Vrednotenje novega analiznega postopka za določanje natriuretičnih peptidov v plazmi bolnikov s srčnim popuščanjem : magistrski študij laboratorijske biomedicine

Gašperlin, Lenka (author), Černe, Darko (mentor), Avberšek-Lužnik, Ivica (comentor)

Številne študije so že potrdile diagnostično in prognostično uporabnost natriuretičnih peptidov pri oceni funkcije miokarda. Ker se natriuretični peptidi sproščajo iz poškodovanega miokarda v krvni obtok in se prenašajo po krvi v različnih strukturnih oblikah, še vedno predstavljajo izziv za raziskovanje na področju analiznih postopkov njihovega določanja. Namen naše raziskave je izmeriti plazemske koncentracije NT-proBNP z novejšim imunoanaliznim postopkom ECLIAFab in že uveljavljenim ECLIARu pri skupini 94 bolnikov, ki so bili zaradi simptomov srčnega popuščanja obravnavani v Urgentnem centru Splošne bolnišnice Jesenice v obdobju med 18. januarjem in 27. februarjem 2018. Zanimalo nas je, če novejši ECLIAFab postopek za določanje NT-proBNP daje primerljive in uporabne rezultate z že uveljavljenim postopkom ECLIARu. Za realizacijo ciljev raziskave smo v vzorcih plazme vseh bolnikov izmerili biokemijske parametre (kreatinin, OGF, holesterol, HDL holesterol, trigliceride, CRP in hemoglobin), ter koncentracije BNP in NT-proBNP z novejšim ECLIAFab in že uveljavljenim ECLIARu postopkom. Izvedli smo obsežno statistično analizo podatkov z uporabo SPSS , V 20 programa. Rezultati vseh parametrov so se porazdeljevali nenormalno, zato smo uporabili neparametrične statistične teste. Bolnike smo razdelili po starosti v tercilne skupine (bolniki do 50 let – I. tercil, od 50 do 75 let – II. tercil in nad 75 let – III. tercil). Dokazali smo, da obstajajo značilne razlike pri koncentraciji kreatinina in vrednostih OGF med bolniki v tercilnih skupinah, najbolj patološke vrednosti kreatinina in OGF so imeli bolniki v tretjem tercilu (p < 0,001). Tudi statistika rangov je pokazala naraščanje koncentracije kreatinina s starostjo in vzporedno padanje OGF. Razlike med bolniki v tercilnih skupinah v koncentraciji drugih biokemijskih parametrov niso bile statistično značilne (p > 0,05). Izmerjene koncentracije NT-proBNP z obema postopkoma so bile značilno višje kot koncentracije BNP. Mediane plazemskih koncentracij natriuretičnih peptidov pri 94 bolnikih so bile: ECLIAFab NT-proBNP 335 ng/L (35-44790 ng/L), ECLIARu NT-proBNP 276 ng/L (5-35000 ng/L) in BNP 56 ng/L (0-4853 ng/L). Analizni postopek ECLIAFab v primerjavi s postopkom ECLIARu daje značilno višje rezultate. Korelacijske analize so potrdile, da je povezava med izmerjenimi natriuretičnimi peptidi močna in statistično značilna: BNP in ECLIAFab NT-proBNP (rs = 0,962, p < 0,001), BNP in ECLIARu NT-proBNP (rs = 0,963, p < 0,001), ECLIAFab NT-proBNP in ECLIARu NT-proBNP (rs = 0,996, p < 0,001). Za nadaljnjo analizo rezultatov smo uporabili mejne vrednosti natriuretičnih peptidov po ESC smernicah za izključitev akutne oz. kroničnega popuščanja srčne mišice. Ugotovili smo, da je za izključitev akutnega kot tudi kroničnega srčnega popuščanja diagnostično uporabna kombinacija meritev plazemskih koncentracij NT-proBNP in BNP. Plazemske koncentracije NT-proBNP, izmerjene z ECLIARu in ECLIAFab, so se značilno razlikovale med starostnimi skupinami bolnikov. Zaključek naše raziskave je, da novejši test ECLIAFab daje primerljive rezultate tistim, ki jih dobimo z uveljavljenim ECLIARu testom pri bolnikih s potencialno diagnozo kroničnega oziroma akutnega srčnega popuščanja. BNP in ECLIAFab NT-proBNP sta tudi uporabna za izključitev diagnoze srčnega popuščanja ob upoštevanju priporočenih mejnih vrednostih po smernicah ESC.

