생명과학회지 (Journal of Life Science)

  • 제20권9호
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  • Pages.1299-1305
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  • 2010
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  • 1225-9918(pISSN)
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  • 2287-3406(eISSN)
한국생명과학회 (Korean Society of Life Science)
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관상동맥질환자에 있어 수술 전 brain natriuretic peptide 농도, 심장표지자, 수술전후기 변수들 간의 상관관계와 임상적 유용성

Relationship and Clinical Usefulness between Preoperative Levels of Brain Natriuretic Peptide, Other Cardiac Markers and Perioperative Parameters in Patients with Coronary Artery Disease

  • 최석철 (부산가톨릭대학교 보건과학대학 임상병리학과) ;
  • 김양원 (인제대학교 의과대학 부산백병원 응급의학과) ;
  • 현경예 (동의대학교 자연과학대학 임상병리학과) ;
  • 황수명 (부산가톨릭대학교 보건과학대학 임상병리학과) ;
  • 문성민 (인제대학교 식의학생명공학대학 임상병리학과)
  • Choi, Seok-Cheol (Department of Clinical Laboratory Science, College of Health Sciences, Catholic University of Pusan) ;
  • Kim, Yang-Weon (Department of Emergency Medicine, Inje University Busan Paik Hospital) ;
  • Hyun, Kyung-Yae (Department of Clinical Laboratory Science, College of Natural Sciences, Dong-Eui University) ;
  • Hwang, Soo-Myung (Department of Clinical Laboratory Science, College of Health Sciences, Catholic University of Pusan) ;
  • Moon, Seong-Min (Biomedical Laboratory of Science, Department of Smart Foods and Drugs, Inje University)
  • 투고 : 2010.07.13
  • 심사 : 2010.09.13
  • 발행 : 2010.09.30
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초록

심혈관질환 진단을 위해 여러 가지 표지자들이 이용되고 있으며 그와 같은 표지자로 cardiac troponin-I (cTNI), creatine kinase-MB (CK-MB), C-reative protein (CRP)이 있다. 최근, 심장기능부전의 표지자로서 brain natriuretic peptide (BNP)에 대한 관심이 집중되고 있다. 이 연구는 심폐바이패스(cardiopulmonary bypass) 비적용 관상동맥우회수술을 시행한 74명의 성인환자를 대상으로 수술 전 BNP 농도와 다른 심장 표지자들 농도, 그리고 수술 전후 표지자들 간의 상관관계를 규명하기 위해 시행하였다. 수술 전 시기의 BNP, cTNI, CK-MB, CRP 각각의 농도는 수술 전 심초음파 변수와 양 또는 음의 상관성을 보였다. 수술 전 BNP 농도와 수술 전 cTNI, CK-MB, CRP 농도 각각과 높은 양의 상관관계가 있었다. 수술 전 BNP, cTNI, CK-MB, CRP 농도 각각은 수술 후 기계호흡보조시간, 중환자실치료기간과 유의한 양의 상관관계를 보였다. 이 연구의 결과들은 수술 전 BNP, cTNI, CK-MB, CR과 같은 심장 표지자들의 측정 및 병용은 심혈관질환자들의 진단, 환자들의 등급화, 수술 후 예후평가에 매우 유용한 방법임을 시사하고 있다.

Cardiac troponin-I (cTnI), creatine kinase-MB (CK-MB), and C-reactive protein (CRP) are routine cardiac markers for the diagnosis of cardiovascular disease. Recently, brain natriuretic peptide (BNP) has garnered attention as a marker of heart failure. This study was retrospectively designed to investigate the relationships between preoperative BNP, other cardiac markers levels and perioperative parameters in seventy-four adult patients that underwent off-pump coronary artery bypass grafting (OPCAB) and to assess its usefulness for predicting postoperative outcomes. Preoperative levels of BNP, cTnI, CK-MB, and CRP had significantly positive or negative correlations with echocadiographic parameters. There were significantly positive relationships between BNP, cTnI, CK-MB, and CRP concentration. Postoperative mechanical ventilation time had a positive correlation to preoperative levels of cTnI, CK-MB, and CRP, while ICU-staying period had a positive correlation with BNP, cTnI and CK-MB. These results reveal that a preoperative level of BNP is a good predictor and that its combination with cTnI, CK-MB, and CRP might be useful for diagnosis and comprehensive risk stratification of patients with coronary heart diseases, as well as prognosis of perioperative outcomes in OPCAB patients.

