脑利钠肽和CA125在老年舒张性心力衰竭诊治中的评价

李美兰 张佩生 梁雪

脑利钠肽和CA125在老年舒张性心力衰竭诊治中的评价

李美兰 张佩生 梁雪

目的测定老年舒张性心力衰竭(DHF)患者治疗前、后血浆脑利钠肽(BNP)和糖类抗原125(CA125)的水平, 探讨老年DHF时BNP和CA125的变化及其意义。方法60例老年DHF患者为老年DHF组, 60例心功能正常者作为对照组。检测老年DHF组患者治疗前后和对照组的血浆BNP和CA125浓度。结果①老年DHF组血浆BNP和CA125浓度明显高于对照组, 差异有统计学意义(P＜0.05)。②老年DHF组治疗后血浆BNP和CA125浓度均显著下降, 差异有统计学意义(P＜0.05)。结论血浆BNP和CA125在老年DHF患者中明显升高, 对疗效观察和病情转归有一定临床指导意义。

老年舒张性心力衰竭；脑利钠肽；糖类抗原125

随着人口的老龄化, 舒张性心力衰竭的发病率及死亡率不断上升, 现已成为一种独立的临床疾病, 日益受到人们的重视。血清CA125于1981年被发现, 随着研究的进展, 人们发现其不仅在卵巢癌患者血清中表达升高, 而且在许多其他疾病中表达也升高[1]。1999年Nagele等[2]首先阐述了CA125与心力衰竭的关系。BNP是一种心脏神经激素, 主要反映心室功能, 左心室功能不全时血浆BNP水平增高, 且增高程度与心功能不全程度相关。但对老年DHF治疗前后BNP和CA125的变化意义的报道较少, 因此本研究通过对老年DHF患者血浆中BNP和CA125水平变化进行研究, 探讨其临床意义。现报告如下。

1 资料与方法

1.1 一般资料 选择2014年1～12月在本院心内科住院确诊并治疗好转的老年DHF患者60例(老年DHF组), 年龄70～90岁, 男40例, 女20例。其中冠心病患者30例, 高血压心脏病患者27例, 肥厚型心肌病患者3例。老年DHF组患者均符合欧洲心脏病学会(ESC) 提出的DHF诊断标准, 即同时存在下述3项指标者DHF诊断成立：①有慢性心力衰竭(临床)依据；②正常或轻微左心室收缩功能异常；③有左心室舒张、左心室充盈扩张功能异常或舒张僵硬依据。老年DHF组治疗包括: 利尿剂、β受体阻滞剂、血管紧张素转化酶抑制剂(ACEI)/血管紧张素受体拮抗剂(ARB)、醛固酮受体拮抗剂等。检测治疗前、临床心力衰竭症状好转(2～3周左右)后患者血浆BNP和CA125浓度。选取60例心功能正常者作为对照组, 年龄70～89岁, 男43例, 女17例。所有入选者均排除急性冠状动脉综合征、肾功能不全、慢性肝病、免疫系统疾病、急性脑血管病、甲状腺疾病、肿瘤、感染性疾病。两组一般资料比较, 差异无统计学意义(P＞0.05),具有可比性。

1.2 方法

1.2.1 BNP浓度测定 所有患者均清晨空腹采肘静脉血2 ml,用100 g/L EDTA抗凝, 并加入抑肽酶, 离心后分离血浆, 采用双抗夹心酶联免疫吸附实验(ELISA)测定血浆BNP浓度,正常值范围0～100 pg/ml。

1.2.2 CA125浓度测定 所有对象均清晨空腹采肘静脉血2 ml, 离心取上清液, 采用ELISA法测定CA125浓度, 正常值＜35 U/ml。

1.3 统计学方法 采用SPSS17.0统计学软件对数据进行统计分析。计量资料以均数±标准差(±s)表示, 采用t检验；计数资料以率(%)表示, 采用χ2检验。P＜0.05表示差异具有统计学意义。

2 结果

2.1 治疗前两组BNP、CA125比较 治疗前老年BNP、CA125水平均高于对照组(P＜0.05)。见表1。

表1 治疗前两组BNP、CA125水平比较(±s)

表1 治疗前两组BNP、CA125水平比较(±s)

注：与对照组比较, P＜0.05

组别 例数 BNP(pg/ml) CA125(U/ml)对照组 60 42.67±18.25 14.30±7.70老年DHF组 60 631.18±437.51 88.30±43.74

2.2 老年DHF组治疗前后BNP、CA125比较 治疗后老年DHF组BNP、CA125水平均低于治疗前(P＜0.05)。见表2。

表2 老年DHF组治疗前后BNP、CA125水平的比较(±s, n=60)

表2 老年DHF组治疗前后BNP、CA125水平的比较(±s, n=60)

注：与治疗前比较, P＜0.05

时间 BNP(pg/ml) CA125(U/ml)治疗前 631.18±437.51 88.30±43.74治疗后 263.20±163.82 38.20±8.35

3 讨论

BNP是一种多肽, 主要在心室分泌, 含32个氨基酸, 心室容量负荷和压力增高时其分泌增多, 目前已成为反映心室功能的重要指标之一。DHF因舒张期充盈压增高和室壁应力增加导致心室肌合成和释放BNP增加[3]。目前认为CA125是一种高分子糖蛋白, 其糖类主要是半乳糖、N-乙酰氨基葡萄糖和N-乙酰氨基半乳糖链, 蛋白部分主要是丝氨酸。近年来多项研究表明, 无论是急性失代偿心力衰竭(HF)还是慢性稳定性HF[4], 无论是轻中度还是重度HF[5], 血清CA125水平在某种程度上是独立于生化指标、BNP和超声心动图有助于评价充血性HF的一种新指标[6,7]。CA125在心力衰竭过程中表达升高的可能机制：容量扩张、间皮细胞承受压力等物理因素引发的间皮细胞刺激或浆膜渗出最终激发CA125水平升高[8]；较为活跃的背景炎症状态刺激间皮细胞过度表达CA125[9-11]。

本研究结果显示, 老年DHF患者血BNP和CA125浓度较对照组升高, 治疗后血BNP和CA125浓度均显著下降, 由此可见, 血BNP和CA125浓度对老年DHF患者的疗效观察和病情转归有一定临床指导意义。

[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 郑州大学第五附属医院心内二科