nghiên cứu nồng độ pro b type natryuretic peptide pro bnp của bệnh nhân suy tim mạn

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NGHIÊN CU N PRO-B TYPE NATRIURETIC PEPTIDE (PRO-BNP)
CA BNH NHÂN SUY TIM MN TÍNH

Tạ Mạnh Cường


Mục tiêu: 1)       -B     

-
siêu âm tim.
Phương pháp: 


-
-

Kết quả: 
32,1%

-
566.6 ± 618.5 480,5 ±
753,2-
-0,04; p< 0,001),

suy tim theo NYHA (r=0,58; p< 0,001).
Kết luận: Pro-


 suy tim, Pro-B type Natriuretic Peptide, pro-BNP.

SUMMARY
RESEARCH ON PRO-B TYPE NATRIURETIC PEPTIDE (PRO-BNP)
CONCENTRATION OF PATIENTS WITH CHRONIC HEART FAILURE
Objectives: 1) to study the differences in Pro-BNP levels of patients on the causes, clinical
stage and severity of heart failure patients; 2) to study the correlation between Pro-BNP levels in
plasma with clinical stage and severity of heart failure and ejection fraction EF on
echocardiography.
Methods: Patients heart failure who referred to Viet nam Heat Institue were recruited for
this study. Diagnosis of heart failure was done through clinical evaluation and echocardiographic
procedure. The severity of heart failure was determined according to New York heart association
(NYHA) classification and clinical stage for each patient The venous blood was obtained from
the subjects and all samples were sent to the Laboratory of Bach Mai Hospital for evaluation of
plasma Pro-BNP level wich for each classification of NYHA and clinical stages and left
ventricular ejection fraction (LVEF) were evaluated.
Results: One hundred six patients, with a mean age of 57.4 ±16.7 years were included in the
study. Seventy-three (68.9%) subjects were female, thirty-four patients (32.1%) were
hypertensive, forty patients (37.7%) were valvular heart disease,thirty-two (30.2%) suffered
from ischemic, congenital heart diseases and arrythmia . The mean plasma level of pro-BNP in
subjects aged 60 years or more was higher than younger subjects, (566.6 ± 618.5 versus 480.5 ±
753.2) but not singificant (p>0.05)). The evaluation of Pro-BNP plasma levels showed
correlation with decreased ejection fraction (r=-0.04; p< 0.001), clinical stages (r=0.57; p<
0.001), and function class according to NYHA classification (r=0.58; p< 0.001).
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Conclusion: Plasma levels of Pro-BNP were elevated proportional to decrease in ejection
fraction and systolic function of left ventricle in patients with heart failure. Measurement of Pro-
BNP is a good laboratory indicator for detection of heart failure and its severity.
Keywords: Heart failure, Pro-B type Natriuretic Peptide, pro-BNP.

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

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 
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
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-
-


-
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1. -

2. -




             


-

-

- 

-

suy tim và phâ



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
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

Theo 
               
(37,8%).
522



pro-
trái trên siêu âm (r = - 

3.-
-BNP

 pro-
-
3.-




Trung bình
(pmol/l)

(pmol/l)
P


53
566,6
618,5
> 0,05
< 60
53
480,5
753,2

Nam
33
596,2
562,1
> 0,05

73
490,7
738,1

34
413,9
557,5

> 0,05

40
592,2
813,8
 máu

nguyên nhân khác
32
504,2
587,2
-

-

3.-


tim

(n)
 BNP
Trung bình
(pmol/l)



95%
ANOVA
(one way)

A
35
54,6
105,9
18,2 - 90,9
F = 17.6
Df = 3
P < 0,001
B
11
302,7
360,1
60,8  544,5
C
22
555,4
600,0
289,4  821,5
D
38
1001,0
795,8
739,4 - 1262,6

106
523,6
687,2
391,2  655,9
-


th-

-
NYHA

(n)
-BNP
Trung bình
(pmol/l)




ANOVA
(one way)
I
35
54,6
105,9
18,2 - 90,9
F = 20.8
Df=3
P<0,001
II
11
302,7
360,1
60,8 - 544,5
III
20

443,8
489,0
109,4
IV
40
1034,5
793.6
125,5

106
523,6
687,2
391,2 - 655,9
523
3.4. -
EF trên siêu âm
EF (%)

(n)
-BNP
Trung bình
(pmol/l)


ANOVA
(one way)

53
274,0
619,9

103,2  444,9
F = 11.4
Df= 2
p<0,001
40 - 55
20
499,5
641,2
199,4  799,6
< 40
33
938,9
632,4
714,6  1163,1

106
523,6
687,2
391,2  655,9
-
 --55%) và

-
- 



thêm do các



        -angiotensin-    




rt type
fatty acid-binding protein: H-        

-
-

-

-

-

 Pro-

-
 -    

-
                   

- giá
-
--
 
-


 [1;2;4].
524


1.  -
-
-

2. -

- 0,4; p <0,001).


1. 
-
Y học Việt Nam-42.
2. -type
tính, Y học Việt Nam
51-56.
3. Hunt, PJ, Richards, AM, Nichollas, MG, et a1 (1997), Immunoreactive amino terminal
Pro- BNP: a new marker of cardiac impairment, Clin Endocrinol (OXF), 47: 287.
4. Maisel, AS, Krishnaswamy, P, Nowak, RM, et al (2002), Rapid measurement of B- type
natriuretic peptide in the emergency diagnosis of heart failure, N Engl J Med, 347: 161-
167.
5. Mohammad A.P. et al (2010), Measurement of NT-ProBNP in patients with heart
faillure, J Cardiovasc Thorac Res, 2(1): 23-27.
6. Richard W. Troughton, Christopher. F.et a1 (2000), Treatment of heart failure guided by
plasma aminoterminal brain natriuretic peptide (N- BNP) concentrations,. Lancet, 355,
1126- 1130.

7. Yoshihiko S., Akio O. et al (2004), Application of NT-proBNP and BNP measurements
in cardiac care: a more discerning marker for the detection an evaluation of heart faillure,
Eur Heart J, 6: 295-300.