血浆B型脑钠肽对心力衰竭和呼吸困难的诊断价值

目的：探讨血浆脑钠肽（BNP）水平在心力衰竭（CHF）T和呼吸困难诊断中的应用。方法：采用免疫荧光快速测试法测定56例已确诊心衰患者、40例心源性呼吸困难患者、29例肺源性呼吸困难患者和30例健康人血浆BNP的含量。结果：心衰组患者血浆BNP水平明显高于对照组,差异显著（P〈0．01）;心源性呼吸困难组患者的BNP值水平（1032．2±879．8pg／ml）与肺源性呼吸困难组患者的BNP值水平（67．1±43．6pg／ml）比较有显著性差异（P〈0．01）。结论：检测BNP水平可为临床诊断CHF及心源性与肺源性呼吸困难的鉴别诊断提供重要依据。     

血清suPAR、PCT、CRP水平在小儿重症肺炎鉴别诊断中的效能分析

摘要 目的：分析血清可溶性尿激酶型纤溶酶原激活物受体（soluble urokinase-type plasminogen activator receptor,suPAR）、降钙素原（procalcitoni, PCT）、C反应蛋白（C-reaction protein,CRP）水平在小儿重症肺炎鉴别诊断中的效能,以更好地评估患儿的病情严重程度,从而指导治疗及降低重症肺炎的死亡率。方法：选取贵阳市第二人民医院及贵阳市儿童医院在2020年1月至2020年12月期间收治入院的80例社区获得性肺炎患儿作为研究对象,其中轻症患儿和重症患儿各40例。检测患儿入院时白细胞计数（white blood count,WBC）、中性粒细胞（neutrophil,N）、CRP、PCT和suPAR水平。采用受试者工作特征曲线（receiver operating characteristic curve,ROC）比较各指标对小儿肺炎病情严重程度的诊断效能。结果：重症组患儿WBC、N以及血清PCT、CRP、suPAR水平均明显高于轻症组患儿,差异具有统计学意义（P<0.05）。Pearson相关分析结果表明,血清suPAR水平与WBC、N、PCT和CRP水平均存在明显正相关性（P<0.05）。ROC曲线结果表明,血清suPAR诊断小儿肺炎病情严重程度的效果最佳,曲线下面积（area under curve,AUC）为0.866（95%CI：0.780~0.951）,最佳截断值为1.8,敏感度、特异度和约登指数分别为85.73 %、83.52 %和69.25 %。结论：早期检测血清suPAR能够预测小儿获得性社区肺炎病情严重程度,效果优于WBC、N以及血清PCT、CRP等指标。     

白细胞介素33通过促进上皮细胞黏附分子表达参与干燥综合征发病

摘要 目的：探讨白细胞介素（Interleukin-33,IL-33）可能通过调控上皮细胞黏附分子（Epithelial cell adhesion molecule, EpCAM）表达参与干燥综合征（Sj?gren''s syndrome, SS）发病的作用机制。方法：收集因SS诊断需要行唇腺活检术的患者血清和唇腺组织标本及相关临床资料,根据2016年ACR-EULAR SS分类诊断标准将患者分为SS组和非SS组,选取性别、年龄匹配的21例SS患者和21例非SS患者,利用多重检测流式试剂盒（人炎症因子组合1）检测血清中IL-33水平并用t检验比较SS患者组与非SS患者组、抗SSA抗体阳性与阴性组以及唇腺病理阳性与阴性组之间IL-33水平的差异。对唇腺组织石蜡切片进行IL-33免疫组织化学染色,用流式细胞术检测新鲜唇腺组织中上皮细胞EpCAM表达水平并与血清IL-33水平进行相关性分析。结果：SS患者组IL-33水平为（1736±590.1,n=21, pg/mL）,显著高于非SS患者组（306.8±120.3, n=21, pg/mL）（t=2.373,P=0.027）;唇腺病理阳性组即灶性血清IL-33水平（489.8±170, n=27, pg/mL）高于病理阴性组（1978±793.1, n=15, pg/mL）,2组之间有统计学差异（t=2.368,P=0.023）;而抗SSA抗体阳性组与阴性组之间无明显差异（P＞0.05）。免疫组化染色结果提示SS患者唇腺组织上皮细胞IL-33表达相较于非SS患者上升,且血清IL-33水平与唇腺上皮细胞EpCAM的表达呈中等强度正相关（r=0.4915,P=0.0009,95%CI 0.2205-0.692）。结论：IL-33是与SS密切相关的炎症因子,IL-33可能通过促进唾液腺上皮细胞EpCAM的表达参与SS发病。     