키워드

참고문헌

  1. Ahn, M. S., B. S. Yoo, K. H. Lee, Y. J. Youn, S. Y. Kim, J. Y. Kim, S. W. Lee, J. H. Yoon, and K. H. Choe. 2009. B-type Natriuretic Peptide and Long-Term Prognosis in Low-Risk Patients with unstable Angina. The Korean Soci. Cardiol. 1, 26-31.
  2. Alpert, J. S., K. Thygesen, E. Antman, and J. P. Bassand. 2000. Myocardial infarction redefined-a consensus document of The Joint European Society of Cardiology/ American College of Cardiology Committee for the redefinition of myocardial infarction. J. Am. Coll. Cardiol. 36, 959-969. https://doi.org/10.1016/S0735-1097(00)00804-4
  3. Bayes-Genis, A., M. Santalo-Bel, E. Zapico-Muniz, L. Lopez, C. Cotes, J. Bellido, R. Leta, P. Casan, and J. Ordonez-Llanos. 2004. N-terminal probrain natriuretic peptide (NT-proBNP) in the emergency diagnosis and in-hospital monitoring of patients with dyspnoea and ventricular dysfunction. Eur. J. Heart Fail. 15, 301-308.
  4. Benedict, M. R., D. C. Ayers, J. D. Calore, and R. A. Richman. 1994. Differential distribution of insulin-like growth factors and their binding proteins within bone: relationship to bone mineral density. J. Bone Miner. Res. 9, 1803-1811. https://doi.org/10.1002/jbmr.5650091118
  5. Buckley, D. I., R. Fu, M. Freeman, K. Rogers, and M. Helfand. 2009. C-reactive protein as a risk factor for coronary heart disease: a systematic review and meta-analyses for the U.S. Preventive Services Task Force. Ann. Intern. Med. 151, 483-495. https://doi.org/10.7326/0003-4819-151-7-200910060-00009
  6. Burnett, J. C. Jr., P. C. Kao, D. C. Hu, D. W. Heser, D. Heublein, J. P. Granger, T. J. Opgenorth, and G. S. Reeder. 1986. Atrial natriuretic peptide elevation in congestive heart failure in the human. Science 231, 1145-1147. https://doi.org/10.1126/science.2935937
  7. Devaraj, S., T. W. Du Clos, and I. Jialal. 2005. Binding and internalization of C-reactive protein by Fc gamma receptors on human aortic endothelial cells mediates biological effects. Arterioscler. Thromb. Vasc. Biol. 25, 1359-1363. https://doi.org/10.1161/01.ATV.0000168573.10844.ae
  8. Dickstein, K., T. Aarsland, and C. Hall. 1997. Plasma N-terminal atrial natriuretic factor: a predictor of survival in patients with congestive heart failure. J. Card. Fail. 3, 83-89. https://doi.org/10.1016/S1071-9164(97)90039-7
  9. Dufour, D. R. 1988. Creatine kinase:aspartate aminotransferase activity ratio as an indicator of the source of an increased creatine kinase activity. Clin. Chem. 34, 2506-2510.
  10. Gao, L., J. M. Kennedy, and R. J. Solaro. 1995. Differential expression of TnI and TnT isoforms in rabbit heart during the perinatal period and during cardiovascular stress. J. Mol. Cell Cardiol. 27, 541-550. https://doi.org/10.1016/S0022-2828(08)80049-1
  11. Hall, E. R., S. A. Martin, J. B. Suzuki, and W. A. Jr. Falkler. 1994. The gingival immune response to periodontal pathogens in juvenile periodontitis. Oral Microbiol. Immunol. 9, 327-334. https://doi.org/10.1111/j.1399-302X.1994.tb00282.x
