氨基末端前脑钠尿肽可预测类风湿关节炎的预后

翻译 郑晓娟博士 审校 刘湘源

摘要 类风湿关节炎与心血管病的发病率及死亡率增高有关，氨基末端前脑钠尿肽(NT-proBNP)是一种预测因子。此研究的目的就是探讨RA患者(排除可能影响NT-proBNP浓度的合并症)的NT-proBNP与患者年龄、性别、炎症标志物、疾病活动度及肾功能的关系。试验组由90名无并发冠心病、高血压、糖尿病、晚期慢性肾病的RA患者组成。综合评估了炎症程度、疾病活动度、肾功能等临床和试验室参数。血浆标本被冰冻用于NT-proBNP的测定。采用高分辨率B超测定颈动脉内-中膜厚度（cIMT）。结果发现，活动度较高的RA组（DAS28>5.1）和伴亚临床动脉粥样硬化RA组（cIMT≥0.6 mm）的平均NT-proBNP浓度明显升高。在所有的RA患者中，NT-proBNP与年龄、C反应蛋白、红细胞沉降率、颈动脉内-中膜厚度、肱三头肌皮肤皱褶厚度呈正相关，而与手握力、血红蛋白、红细胞计数和白蛋白呈负相关。在女性RA患者组中发现，NT-proBNP与胱蛋白酶抑制剂C（cystatin-C）呈明显的正相关。与NT-proBNP <100 pg/ml的患者相比，nt-probnp≥100 pg/ml患者的胱蛋白酶抑制剂c(cystatin-c)明显增高。ra患者(排除可能影响nt-probnp合并症)的nt-probnp浓度与年龄、疾病炎症活动指标及亚临床肾损害有关。结果提示，活动度较高的年龄较大ra患者罹患心血管病病的风险增高。

附原文：Rheumatoid arthritis (RA) is associated with increased cardiovascular (CV) morbidity and mortality, of which amino-terminal pro-brain natriuretic peptide (NT-proBNP) is a predictor. The objective of the study was to investigate associations between NT-proBNP and age, gender, markers of inflammation, disease activity, and kidney function in RA patients,without co-morbidities potentially influencing NT-proBNP concentration. The study group consisted of 90 patients with RA, without clinically relevant coronary heart disease, hypertension, diabetes, advanced chronic kidney disease. The comprehensive assessment of clinical and laboratory parameters of inflammation, disease activity, and kidney function was performed. Plasma samples were frozen for NT-proBNP analysis. Carotid intima media thickness (cIMT) was determined by high-resolution B-mode ultrasonography. The mean NT-proBNP concentrations were significantly higher in a group of RA patients with high disease activity (DAS28?>?5.1) and in a group of patients with subclinical atherosclerosis diagnosed by cIMT?≥?0.6 mm. In all RA patients, NT-proBNP correlated positively with the age, C-reactive protein, erythrocyte sedimentation rate, cIMT, tricipital skin fold and negatively with hand-grip strength, hemoglobin, red blood cell count, albumin. In the group of women with RA, we found significant positive correlation between NT-proBNP and cystatin-C. Also, patients with NT-proBNP level?≥?100 pg/ml had significantly higher cystatin-C than those with lower NT-proBNP. NT-proBNP level, in RA patients without co-morbidities potentially influencing this level, is correlated with age, disease activity markers of inflammation, and subclinical renal impairment. It means that risk of CV disorders is higher in older patients with more active RA.

引自：Targońska-St?pniak B, Majdan M. Amino-terminal pro-brain natriuretic peptide as a prognostic marker in patients with rheumatoid arthritis. Clin Rheumatol. 2010 Nov 26