与心衰发作相关的CV生物标志物
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By LabMedica International staff writers Posted on 22 Apr 2018 |
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心力衰竭的两种形式与正常心脏的对比图（图片蒙南卡罗莱纳医科大学惠赐）。
近半心衰患者射血分数并未降低，而是保持不变，但是尚不完全清楚生物标志物与将来心衰亚型的关联。
射血分数正常性心力衰竭(HFpEF)是一种充血性心力衰竭，每次心跳从左心室泵出的量（射血分数）都大于50%。当左心室向机体泵出的血量少于正常量时，会发生射血分数减低性心力衰竭(HFrEF)。
一大组来自多国的科学家与荷兰格罗宁根大学医学中心(www.umcg.nl)合作，招募了22,756名参与者，分为四个基于社区的纵向队列，并测量了肾功能障碍、内皮功能障碍和炎症的几个生物标志物，另外还测量了钠尿肽和高灵敏肌钙蛋白。
检查了下列生物标志物：N末端B型钠尿肽前体或脑钠尿肽，高灵敏肌钙蛋白T或I (cTn)，C反应蛋白(CRP)，尿白蛋白与肌酐之比(UACR)，肾素与醛甾酮之比，D-二聚体，纤维蛋白原，可溶的肿瘤抑制物，半乳糖凝集素-3，胱抑素C，纤溶酶原激活剂抑制剂1，白细胞介素6。
在四个队列的22756名参与者中，有12,087名女性，10,669名男性；年龄为60 ±13岁；在中值为12年的随访中，633名参与者发生HFpEF，841人发生HFrEF。与HFpEF显著相关的有两种生物标志物：UACR和钠尿肽；与高灵敏肌钙蛋白有暗示性相关。另一方面，反映肾功能障碍、内皮功能障碍和炎症的六个生物标志物与HFrEF发病相关，它们是钠尿肽、UACR、cTn、胱抑素C、D-二聚体和CRP。如果直接比较，那么钠尿肽、高灵敏肌钙蛋白和CRP与HFrEF的关联比与HFpEF的关联更密切。
该研究的论文发表于2018年3月1日的《JAMA心内科》杂志。作者总结说，肾功能障碍、内皮功能障碍和炎症的生物标志物与HFrEF发病相关。相较而言，只有钠尿肽和UACR与HFpEF相关。这些发现把将来的研究重点导向甄别HFpEF风险的新型生物标志物。
格罗宁根大学医学中心>>> www.umcg.nl
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