Carbohydrate antigen125 predicts long-term mortality in African American patients with acute decompensated heart failure. Congest Heart Fail, 2010, 16(1):15-20.

[5]Vizzardi E, D’Aloia A, Pezzali N, et al. Long-term prognostic value of CA 125 serum levels in mild to moderate heart failure patients. J Card Fail, 2012, 18(1):68-73.

[6]Hung CL, Hung TC, Liu CC, et al. Relation of carbohydrate antigen-125 to left atrial remodeling and its prognostic usefulness in patients with heart failure and preserved left ventricular ejection fraction in women. Am J Cardiol, 2012, 110(7):993-1000.

[7]Ordu S, Ozhan H, Alemdar R, et al. Carbohydrate antigen-125 and N-terminal pro-brain natriuretic peptide levels: compared in heart failure prognostication. Tex Heart Inst J, 2012, 39(1):30-35.

[8]Turk HM, Pekdemir H, Buyukberber S, et al. Serum CA125 levels in patients with chronic heart failure and accompanying pleural fluid. Tumour Biol, 2003, 24(4):172-175.

[9]Kosar F, Aksoy Y, Ozguntekin G, et al. Relationship between cytokines and tumour markers in patients with chronic heart failure. Eur J Heart Fail, 2006, 8(3):270-274.

[10]Nunez J, Minana G, Gonzalez M, et al. Antigen carbohydrate 125 in heart failure: Not just a surrogate for serosal effusions. Int J Cardiol, 2010, 146(3):473-474.

[11]Hamdy NM. Relationship between pro-anti-inflammatory cytokines, T-cell activation and CA125 in obese patients with heart failure. Med Sci Monit, 2011, 17(3):173-178.

Evaluation of brain natriuretic peptide and CA125 in diagnosis and treatment of senile diastolic heart failure

LI Mei-lan, ZHANG Pei-sheng, LIANG Xue. The Second Department of Cardiology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China

ObjectiveTo detect plasma brain natriuretic peptide (BNP) and carbohydrate antigen 125 (CA125) in senile diastolic heart failure (DHF) patients before and after treatment, and to investigate changes and significance of BNP and CA125 in senile DHF.MethodsThere were 60 senile DHF patients as senile DHF group, and another 60 people with normal cardiac function as control group. Plasma BNP and CA125 were detected in senile DHF group and control group before and after treatment.Results① Senile DHF group had obviously higher plasma BNP and CA125 levels than the control group, and their difference had statistical significance (P＜0.05). ② Senile DHF group had remarkably reduced plasma BNP and CA125 levels after treatment, and the difference had statistical significance (P＜0.05).ConclusionObviously increased plasma BNP and CA125 levels in senile DHF patients provide certain clinical guidance significance for curative effect observation and disease outcomes.

Senile diastolic heart failure; Brain natriuretic peptide; Carbohydrate antigen 125

10.14164/j.cnki.cn11-5581/r.2015.19.008

2015-04-23]

450052 鄭州大學(xué)第五附屬醫(yī)院心內(nèi)二科