血清中性粒细胞明胶酶相关脂质运载蛋白、胱抑素C联合红细胞分布宽度对脓毒症患儿急性肾损伤的预测价值

摘要 目的：研究血清中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、胱抑素C联合红细胞分布宽度（RDW）对脓毒症患儿急性肾损伤（AKI）的预测价值。方法：选取我院从2016年1月～2019年1月收治的脓毒症患儿154例。将所有患儿根据是否合并AKI分为AKI组67例和非AKI组87例。分析两组临床资料的差异,检测并比较血清NGAL、胱抑素C以及RDW水平。采用多因素Logistic回归分析脓毒症患儿发生AKI的影响因素。采用受试者工作特征（ROC）曲线分析血清NGAL、胱抑素C以及RDW预测脓毒症患儿AKI的效能。结果：AKI组与非AKI组在年龄、小儿危重病例评分（PCIS）、儿童重症监护室（PICU）停留时间、第三代小儿死亡危险评分(PRISM-Ⅲ)、肌酐（Cr）方面比较差异均有统计学意义（P＜0.05）。AKI组血清NGAL、胱抑素C以及RDW水平均高于非AKI组（P＜0.05）。经多因素Logistic回归分析发现：脓毒症患儿发生AKI的危险因素有PICU停留时间≥15 d、PRISM-Ⅲ＞32分、Cr＞100 μmol/L、血清NGAL＞220 ng/mL、血清胱抑素C＞1.55 mg/L以及RDW＞14%（均OR＞1,P＜0.05）;而防止脓毒症患儿发生AKI的保护因素包括年龄＞50月、PCIS＞70分（均OR＜1,P＜0.05）。经ROC曲线分析发现：血清NGAL、胱抑素C以及RDW联合检测预测脓毒症患儿AKI的曲线下面积、灵敏度、特异度以及约登指数均高于上述三项指标单独检测。结论：脓毒症合并AKI的患儿血清NGAL、胱抑素C以及RDW水平异常升高,且联合检测以上指标对脓毒症患儿AKI的预测价值较高,具有一定临床应用价值。     

血清C反应蛋白、正五聚蛋白-3对小儿肺动脉高压的诊断价值

目的:研究血清C反应蛋白(CRP)和正五聚蛋白-3(PTX-3)在小儿肺动脉高压(PAH)诊断中的临床价值。方法:选择32例PAH患儿及32例健康小儿,检测和比较其血清CRP、PTX-3水平,分析血清CRP、PTX-3水平的相关性,通过绘制ROC曲线评价其对于PAH的诊断价值。结果:PAH组血清CRP水平(29.63±15.82 mg/L)、PTX-3水平(1.20±1.03 ng/m L)与对照组[CRP水平(3.38±1.74 mg/L)、PTX-3水平(0.64±0.43 ng/m L)]相比均显著升高(P0.01)。血清CRP与PTX-3的相关系数r为0.356(P0.05)。血清CRP诊断PAH的ROC曲线AUC为0.983,临界点为6.6 mg/L;PTX-3诊断PAH的ROC曲线AUC为0.669,临界点为0.95ng/m L;两者联合诊断的AUC为0.986,临界点为1.01。结论:PAH患儿血清PTX-3和CRP水平均显著升高,CRP大于PTX对PAH的诊断价值,两者联合诊断的价值更大。     