  12. Henry, J. P. and J. W. Pearce. 1956. The possible role of cardiac atrial stretch receptors in the induction of changes in urine flow. Physiology 131, 572-585. https://doi.org/10.1113/jphysiol.1956.sp005483
  13. Houben, A. J., K. van der Zander, and P. W. de Leeuw. 2005. Vascular and renal actions of brain natriuretic peptide in man: physiology and pharmacology. Fundam. Clin. Pharmacol. 19, 411-419. https://doi.org/10.1111/j.1472-8206.2005.00336.x
  14. Iwanaga, Y., I. Nishi, S. Furuichi, T. Noguchi, K. Sase, Y. Kihara, Y. Goto, and H. Nonogi. 2006. B-type natriuretic peptide strongly reflects diastolic wall stress in patients with chronic heart failure: comparison between systolic and diastolic heart failure. Cardiology 47, 742-748.
  15. Jung, T. E., D. H. Lee, J. H. Lee, H. D. Do, and S. S. Han. 2008. The Role of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients Undergoing Coronary Artery Bypass Graft. Kor. J. Thorac. Cardiovasc. Surg. 41, 55-60.
  16. Kang, D. H., M. J. Kim, S. J. Kang, Y. H. Kim, J. M. Song, J. K. Song, and J. J. Kim. 2006. Role of B-typen natriuretic peptide in diagnosis and follow-up of diastolic heart failure. Kor. Circulation 36, 359-365. https://doi.org/10.4070/kcj.2006.36.5.359
  17. Kangawa, K., A. Fukuda, N. Minamino, and H. Matsuo. 1984. Purification and complete amino acid sequence of beta- rat atrial natriuretic polypeptide (beta-rANP) of 5,000 daltons. Biochem. Biophys. Res. Commun. 119, 933-940. https://doi.org/10.1016/0006-291X(84)90863-5
  18. Katus, H. A., A. Remppis, T. Scheffold, K. W. Diederich, and W. Kuebler. 1991. Intracellular compartmentation of cardiac troponin T and its release kinetics in patients with reperfused and nonreperfused myocardial infarction. Am. J. Cardiol. 67, 1360-1367. https://doi.org/10.1016/0002-9149(91)90466-X
  19. Lee, H. S., Q. L. Cheng, and N. V. Thako. 1987. ECG waveform analysis by significant point extraction. I. Data reduction. Comput. Biomed. Res. 20, 410-427. https://doi.org/10.1016/0010-4809(87)90030-9
  20. Lee, T. H. and L. Goldman. 1986. Serum enzyme assays in the diagnosis of acute myocardial infarction. Recommendations based on a quantitative analysis. Ann. Intern. Med. 105, 221-233. https://doi.org/10.7326/0003-4819-105-2-221
  21. Levin, E. R., D. G. Gardne, and W. K. Samson. 1998. Natriuretic peptides. N. Engl. J. Med. 339, 321-328. https://doi.org/10.1056/NEJM199807303390507
  22. Lindahl, B., J. Lindbä^ck, T. Jernberg, N. Johnston, M. Stridsberg, P. Venge, and L. Wallentin. 2005. Serial analyses of N-terminal pro-B-type natriuretic peptide in patients with non-ST-segment elevation acute coronary syndromes: a Fragmin and fast Revascularisation during In Stability in Coronary artery disease (FRISC)-II substudy. J. Am. Coll. Cardiol. 45, 533-541. https://doi.org/10.1016/j.jacc.2004.10.057
  23. Maseri, A. 1997. Inflammation, atherosclerosis, and ischemic events - exploring the hidden side of the moon. N. Engl. J. Med. 336, 1014-1016. https://doi.org/10.1056/NEJM199704033361409
