- 學位論文
N端B型排鈉尿胜肽( N-Terminal Pro-Brain Natriuretic Peptide )於心臟疾病犬隻血液中濃度之臨床研究
The Clinical Study of N-Terminal Pro-Brain Natriuretic Peptide Levels in Dogs with Heart Disease
摘要
B型排鈉尿胜肽(Brain natriuretic peptide, 以下簡稱BNP)為排鈉尿胜肽家族成員之一，在1988年首先在豬腦中發現，心臟的心室是其主要的分泌來源。當心室的容積或壓力負荷增加時，BNP會反應性地大量分泌。即時且準確地診斷犬隻心臟衰竭是有挑戰性的，即使從病史問診與理學檢查也可能無法與其他呼吸道疾病區別。在人類醫學，測量血中BNP數值是診斷急性心臟衰竭常用的檢驗工具。此外，在有症狀的心臟衰竭，BNP會隨症狀的嚴重性等比升高。本研究目的為探討犬隻血液中N端B型排鈉尿胜肽(N-terminal pro-brain natriuretic peptide, 以下簡稱Nt-proBNP)濃度與犬隻心臟疾病之相關性。本研究收集45隻臨床上具有心臟疾病病例與10隻健康正常犬隻，分別以傳統診斷方式（問診、理學檢查、例行血液檢查、心電圖檢查、胸腔X光檢查、心臟超音波檢查等），以及心臟衰竭的專一性生物標記Nt-proBNP 來診斷犬隻心臟衰竭。本研究結果指出患有心臟疾病的犬隻其血液中Nt-proBNP濃度顯著的比正常犬隻來得高(P < 0.01)，特別是具有心臟衰竭犬隻其Nt-proBNP濃度更為顯著升高；而且Nt-proBNP濃度與心臟大小、食慾減退、飲水量、精神沉鬱狀態、以及紐約心臟學會(New York Heart Association, NYHA)的心臟衰竭分級等之間有顯著關聯性(分別為r = 0.350, p < 0.05; r = 0.516, p < 0.01; r = 0.393, p < 0.01; r = 0.348, p < 0.05; r = 0.571, p < 0.01)。本研究結果顯示，由臨床症狀（心臟大小與飲水量）點數比中，可以推測犬隻心臟疾病之嚴重度。
並列摘要
B-type natriuretic peptide (BNP) is a member of the natriuretic peptide family, which was originally identified in extracts of porcine brain in 1988. The main source of the BNP is the ventricles of the heart. BNP is secreted in response to increased ventricular volume and pressure. The timely and accurate diagnosis of the congestive heart failure (CHF) in dogs can be challenging. Historical and physical examination findings are not pathognomonic for CHF and can be compatible with other diseases, e.g. respiratory disease. In humans, measurement of the BNP plasma concentrations is useful tool in diagnosis of acute CHF. Patients with symptomatic CHF have increased BNP levels that correlate well with New York Heart Association. The purpose of this study was to evaluate the relationship of Nt-proBNP (N-terminal pro-brain natriuretic peptide) levels in dogs with heart disease. This study had collected 45 clinical heart disease cases, 10 health dogs from animal hospital of the Taipei and planned to use including conventional diagnostic testing: historical, physical examination, routine blood examination, electrocardiogram, thoracic radiographic, echocardiographic et al. and a specific diagnosis marker Nt-proBNP to diagnostic canine CHF. The result of this study were that dogs with heart disease would have increased Nt-proBNP compared to normal dogs (p < 0.01) and that the Nt-proBNP would increase further when CHF is present. The Nt-proBNP concentration was significantly correlated with the Cardiac size (Vertebral heart score, VHS), Appetite, Drink, Spirit and New York Heart Association class (r = 0.350, p < 0.05; r = 0.516, p < 0.01; r = 0.393, p < 0.01; r = 0.348, p < 0.05; r = 0.571, p < 0.01, respectively). This study suggests that clinical symptom score (VHS and Drink) can infer the severity of canine heart disease.