Association between serum NT-proBNP/hs-CRP and acute rejection after heart transplantation
10.3760/cma.j.issn.0253-3758.2009.02.014
- VernacularTitle:N末端B型利钠肽原和高敏C反应蛋白在心脏移植术后排斥反应中的意义
- Author:
Dong YIN
1
;
Jie HUANG
;
Lei FENG
;
Guang-Xun FENG
;
Sheng-Shou HU
Author Information
1. 中国医学科学院北京协和医学院阜外心血管病研究所阜外心血管病医院
- Keywords:
Heart transplantation;
Natriuretic peptide,brain;
C-reactive protein
- From:
Chinese Journal of Cardiology
2009;37(2):145-148
- CountryChina
- Language:Chinese
-
Abstract:
Objective The aim of the present work was to investigate the potential relationship between acute rejection and serum concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP)/high sensitivity C reactive protein (hs-CRP) in post-transplant patients. Methods Sixty-one consecutive orthotopic heart transplantation recipients were prospectively recruited from the cardiac transplantation programme at Fuwai Hospital Endomyocardial biopsies (EMB) were performed routinely at 3 weeks, 3, 6 and 12 months after transplantation. EMB were also performed when patients had new symptoms of heart failure or at 2 weeks after steroid pulse therapy. Serum NT-proBNP and hs-CRP were simultaneously measured before EMB procedure. Results A total of 126 biopsy samples were obtained from the 61 patients.Serum NT-proBNP concentrations progressively decreased after transplantation (spearman correlation coefficient-0.520, P=0.000). NT-proBNP levels within 6 months after transplantation were significantly higher than those beyond 6 months post transplantation [(11.86±11.16 ) × 10-16 mol/L vs. (5.83 ± 6.58) × 10-16 mol/L,P=0.002]. NT-proBNP concentrations in patients with rejection tended to be higher than patients without rejection (13.68 × 10-16 mol/L vs. 9.26 × 10-16 mol/L, P=0.073 ). After time adjustment, the difference of NT-proBNP concentrations between patients with or without rejection becomes statistically significant (14. 45 x 10-16 mol/L vs. 9.1 x 10-16 mol/L, P=0.025 ). Receiver operating characteristics analysis for NT-proBNP versus rejection grade revealed an area under the curve of 0.566,indicating a low predictive value for NT-proBNP. A cutoff of 6.00 x 10-16 mol/L yielded poor specificity (44.8% ) and sensitivity (57.1% ), the sensitivity and specificity were 38.1% and 61.0%, respectively with a cutoff of 8.00 x 10-16 mol/L, hs-CRP levels within 6 months after transplantation tended to be higher than those beyond 6 months [(2.39 ± 3.90) mg/L vs. (1.34 ± 2.73) mg/L, P=0.069] . hs-CRP concentrations in patients with rejection were similar as patients without rejection (2.995 mg/L vs. 1.833 mg/L, P=0.138). The incidence of rejeetion was similar in patients with two higher biomarkers (5/20,25%) compared to patients with two low biomarkers (3/26, 11.5%, P=0.232). Conclusions NT-proBNP level decreased after transplantation. Although increased NT-proBNP coneentrations were related to rejection, the diagnostic capacity was low. Elevated hs-CRP concentrations were not related to rejection after heart transplantation.
