CAJ | 학술논문

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,NYHA Ⅰ ～Ⅱ级(A组)37例、NYHAⅢ～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.
목적 탐토뇨액뇌납태수평적측정재131Ⅰ치료갑상선공능항진성심장병(갑심병)중적응용개치.방법 채용화학발광법검측111례접수131Ⅰ치료적갑상선공능항진증(갑항)환자화30명건강대조자적혈장화뇨액뇌납태농도이급혈청유리삼전갑상선원안산(FT3)、유리갑상선소(FT4)수평.장111례갑항환자분위단순갑항조(51례)화갑심병조(60례),병대갑심병조환자안조뉴약심장병학회(NYHA)표준대기심공능진행분급,기중,NYHA Ⅰ ～Ⅱ급(A조)37례、NYHAⅢ～Ⅳ급(B조)23례.대정상대조조급131Ⅰ치료전후각조환자적혈장화뇨액뇌납태수평이급FT3、FT4수평진행비교분석.결과 A、B량조갑심병환자치료전혈장화뇨액뇌납태수평균현저고우단순갑항조(혈장:t=8.98、9.52,P균＜0.01；뇨액:t=10.83、12.73,P균＜0.01)화정상대조조(혈장:t=8.97、9.52,P균＜0.01；뇨액:t=9.21、5.64,P균＜0.01)；갑심병B조131Ⅰ치료전、치료후6개월、12개월적혈장、뇨액뇌납태수평균명현고우갑심병A조(혈장:t=5.98、5.87、6.35,P균＜0.01；뇨액:t=4.33、4.09、5.02,P균＜0.01).수착심공능불전정도적가중,뇨액뇌납태수평축점승고,여혈장뇌납태수평정정상관(r=0.829,P＜0.01)；여NYHA분급정정상관(r=0.751,P＜0.01)；여FT3、FT4수평정정상관(FT3:r=0.635; FT4:r=0.672,P균＜0.01).결론 갑심병환자뇨액뇌납태수평수착심공능엄중정도적증가이승고,뇨액뇌납태가이준학평개갑항환자적심공능,가작위림상진단、료효관찰이급예후판단적객관지표,여혈장뇌납태구유상동적응용개치.
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.