摘要目的 探讨慢性心力衰竭患者肾上腺髓质中段肽(MR-proADM)水平的变化及意义.方法 随机入选330例慢性心力衰竭患者,其中Ⅱ、Ⅲ级各120例(心功能Ⅱ级组和心功能Ⅲ级组),Ⅳ级90例(心功能Ⅳ级组).入组后24 h内及症状缓解后7 d均测定N未端B型钠尿肽前体(NT-proBNP)、MR-pro ADM、左心室舒张末期内径(LVEDD)及左心室射血分数(LVEF),同期选择健康体检者90例作为健康对照组.分析慢性心力衰竭患者MR-proADM水平的变化及意义.结果 治疗前与健康对照组MR-pro ADM(610.22±60.84 pmmol/L)相比,慢性心力衰竭患者随着心力衰竭病情加重明显升高[NYHA Ⅱ级(641.55±106.34) pmmol/L、Ⅲ级(684.46±101.33) pmmol/L、Ⅳ级(737.81±479.37) pmmol/L),差异有统计学意义(F=5.33,P=0.001)];经过药物治疗后MR-proADM会下降[Ⅱ、Ⅲ、Ⅳ级组分别到(608.09±100.81)、(617.64±94.32)、(642.22±163.53) pmmol/L].且MR-proADM水平与心力衰竭患者的NT-proBNP水平及NYHA心功能分级有显著正相关(r=0.194,P=0.003;r=0.206,P=0.000).结论 MR-proADM水平对慢性心力衰竭患者的诊断及病情分级有重要的指导意义.

abstractsObjective To study the change of mid-regional pro-adrenomedullin(MR-proADM) level in patients with chronic heart failure and its significance.Methods Randomly selected 330 patients with chronic heart failure,including 120 cases of grade Ⅱ and Ⅲ,90 cases of grade Ⅳ,90 cases were selected.,Within 24 h after the entry of the group and 7 d after symptom relieved,serum N-terminal pro-B-type natriuretic peptide(NT-proBNP),MR-proADM,cardiac ultrasound(left ventricular diameter(LVEDD) and left ventricular function(LVEF)) were measured.Ninety physical examination in the same period as healthy control during the same period.The change of MR-proADM level in patients with chronic heart failure and its significance were analyze.Results Compared with the healthy control group,the level of MR-proADM in patients with chronic heart failure(grade Ⅱ:(641.55±106.34) pmol/l;grade Ⅲ:(684.46±101.33) pmol/l;grade Ⅳ:(737.81±479.37) pmol/l) was significantly higher than that in the control group(610.22±60.84) pmol/l),the difference was statistically significant(F=5.33,P=0.001).At the same time,the level of MR-proADM was increased with the aggravation of heart failure,after drug treatment will decline((608.09±100.81),(617.64±94.32),(642.22±163.53) pmol/L).And MR-proADM levels were significantly positively correlated with NT-proBNP levels and NYHA classification in patients with heart failure(r=0.194,P=0.003;r=0.206,P=0.000).Conclusion MR-proADM has important guiding significance in the diagnosis,classification of patients with chronic heart failure.