孟鲁司特钠联合双歧杆菌四联活菌片 对小儿过敏性紫癜的疗效

摘要：目的 对孟鲁司特钠联合双歧杆菌四联活菌片治疗小儿过敏性紫癜的临床疗效进行分析。方法 选取2015年3月1日至2018年3月31日我院收治的96例过敏性紫癜患儿为研究对象,依据随机数字表法分为A组、B组、C组、D组,每组24例。A组患儿施以常规临床治疗,B组在A组基础上给予孟鲁司特钠治疗、C组在A组基础上给予双歧杆菌四联活菌片治疗、D组在A组基础上施以孟鲁司特钠联合双歧杆菌四联活菌片治疗,4组患儿持续用药至出院后2个月。结果 A组患儿治疗有效率为66.67%,皮肤紫癜消失时间为（10.49±3.01）d,关节肿痛消失时间为（5.87±1.56）d,腹痛消失时间为（4.05±1.28）d,Alb水平为（27.11±7.80）mg/L,β2-MG水平为（0.31±0.15）mg/L,治疗后复发率为29.17%。D组患儿治疗有效率为91.67%、皮肤紫癜消失时间为（6.98±2.57）d,关节肿痛消失时间为（3.07±1.04）d,腹痛消失时间为（2.77±1.05）d,Alb水平为（22.00±8.47）mg/L,β2-MG水平为（0.19±0.06）mg/L,治疗后复发率为4.17%。D组患儿各指标与A组比较差异均有统计学意义（均P＜0.05）。B、C组患儿治疗有效率高于A组,但低于D组。B、C组患儿皮肤紫癜消失时间、关节肿痛消失时间、腹痛消失时间与A组比较差异无统计学意义（P＞0.05）,与D组相比差异有统计学意义（P＜0.05）。结论 孟鲁司特钠联合双歧杆菌四联活菌片对小儿过敏性紫癜的疗效显著,能减少患儿不良反应发生,促进患儿恢复健康,值得临床推广。     

血浆B型脑钠肽对心力衰竭和呼吸困难的诊断价值

目的:探讨血浆脑钠肽(BNP)水平在心力衰竭(CHF)T和呼吸困难诊断中的应用。方法:采用免疫荧光快速测试法测定56例已确诊心衰患者、40例心源性呼吸困难患者、29例肺源性呼吸困难患者和30例健康人血浆BNP的含量。结果:心衰组患者血浆BNP水平明显高于对照组,差异显著(P<0.01);心源性呼吸困难组患者的BNP值水平(1032.2±879.8 pg/ml)与肺源性呼吸困难组患者的BNP值水平(67.1±43.6 pg/ml)比较有显著性差异(P<0.01)。结论:检测BNP水平可为临床诊断CHF及心源性与肺源性呼吸困难的鉴别诊断提供重要依据。     

血清降钙素原在小儿早期中枢神经系统感染鉴别诊断中的价值

目的研究细菌性脑膜炎和病毒性脑炎患儿血清降钙素原（PCT）水平的变化,探讨其在小儿早期中枢神经系统感染鉴别诊断中的价值。方法采用双抗夹心免疫发光测量法,检测78例早期中枢神经系统感染患儿的血清及脑脊液降钙素原水平,分析它们之间的相关性;并和脑脊液白细胞数、血白细胞数、血清C反应蛋白相对比;PCT阳性细菌性脑膜炎患儿使用抗生素治疗后再测定血清PCT。结果33例急性细菌性脑膜炎患儿的血清降钙素原浓度为（18．46±9．18）ng／mL,45例急性病毒性脑炎的血清降钙素原水平轻度升高（0．58±0．31）ng／mL,P〈0．01,两者相比较差异有统计学意义。细菌性脑膜炎组患儿血清PCT在经过抗生素治疗后较入院时明显下降,两者比较差异有统计学意义（P〈0．05）。并且在细菌组急性期脑脊液PCT与血清PCT存在正相直线相关性。结论血清降钙素原检测在小儿早期中枢神经系统感染鉴别诊断中有重要应用价值。     