• Language: Slovenian
• Keywords: srčno popuščanje možganski natriuretični peptid N-terminalni fragment pro B-natriuretičnega peptida elektrokemilumiscetna imunoanaliza
• Work type: Master's thesis/paper
• Typology: 2.09 - Master's Thesis
• Organization: FFA - Faculty of Pharmacy
• Place of publishing: Ljubljana
• Publisher: [L. Gašperlin]
• Year: 2018
• Number of pages: IX, 50 f.
• PID: 20.500.12556/RUL-120168
• UDC: 616-074:616.12-009.17(043.3)
• COBISS.SI-ID: 4645745
• Publication date in RUL: 16.09.2020

Secondary language

• Language: English
• Title: Evaluation of the new analytical procedure for determination of natriuretic peptides' plasma concentration in patients with cardiac failure

Abstract

Many studies have shown that natriuretic peptides are useful diagnostic and prognostic tool in the assessment of cardiac function. Natriuretic peptides are released from injured myocardium into bloodstream and transmitted by blood in various structures. So the measuring of their concentrations is still an analytical research challenge. The goal of our study is to measure plasma concentrations of NT-proBNP with new imunoanalytical method ECLIAFab and already known ECLIARu method in a group of 94 patients, who were treated in Emergency room in General hospital Jesenice because of suspected heart failure between 18 January and 27 February 2018. The aim of our study was to find out if the new method ECLIAFab for determination of NT-proBNP shows similar and useful results in comparison with already validated method ECLIARu. Therefore in all samples, biochemical parameters (creatinine, estimation of the glomerular filtration rate, cholesterol, HDL cholesterol, triglycerides, CRP, hemoglobin) and natriuretic peptides were determined. The concentrations of BNP and NT-proBNP were measured with the new ECLIAFab and already established ECLIARu method. Statistical analysis were carried out using SPSS version 20. Shapiro-Wilk test showed that our results of all the parameters are distributed abnormally, therefore we used nonparametric statistic. Included patients were divided according age into three groups (I. group – patients under 50 years, II. group – patients between 50 and 75 years, III. group – patients over 75 years). We proved the significant difference in creatinine concentrations and estimation of the glomerular filtration rate between patients groups. The most pathological values of creatinine concentrations and estimation of the glomerular filtration rate were in the third group (p < 0.001). The rang statistics showed increasing trend of creatinine concentrations and at the same time decreasing trend of the glomerular filtration rate. The differences between groups were not proved in concentration of other biochemical parameters (p > 0.05). Measured concentrations of NT-proBNP with both methods were significantly higher than concentration of BNP. Median plasma concentrations of natriuretic peptides in 94 patients were: ECLIAFab NT-proBNP 335 ng/L (35-44790 ng/L), ECLIARu NT-proBNP 276 ng/L (5-35000 ng/L) and BNP 56 ng/L (0-4853 ng/L). ECLIAFab provided significantly higher results in comparison with ECLIARu. Correlation analysis showed high and statistically significant correlation between BNP and ECLIAFab NT-proBNP (rs = 0.962, p < 0.001), BNP and ECLIARu NT-proBNP (rs = 0.963, p < 0.001), ECLIAFab NT-proBNP and ECLIARu NT-proBNP (rs = 0.996, p < 0.001). According to ESC guidelines for heart failure in acute and non-acute settings the best combination for suspected heart failure are BNP and NT-proBNP plasma concentration. We concluded that the results of NT-proBNP measured with ECLIARu and ECLIAFab were statistically different between three age groups. We proved that the new ECLIAFab method provides similar results as validated ECLIARu method in patients with the potential diagnosis of acute or chronic heart failure. BNP and ECLIAFab NT-proBNP are useful for ruling out the diagnosis of heart failure taking into account ESC guidelines for upper-limit of normal values.

• Keywords: heart failure brain natriuretic peptide N-terminal of pro-A-type natriuretic peptide electrochemiluminescence immunoassay method