| PrefaceDyspnea is one of the commonly emergent synodroms of the department of internal medicine, whose causes are mainly classified by two kinds, including cardiogenic and pulmonary disease, but their cause , treatment and outcome are obviously distint. Unfortunately, so far as, a lot of ways used to differentiate diagnosis from dyspnea are nonspecial, it is still troublesome for physicians in distinguishing congestive heart failure from lung disease in patients presenting with dyspnea. Therefore, now intense interest has emerged to search the cheat and convenient way in differentiating diagnosis from dyspnea. Brain natriuretic peptide (BNP) is a cardiac neurohormone predominantly released from the cardiac ventricles. BNP is one member of the natriuretic peptide family, the family also includes atrial natriuretic peptide ( ANP). BNP have important roles in diuresis, natriuresis , vasodilation , antihypertensive effect , blocking the activity of renin- angiotensin - aldosterone system ( RAAS) and sympathetic nervous system as well as regulating extracellular fluid volume, vascular pressure and the balance of electrolyte. Endothdlin(ET) is a kind of active multi -peptide produced by the cardiovascular system. ET may be responsible for intensivly vasoconstrictive effect and promoting the growth of many cells. Both BNP and ET exist a counter- regulatory function, their interaction is useful tool in the diagnosis and treatment of various diseases. The aim of our experiment is to investigate the correla-tive relationship of the serum level of BNP as well as the plasma level of ET and the severity of disease in patients presenting with dyspnea, and to evaluate the diagnostic value of the level.of BNP and ET in distinguishing congestive heart failure from lung disease.Methods15 patients diagnosed with CHF, 15 patients with pulmonary dyspnea without CHF and 15 healthy subjects were involved in the study. The levels of serum BNP were measured with enzyme - linked immunosorbent assay , and the plasma level of ET was detected by immunoradiometric assay . The patients were also e-valuated with chest roentgenogram, echocardiogram and arterial blood.Statistic assay: quantitative variables were given as X S. Group comparisons were made using analysis of variance. The correlation analysis between factors was used by Pearson analysis method. There was statistical difference when p<0.05.Results①The levels of serum BNP were much higher in CHF group and dyspneic patients without CHF group than those in healthy subjects ( p < 0. 001) , they were higher in CHF patients than those in dyspneic patients without CHF( p<0. 01). The levels of plasma ET were much higher in CHF group and dyspneic patients without CHF group than those in healthy subjects (p<0.001) , they also were higher in dyspneic patients without CHF patients than those in CHF group (p<0.01) .②The levels of serum BNP in CHF group was negatively correlated with left venticular ejection fraction ( LVEF) ( r= -0. 68 ,P <0.01) , and was positively correlated with pulmonary artery systolic pressure (r = 0.72, P < 0.05).③The levels of serum BNP in CHF group was positively correlated with the diameter of right pulmonary lower artery and heart - chest proportion, but there was not statistical difference.④The level of plasma ET in dyspneic patients without CHF was negatively correlated with artenal pressure of oxygen (PaO2) (r=-0.64,P<0.05). The level of plasma ET in dyspneic patients without CHF was positively jcorrelated with artenal pressure of carbon dioxide (PaCO2) (r = 0.58,P <0.05).⑤The level of ET was positively correlated with the level of BNP in dyspneic patients without CHF (r = 0.59, P < 0.05).DiscussionDyspnea is one of the commonly emergent synodroms of the department of internal medicine, now intense interest has emerged to search the cheat and convenient way in differentiating diagnosis from dyspnea. We found that the level of ET and BNP had a compensative role in distinguishing congestive heart failure from lung disease in patients presenting with dyspnea, our results conformed to other references. BNP is a cardiac neurohormone predominantly released from the cardiac ventricles. BNP is one member of the natriuretic peptide family, the family also includes atrial natriuretic peptide ( ANP). BNP have important roles in diuresis % natriuresis x vasodilation N antihypertensive effect , blocking the activity of renin - angiotensin - aldosterone system ( RAAS) and sympathetic nervous system as well as regulating extracellular fluid volume, vascular pressure and the balance of electrolyte. ET is a kind of active multi - peptide produced by the cardiovascular system. ET may be responsible for intensivly vasoconstrictive effect.At present, it is demonstrated that the levels of serum BNP are much higher in CHF patients and dyspneic patients without CHF than those in healthy subjects, moreover, patients with the history of pulmonary disease appeared heart failure, the levels of serum BNP are also high, on the contrary, their levels are low, but they are higher than those in control group. Serum BNP level may be the more valuable laboratory marker for differential diagnosis of dyspnea , even if patients appear heart failure caused by the pulmonary heart disease, pulmonary arterial hypertension or merging the coronary heart disease. The level of serum BNP in CHF group was negatively correlated with LVEF, while was positive-... |
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