PCT与IL-6联合检测鉴别诊断脓毒性和非脓毒性全身炎症反应综合征的临床价值

目的:探讨降钙素原(PCT)与白细胞介素-6(IL-6)联合检测鉴别诊断ICU患者脓毒性和非脓毒性全身炎症反应综合征(SIRS)的临床价值。方法:选择2013年~2016年入住我院ICU的100例患者,包括61例非脓毒性SIRS患者与39例脓毒症患者,同时选择同期50例健康者作对照,分别设为非脓毒性组、脓毒血症组及对照组,采用电化学发光分析法检测三组血清PCT与IL-6水平,并以PCT为2μg/L和IL-6为50 ng/L为临界值来鉴别非感染性SIRS和脓毒血症,评价联合检测的临床诊断价值。结果:非脓毒性组PCT与IL-6最大值分别为0.91±0.54μg/L、62.77±11.75 ng/L,脓毒血症组为24.49±5.00μg/L、1542.69±361.66 ng/L,对照组为0.08±0.06μg/L、3.68±1.11 ng/L,非脓毒性组与脓毒血症组PCT与IL-6最大值均显著高于对照组(P0.05);与非脓毒性组比较,脓毒血症组PCT与IL-6均显著升高(P0.05)。非脓毒性组PCT2μg/L、IL-650 ng/L的占比分别为21.31%、65.57%,脓毒血症组为92.31%、87.18%,脓毒血症组PCT2μg/L、IL-650 ng/L的占比均显著提高于非脓毒性组(P0.05)。PCT的阳性预期值、灵敏度、特异度均显著高于IL-6,而联合检测的阳性预期值、特异度显著高于IL-6及PCT,联合检测的灵敏度显著高于IL-6,P均0.05。结论:PCT与IL-6联合检测有助于脓毒性和非脓毒性SIRS的鉴别诊断。     

血清PCT、Cyt-C、PGRN、动脉血乳酸联合检测诊断新生儿早发型败血症的临床价值及与预后不良的关系研究

摘要 目的：探讨血清降钙素原（PCT）、细胞色素C（Cyt-C）、颗粒蛋白前体（PGRN）、动脉血乳酸联合检测诊断新生儿早发型败血症（EOS）的临床价值,分析其与患儿预后不良的关系。方法：选择2019年2月-2021年6月我院收治的EOS患儿115例作为EOS组,同期健康新生儿80例作为对照组,比较两组血清PCT、Cyt-C、PGRN、动脉血乳酸水平,并应用受试者工作特征（ROC）曲线分析血清PCT、Cyt-C、PGRN、动脉血乳酸对EOS的诊断价值。所有患儿出院后随访6个月,根据患儿预后结局分为预后良好组和预后不良组,应用单因素和多因素Logistic回归分析EOS患儿预后不良的危险因素。结果：EOS组血清PCT、Cyt-C、PGRN、动脉血乳酸水平显著高于对照组（P<0.05）。ROC曲线分析显示,血清PCT、Cyt-C、PGRN、动脉血乳酸联合检测对EOS诊断具有较高的敏感度、特异度、阳性预测值、阴性预测值,曲线下面积（AUC）为0.836。预后不良组血清PCT、Cyt-C、PGRN、动脉血乳酸水平显著高于预后良好组（P<0.05）。多因素Logistic回归分析结果显示,早产、低出生体重儿、病理性黄疸、颅内感染、血清PCT≥8.32 ng/L、血清Cyt-C≥42.52 ng/mL、血清PGRN≥48.83 ng/mL、动脉血乳酸≥5.21 mmol/L是EOS患儿预后不良的危险因素（P＜0.05）。结论：EOS新生儿血清PCT、Cyt-C、PGRN、动脉血乳酸水平异常升高,其联合检测具有较高的诊断价值。早产、低出生体重儿、病理性黄疸、颅内感染、血清PCT、Cyt-C、PGRN、动脉血乳酸是EOS新生儿预后不良的危险因素,对于存在危险因素的新生儿应予以重视,早期采用干预措施,以改善其预后。     

rhBNP治疗射血分数保留急性心力衰竭的临床研究

目的:探讨重组人脑利钠肽(rh BNP)对急性射血分数保留心力衰竭的临床治疗作用。方法:选择2008年6月至2014年6月间我院收治的20例急性射血分数保留心力衰竭患者为研究对象,其中10例予以硝普钠静脉注射48小时,10例予以rh BNP静脉注射48小时。48小时后,评估和比较两组患者心力衰竭的临床改善情况;72小时后,复查和比较两组患者血浆NT-pro BNP的下降值。结果:硝普钠组患者呼吸困难缓解积分(1.4±1.35)明显低于rh BNP组(3.5±0.71),rh BNP组呼吸困难缓解时间(3.68±1.69 h)显著短于硝普钠组(21.50±18.43 h),血浆NT-pro BNP浓度下降值(864.60±585.92 pg/ml)明显高于硝普钠组(423.30±284.06 pg/ml)。结论:rh BNP治疗急性射血分数保留心力衰竭的临床疗效优于硝普钠。     

