131I治疗甲亢性心脏病患者尿脑钠肽水平变化的研究

The dynamic changes of brain natriuretic peptide level in patients with hyperthyroid heart disease after 131I therapy

    摘要
  • 摘要:
    目的 探讨尿液脑钠肽水平的测定在131I治疗甲状腺功能亢进性心脏病(甲心病)中的应用价值。
    方法 采用化学发光法检测111例接受131I治疗的甲状腺功能亢进症(甲亢)患者和30名健康对照者的血浆和尿液脑钠肽浓度以及血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平。将111例甲亢患者分为单纯甲亢组(51例)和甲心病组(60例), 并对甲心病组患者按照纽约心脏病学会(NYHA)标准对其心功能进行分级, 其中, NYHAⅠ~Ⅱ级(A组)37例、NYHA Ⅲ~Ⅳ级(B组)23例。对正常对照组及131I治疗前后各组患者的血浆和尿液脑钠肽水平以及FT3、FT4水平进行比较分析。
    结果 A、B两组甲心病患者治疗前血浆和尿液脑钠肽水平均显著高于单纯甲亢组(血浆:t=8.98、9.52, P均＜0.01;尿液:t=10.83、12.73, P均＜0.01)和正常对照组(血浆:t=8.97、9.52, P均＜0.01;尿液:t=9.21、5.64, P均＜0.01);甲心病B组131I治疗前、治疗后6个月、12个月的血浆、尿液脑钠肽水平均明显高于甲心病A组(血浆:t=5.98、5.87、6.35, P均＜0.01;尿液:t=4.33、4.09、5.02, P均＜0.01)。随着心功能不全程度的加重, 尿液脑钠肽水平逐渐升高, 与血浆脑钠肽水平呈正相关(r=0.829, P＜0.01);与NYHA分级呈正相关(r=0.751, P＜0.01);与FT3、FT4水平呈正相关(FT3:r=0.635;FT4:r=0.672, P均＜0.01)。
    结论 甲心病患者尿液脑钠肽水平随着心功能严重程度的增加而升高, 尿液脑钠肽可以准确评价甲亢患者的心功能, 可作为临床诊断、疗效观察以及预后判断的客观指标, 与血浆脑钠肽具有相同的应用价值。

     

    Abstract:
    Objective To investigate the application value of urine brain natriuretic peptide(BNP)level in 131I treatment of hyperthyroid heart disease.
    Methods One hundred and eleven hyperthyroidism patients who received 131I therapy were divided into two groups, hyperthyroidism group(51 cases) and hyperthyroid heart disease group(60 cases), and 30 healthy subjects as control. Sixty patients in the hyperthyroid heart disease group all received ultrasonic cardiogram. The hyperthyroid heart disease group was divided into two subgroups according to New York Heart Association(NYHA) functional classification(hyperthyroid heart disease A subgroup and hyperthyroid heart disease B subgroup). The urine and serum BNP level and serum free triiodothyronine(FT3), free thyroxine(FT4) level were measured through chemiluminescence before and after therapy.
    Results The urine and serum BNP level before 131I therapy of the hyperthyroid heart disease group were significantly higher than those of hyperthyroidism group(serum:t=8.98 and 9.52, both P < 0.01; urine:t=10.83 and 12.73, both P < 0.01)and the control group(serum:t=8.97 and 9.52, both P < 0.01; urine:t=9.21 and 5.64, both P < 0.01). The urine and serum BNP level before and 6, 12 months after 131I therapy of the hyperthyroid heart disease A subgroup were significantly higher than those of hyperthyroid heart disease B subgroup(serum:t=5.98, 5.87 and 6.35, all P < 0.01; serum:t=4.33, 4.09 and 5.02, all P < 0.01). The urine level of BNP was gradually increased with the severity of cardiac insufficiency and it was positively correlated with the serum level of BNP(r=0.829, P < 0.01), the NYHA functional classification(r=0.751, P < 0.01)and the serum level of FT3 and FT4(FT3:r=0.635, P < 0.01; FT4:r=0.672, P < 0.01).
    Conclusions The urine BNP level of hyperthyroid heart disease patient increased with the severity of cardiac insufficiency. The urine BNP level could accurately reflect cardiac function of hyperthyroid heart disease patient, and could be used as objective indicator for clinical diagnosis, effective evaluation and prognosis evaluation. The urine BNP level has the same value as the serum BNP level.

     

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