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심부전증에서 임상 양상에 따른 혈청 brain natriuretic peptide의 임상적 유용성 및 좌심실벽 긴장도와의 상관성

Other Titles
 (The) clinical utility of serum B-Type Natriuretic Peptide (BNP) according to the clinical 
Authors
 윤세정 
Department
 Dept. of Internal Medicine (내과학교실) 
Issue Date
2003
Description
의학과/석사
Abstract
[한글]

울혈성 심부전증(Congestive Heart Failure)은 높은 유병율과 사망률을 보이는 질환으로 조기 진단과 적절한 치료를 위한 평가 기준이 필요하다. 현재 임상적, 그리고 심초음파도상의 중증도를 기준으로 환자의 상태와 예후를 평가하고 있으나 이들의 임상적 지표 및 심초음파도는 임상의와 검사자의 숙련도에 의해 주관적인 판단의 한계로 인해 보다 객관적이고, 용이하고 반복검사시행이 가능한 정확한 진단적 접근방법이 필요하다. 최근 울혈성 심부전증에서 혈청 Brain (B-type) natriuretic peptide (이하 BNP )의 임상적 유용성과 다양한 임상적 지표와의 상관 관계를 보고된 바 있다. 본 연구에서는 혈청BNP가 질환의 중증도 및 좌심실벽 긴장도 분석에 유용한 지표인지에 대해 대조군(n=114)과 함께 임상적, 심초음파도상의 지표와 비교 분석하고자 하였다. 울혈성 심부전으로 인한 임상상을 주소로 내원한 환자 중 동반된 간 질환이나 신질환 등이 없는 환자를 대상(n=246)으로 심부전증을 임상 양상에 따라 네 군(Only diastolic heart failure, Chronic heart failure , Acute heart failure , Chronic heart failure with acute exacerbation)으로 분류하여 각각에서 혈중 BNP및 심초음파도상의 지표를 비교 분석하였다.심부전증 증상을 동반한 환자에서 혈청BNP (상한치: 81.2 pg/ml)의 예민도와 특이도는 각각 53.3% 98.4%를 보였다. 또한 혈청BNP 수치는 NYHA 분류에 따라 차이가 있었으며 (p<0.0001), log BNP는 좌심실 구혈율(r2=0.3015, p<0.0001), 산술 좌심실벽 긴장도(Meridional wall stress index, r2=0.0452, p<0.0001)와 유의한 상관관계를 보였다. 혈청 BNP 수치는 임상양상에 따른 각 환자군에서 유의한 차이를 보였고( only diastolic heart failure, n=84, Mean+SD, 89.8 ± 12.8 pg/ml; chronic heart failure, n=60, 208.2 ± 210.2 pg/ml; acute heart failure, n=28, 477.9 ±498.4 pg/ml, Chronic heart failure with acute exacerbation , n=74, 754.1 ± 419.2 pg/ml, p<0.0001), 또한 증상을 동반한 Only diastolic heart failure군에서 diastolic dysfunction을 동반한 대조군보다 유의하게 높았다 (각각 89.8 ± 12.8 및 22.8 ± 5.1 pg/ml, p<0.0001). 혈청BNP 는 심실의 과부하에 대해 보상 및 평형을 유지하기 위해 심실벽의 긴장도의 증가에 비례하여 분비되는 신경호르몬(neurohormone)으로서 심실벽 긴장도와 밀접하게 연관성을 가지며 심부전증의 임상 양상에 따라 유의한 차이가 있는 객관적이고 유용한 혈중 지표중의 하나이다.

[영문]

Congestive heart failure(CHF) is a serious disease with high prevalence and mortality rate, it necessitates standardized methods for early diagnosis and proper management. Up to now most physicians rely on clinical and echocardiographic severity for the diagnosis and treatment of CHF for which role of echocardiography is very important. But since there are some limitations in this tool, more accessible, inexpensive and accurate diagnostic approach is required. Recently, there were many reports about Brain( B-type) natriuretic peptide (BNP), a neurohormone secreted from ventricular myocardium in response to wall stress, significantly increases in CHF. This study was performed to find correlation of BNP with clinical and echocardiographic markers in determining the disease severity and myocardial wall stress. The subjects of this study were the patients without hepatic or renal dysfunction who admitted to hospital complaining the symptoms of CHF. We subgrouped them into four pattens according to the clinical progression (only acute diastolic heart failure(HF), acute HF, chronic HF, chronic HF with acute exacerbation ), then checked plasma BNP level and performed echocardiography. A sensitivity specificity at a cutoff 81.2 pg/ml of BNP levels was 53.3% 98.4% for detecting symptomatic CHF (Area under curve, 0.882; p<0.0001). BNP level was closely related with NYHA classification except relation between control group and NYHA 1 (p<0.0001). Log BNP was related with LVEF (r2=0.3015, p<0.0001) and Meridional wall stress index (r2 = 0.4052, p<0.0001). Analysis of subgroups of patients, who had only diastolic HF with LVEF >45% (n= 84, 89.8 ± 117.6 pg/ml), chronic HF (n= 60, 208.2 ± 210.2 pg/ml), acute HF ( n=28, 477.9 ± 498.4 pg/ml), chronic HF with acute exacerbation ( n= 74, 754.1 ± 419.2 pg/ml),( p< 0.0001) except relation between control group and only diastolic heart failure. In only diastolic heart failure group (symptomatic patients with normal LV systolic function and diastolic dysfunction), the level of BNP was significantly higher than control group with diastolic dysfunction (89.8 ± 12.8 vs. 22.8 ± 5.1 pg/ml, p<0.0001). Chronic ventricular loading results the overflow of BNP into the circulation in proportion to myocardial wall stress and might reflect to failure of adequate compensation under chronic condition of impending ventricular damage. BNP might also be a good indicator for differential diagnosis of broad spectrum of heart failure, especially in patients of early heart failure (only diastolic heart failure) with normal LV systolic function as well as establishing or excluding the diagnosis of congestive heart failure in patients with dyspnea.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 2. Thesis
Yonsei Authors
Yoon, Se Jung(윤세정)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/128256
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