Diagnostic Accuracy of NT-ProBNP for Heart Failure with Sepsis in Patients Younger than 18 Years

This clinical study investigated plasma NT-proBNP levels as a potential predictor of heart failure in pediatric patients with sepsis. Plasma NT-ProBNP levels of 211 pediatric patients with sepsis and 126 healthy children were measured. Patients were stratified as with heart failure (HF) or without heart failure (non-HF). Patients were graded as having sepsis, severe sepsis, or septic shock. The optimal cut-off values of plasma NT-ProBNP for heart failure were determined by analyzing the receiver operating characteristic (ROC). In the HF, non-HF and control groups, the median plasma NT-proBNP levels were 3640, 656, and 226 ng/L, respectively. For all patients with sepsis, the optimal diagnostic cut-off value was 1268 ng/L for differentiating heart failure. In the severe sepsis patients and septic shock patients, the optimal diagnostic cut-off values were 1368 ng/L and 1525 ng/L, respectively. This report is the first one to reveal that NT-proBNP may predict heart failure in children with sepsis. It provides an important clinical reference for the diagnosis of heart failure in pediatric patients with sepsis, and enables monitoring septic children for cardiac involvement.     

MCL-1 (myosin light chains-1) in differential diagnosis of dyspnea

Myosin light chains-1 (MLC-1) have been recently associated with the markers of heart function (NYHA, LVEF, NT-proBNP). Verification of the relationship between markers of heart function (New York Heart Association classification (NYHA), left ventricle ejection fraction determination (LVEF), N terminal prohormone of natriuretic peptide B type BNP (NT-proBNP) and concentrations of myosin light chains-1 (MLC-1) was assessed. Patients examined for dyspnea without signs of acute coronary syndrome. All patients underwent echocardiography (calculation of left ventricle ejection fraction--LVEF) and in the serum of all subjects NT-proBNP (ELEIA) and MLC-1 (ELISA) were determined. In the 38 patients (21 men, 17 women), mean age of 58 years (+/-12 years as 1 SD), a significant negative correlation was found between NT-proBNP and LVEF (r = - 0.47; p = 0.02, Spearman). The median levels of NT pro-BNP were closely associated with NYHA classification (type II--584 ng/l, type III--2792 ng/l, type IV--6400 ng/l; p < 0.05). Individuals with clinical NYHA IV differed significantly in median MLC-1 concentrations from persons with clinical NYHA classification II and III (type II--5.7 ng/l, type III--8.9 ng/l, type IV--17 ng/l; p < 0.05). A significant negative correlation between MLC-1 and LVEF (-0.35; p < 0.03) and significant positive correlations between MLC-1 and NT-proBNP (0.42; p < 0.012) were found. In conclusion MLC-1 cannot be used as a diagnostic marker in differential diagnosis of dyspnea.     

替罗非班联合尼可地尔对急诊PCI患者心功能和短期预后的影响

目的:探讨急诊PCI患者在联合使用替罗非班和尼可地尔后对心功能和短期预后的影响。方法:入选98例接受急诊PCI的AMI患者随机分为对照组(n=49)和联合治疗组(n=49)。对照组单纯给予替罗非班治疗,联合治疗组在对照组基础上给予尼可地尔5 mg tid口服治疗。观察记录两组患者治疗8周前后LVEF、NT-pro BNP水平,并随访MACE事件发生情况。结果:两组患者在治疗前LVEF及NT-pro BNP水平比较没有统计学差异(P0.05)。在治疗8周后联合治疗组和对照组LVEF及NT-pro BNP水平均较治疗前水平明显改善(P0.05)。治疗8周后联合治疗组患者LVEF及NT-pro BNP水平明显优于对照组患者(P0.05)。经过8周的治疗,联合治疗组再次发生心绞痛事件(6.12%VS 24.49%,P=0.025)、恶性心律失常(2.04%VS 16.33%,P=0.036)和心力衰竭事件(2.04%VS 18.37%,P=0.020)明显低于对照组。结论:替罗非班联合尼可地尔可进一步改善急诊PCI患者心功能及短期预后,值得临床推广。     

