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您的检索式：作者名="Handler C.E."
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| 1 | N末端脑利钠肽(NT-proBNP)对硬皮病相关性肺动脉高压的作用显示文摘Aims: The aims of this study were to evaluate the diagnostic value and to explore the prognostic value of N-terminal brain natriuretic peptide(N-TproBNP) in patients with systemic sclerosis(SSc) both with and without pulmonary arterial hypertension(PAH). Methods and results: N-TproBNP, six minute walk distance(SMWD), haemodynamics(at right heart catheterization) or tricuspid gradient(by echocardiography), and survival were assessed in 109 patients with SSc. The study population included 68 individuals with PAH[mean pulmonary artery pressure(PAP) >25 mmHg and pulmonary capillary wedge pressure< 15 mmHg] and 41 individuals without PAH. In patients with PAH, the prognostic value of baseline and change in WHO functional class, N-TproBNP levels, and SMWD were compared using Kaplan-Meier survival curves and Cox proportional hazard analysis. The mean duration of follow-up was 10 months(range 1-18 months). One year survival in patients with normal PAP was 100%when compared with 83.5%in those with SSc-PAH(P< 0.05). The patients without PAH had a mean N-TproBNP level of 139 pg/mL(SD 151); those with SSc-PAH had a significantly higher mean NTproBNP level of 1474 pg/mL(SD 2642)(P=0.0002). Among patients with PAH for every order of magnitude increase in N-TproBNP level there was a four-fold increased risk of death(P=0.002 for baseline level and P=0.006 for follow-up level). Baseline N-TproBNP levels were correlated positively with mean PAP(r=0.62; P< 0.0001), pulmonary vascular resistance(PVR)(r=0.81; P< 0.0001), and inversely with SMWD(r=-0.46; P< 0.0001). Among patients with SSc-PAH, 13 patients(19%) were in WHO functional classes Ⅱ and had mean NTproBNP levels of 325 pg/mL(SD 388). Fifty-three patients(78%) were in WHO classes Ⅲ and IV and had significantly higher mean N-TproBNP levels of 1677 pg/mL(SD 2835)-(P=0.02). At an N-TproBNP level of 395 pg/mL, the sensitivity and specificity for predicting the presence of SSc-PAH were 56 and 95%respectively. Conclusion: Raised N-TproBNP levels are directly related to the severity of PAH. In screening programs, SSc patients with an N-TproBNP in excess of 395 pg/mL have a very high probability of having pulmonary hypertension. Baseline and serial changes in N-TproBNP levels are highly predictive of survival. A 10-fold increase in N-TproBNP level on therapy is associated with a greater than three-fold increase in mortality, and may indicate therapeutic failure. | Williams M.H. Handler C.E. Akram R. J.G. Coghlan 郭俊 | 2006 | 世界核心医学期刊文摘(心脏病学分册)2006，，12： | 4 |
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