  24. Medeiros, L. J., A. B. Gelb, and L. M. Weiss. 1987. Low-grade renal cell carcinoma. A clinicopathologic study of 53 cases. Am. J. Surg. Pathol. 11, 633-642. https://doi.org/10.1097/00000478-198708000-00007
  25. Nielsen, L. S., J. Svanegaard, N. A. Klitgaard, and H. Egeblad. 2004. N-terminal pro-brain natriuretic peptide for discriminating between cardiac and non-cardiac dyspnoea. Eur. J. Heart Fail. 6, 63-70. https://doi.org/10.1016/j.ejheart.2003.10.003
  26. Pearson, T. A., G. A. Mensah, R. W. Alexander, J. L. Anderson, 3rd. R. O. Cannon, M. Criqui, Y. Y. Fadl, S. P. Fortmann, Y. Hong, G. L. Myers, N. Rifai, S. C. Jr. Smith, K. Taubert, R. P. Tracy, and F. Vinicor. 2003. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the centers for disease control and prevention and the American heart association. Circulation 107, 499-511. https://doi.org/10.1161/01.CIR.0000052939.59093.45
  27. Ray, P., M. Arthaud, Y. Lefort, S. Birolleau, C. Beigelman, and B. Riou. 2004. Usefulness of B-type natriuretic peptide in elderly patients with acute dyspnea. Intensive Care Med. 30, 2230-2236. https://doi.org/10.1007/s00134-004-2469-0
  28. Rifai, N. and G. R. Warnick. 2004. Quality specifications and the assessment of the biochemical risk of atherosclerosis. Clin. Chim. Acta. 346, 55-64. https://doi.org/10.1016/j.cccn.2004.02.034
  29. Rifai, N. and P. M. Ridker. 2001. Proposed cardiovascular risk assessment algorithm using high-sensitivity C-reactive protein and lipid screening. Clin. Chem. 47, 28-30.
  30. Sabatine, M. S., D. A. Morrow, J. A. de Lemos, T. Omland, M. Y. Desai, M. Tanasijevic, C. Hall, C. H. McCabe, and E. Braunwald. 2004. Acute changes in circulating natriuretic peptide levels in relation to myocardial ischemia. J. Am. Coll. Cardiol. 44, 1988-1995. https://doi.org/10.1016/j.jacc.2004.07.057
  31. Steiner, J. and M. Guqlin. 2008. BNP or NTproBNP? A clinician's perspective. Cardiol. 129, 5-14.
  32. Sudoh, T., K. Kangawa, N. Minamino, and H. Matsuo. 1998. A new natriuretic peptide in porcine brain. Nature 332, 78-81. https://doi.org/10.1038/332078a0
  33. Taniguchi, R., Y. Sato, T. Yamada, M. Ooba, H. Higuchi, A. Matsumori, T. Kimura, and T. Kita. 2004. Combined measurements of cardiac troponin T and N-terminal pro-brain natriuretic peptide in patients with heart failure. Circ. J. 68, 1160-1164. https://doi.org/10.1253/circj.68.1160
  34. Watanabe, S., J. Shite, H. Takaoka, T. Shinke, Y. Imuro, T. Ozawa, H. Otake, D. Matsumoto, D. Ogasawara, O. L. Paredes, and M. Yokoyama. 2006. Myocardial stiffness is an important determinant of the plasma brain natriuretic peptide concentration in patients with both diastolic and systolic heart failure. Eur. Heart 27, 832-838. https://doi.org/10.1093/eurheartj/ehi772
  35. Yasue, H., M. Yoshimura, H. Sumida, K. Kikuta, K. Kugiyama, M. Jougasaki, H. Ogawa, K. Okumura, M. Mukoyama, and K. Nakao. 1994. Localization and mechanism of secretion of B-type natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure. Circulation 90, 195-203. https://doi.org/10.1161/01.CIR.90.1.195