110例肺栓塞实验室结果分析

目的:探讨肺栓塞患者的危险因素、临床表现及实验室检查,提高临床对肺栓塞的认识。方法:收集本院2006年1月至2009年2月住院期间确诊为肺栓塞的110名患者的一般资料、危险因素、临床表现、相关检查等数据,对所统计的数字进行SPSS13.0分析。结果:呼吸困难组74例(67.3%),无呼吸困难组(32.7%),两组比较危险因素无统计学差异,比较发现氧分压、二氧化碳分压、肺动脉内径无差异,但是右心室内径检查显示两组具有明显的差异。结论:1.不可过分依赖三联征诊断肺栓塞,以免误诊、漏诊。2.危险因素:外伤、手术、制动、深静脉血栓,慢性支气管炎,高血压对呼吸困难组与非呼吸困难组中的肺栓塞形成无统计学差异。3.肺栓塞患者呼吸困难与心功能不全具有明显相关性,呼吸困难组应住监护病房,密切观察病情变化。     

15例儿童心动过速性心肌病的诊疗体会

目的:探讨儿童完全性心动过速性心肌病(pTIC)的临床特点、治疗及预后。方法:回顾分析2009年1月至2016年10月安徽省儿童医院心内科收治的15例完全性心动过速性心肌病患儿的临床表现、心功能、心电图、心脏彩超的特点,观察心律失常控制后的心室率、心脏左室内径大小及心功能恢复情况。结果:15例pTIC患儿以室上性快速心律失常多见(14例),10例单纯药物治疗,3例接受射频消融转为窦性心律,2例失访。随访半年至3年与治疗前比较心室率明显下降[(116±27)次/分vs.(189±28)次/分]、NT-proBNP降低[(404±355)pg/mL vs.(6280±3155)pg/mL]、心脏左室舒张末内径变小[(3.12±0.48)cm vs.(3.69±0.70)cm]、左室射血分数升高[(57.9±9.3)%vs.(42.2±9.5)%]、改良ROSS评分下降[1(0-5)分vs.7(4-10)分]。结论:儿童pTIC由各种快速心律失常引起,心脏扩大和心功能障碍可完全恢复,早期识别、有效治疗的儿童pTIC长期预后良好。     

奥美沙坦对慢性心力衰竭患者血清Galectin-3 水平的影响

目的：探讨奥美沙坦对慢性心力衰竭患者血清半乳凝集素-3（Galectin-3）水平的影响。方法：入选慢性心力衰竭患者100 例, 随机分为2 组,对照组和奥美沙坦治疗组,每组50 例,持续治疗3 月。其中对照组男32 例,女18 例,平均年龄（53.2± 11.8）;奥美 沙坦治疗组,男35 例,女15 例,平均年龄为（52.6± 13.2）岁。超声心动图评估治疗前后心功能,采用双抗体酶联免疫吸附(ELISA) 法测定血清Galectin-3 和N 末端B 型钠尿肽（NT-proBNP）水平。结果：对照组治疗和奥美沙坦治疗均可以改善慢性心力衰竭患 者的射血分数（EF）,降低NT-proBNP和Galectin-3 的浓度。其中,对比对照组患者,奥美沙坦治疗的患者心功能改善的程度更明 显,并伴有血清Galectin-3 的明显下降,差异具有统计学意义,P<0.05。Pearson 相关分析结果显示,慢性心力衰竭患者血清 Galectin-3 水平与心功能指标EF和NT-proBNP均相关,相关系数分别为-0.563和0.605,统计学有意义（P<0.05）。结论：奥美沙坦 治疗能有效降低慢性心力衰竭患者血清Galectin-3 水平和改善心功能。     

Prediction of Perioperative Cardiac Events through Preoperative NT-pro-BNP and cTnI after Emergent Non-Cardiac Surgery in Elderly Patients

Objectives

Clinical risk stratification has an important function in preoperative evaluation of patients at risk for cardiac events prior to non-cardiac surgery. The aim of this study was to determine whether the combined measurement of pre-operative N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and cardiac troponin I (cTnI) could provide useful prognostic information about postoperative major adverse cardiac events (MACE) within 30 days in patients aged over 60 years undergoing emergent non-cardiac surgery.

Methods

The study group comprised 2519 patients aged over 60 years that were undergoing emergent non-cardiac surgery between December 2007 and December 2013. NT-pro-BNP and cTnI were measured during hospital admission. The patients were monitored for MACE (cardiac death, non-fatal myocardial infarction, or cardiac arrest) during the 30-day postoperative follow-up period.

Results

MACE occurred in 251 patients (10.0%). Preoperative NT-pro-BNP and cTNI level were significantly higher in the individuals that experienced MACE than in those who did not (P < 0.001). The confounding factors of age, sex, co-morbidities and preoperative medications were adjusted in a multivariate logistic regression analysis. This analysis showed that preoperative NT-proBNP level > 917 pg/mL (OR 4.81, 95% CI 3.446–6.722, P < 0.001) and cTnI ≥ 0.07 ng/mL (OR 8.74, 95% CI 5.881–12.987, P < 0.001) remained significantly and independently associated with MACE after the adjustment of the confounding factors. Kaplan-Meier event-free survival curves demonstrated that patients with preoperative simultaneous NT-proBNP level > 917 pg/mL and cTnT ≥0.07 ng/mL had worse event-free survival than individual assessments of either biomarker.

Conclusion

Preoperative plasma NT-proBNP and cTnI are both independently associated with an increased risk of MACE in elderly patients after emergent non-cardiac surgery. The combination of these biomarkers provides better prognostic information than using either biomarker separately.     

Application of determined NT-proBNP in physical standardized exercise

Natriuretic peptides can be used as markers of heart failure, its severity and also in the differential diagnosis of dyspnea. Moreover, the dynamics of natriuretic peptides in physical standardized exercise may be used in the assessment of latent heart failure. AIM OF THE STUDY: Can determination of NT-proBNP be used in the diagnosis of exercise-induced ischemia or latent heart failure? 18 probands (10 men, 8 women) under study were risk persons with unspecified ECG, without signs of manifest heart failure. They were subjected to ergometric bike exercises up to the subjective maximum, SPECT myocardium with estimated ejection fraction of the left ventricle at peak ergometric exercise. The following parameters were followed-up: a) before ergometric exercise: NT-proBNP, CRP, TNF-alpha, Hb, Htc, lactate b) at subjective maximum: NT-proBNP, Hb, Htc, lactate c) 30 min after stopping the exercise: NT-proBNP d) 60 min after stopping the exercise: NT-proBNP. The volume blood changes were taken into account (estimation from the dynamics of Htc, Hb with calculation of metabolic changes of NT-proBNP). To evaluate the dynamics of NT-proBNP, the group was divided into subgroups according to the results obtained in ergometric exercises. RESULTS: initial values of NT-proBNP within normal limits (< 59 pmol/l, 500 ng/l) in 94%, the submaximal pulse rate was reached in 94%, ischemic changes in ECG were observed in 59%, typical clinical signs of heart ischemia were recorded in 35%. Signs of heart dysfunction according to SPECT were found in 47% and ischemic symptoms were observed in 43%. In general, the plasmatic volume decreased by 24% at maximal exercise. Lactate concentration in the plasma increased in all cases. Conversion of NT-proBNP into volume blood changes revealed that increased NT-proBNP occurred only in 22%. Differences between NT-proBNP before exercises and at maximal exercise prior and after correction into volume blood changes were statistically insignificant. 30 and 60 min after the exercise, no significant differences were found in NT-proBNP concentrations. Dividing into subgroups according to the results of ergometric exercises, showed no significant differences in NT-proBNP concentrations. Dynamics of NT-proBNP changes during and after ergometric exercises cannot be used for the diagnosis of exercise-induced heart failure. The high stability of NT-proBNP related to physical activity was confirmed.