医学院正确应用心脏功能标志物.pptVIP

-50 -25 0 25 50 4 12 24 Months Valsartan Placebo P 0.001 P = 0.006 P 0.001 *Least squares mean change ±SEM. BNP (pg/ml) Latini R. Circulation 2002 缬沙坦治疗对BNP的影响 Changes in plasma levels of brain natriuretic peptide (BNP) (expressed on a log scale) from baseline to three and six months in the placebo and spironolactone groups. Rousseau MF. JACC 2002 严重心力衰竭中螺内酯改善神经激素水平 NT-proBNP（BNP）与急性冠状动脉综合征 BNP与缺血相关 Patients with non-ST elevation ACS NT-proBNP adds substantial information toTIMI risk score and ACC/AHA classification Bazzino et al. Eur Heart J 2004; 25:1-8 0-2 3-4 5-7 NT-proBNP as predictor of short-termoutcome in patients with ACS: PRISMC Heeschen, C Hamm et al. Circulation 2004; 110 Association between baseline NT-proBNP and cardiac event rate during 30 days of follow up (n = 1392) 250 pg/ml 250 pg/ml Dynamic risk assessment in patients withACS using serial NT-proBNP measurements Heeschen, C Hamm et al. Circulation 2004; 110 Despite low NT-proBNP levels on admission (baseline 250 pg/ml), an increase in NT-proBNP levels during the following 72h indicated adverse clinical outcome Dynamic risk assessment in patients withACS using serial NT-proBNP measurements Heeschen, C Hamm et al. Circulation 2004; 110 In patients with high NT-proBNP levels on admission (baseline 250 pg/ml), rapid decline over 72h indicated low cardiac risk during the following 27 days. Patients with consistently high NT-proBNP level continued to be at increased cardiac risk NT-ProBNP and Early Invasive Strategy GUSTO IV study, James et al, AHA 2004 NT-proBNP、肌钙蛋白T与ACS患者血管重建的效果 James SK, GUSTO-IV substudy. JACC. 2006 NT-proBNP（BNP）小结 BNP（NT-proBNP）升高的潜在原因（心脏原因） 心衰 舒张功能不全 急性冠状动脉综合征 高血压伴左室肥厚 瓣膜性心脏病(主动脉缩窄，二尖瓣返流) 房颤 炎症性心脏疾病 BNP（NT-proBNP）升高的潜在原因（非心脏原因） 急性肺栓塞 肺动脉高压（原发性或者继发性） 脓毒血症（可能由于组织低氧或者继发心肌抑制） 慢性阻塞性肺疾病伴肺心病或者呼吸衰竭 甲亢 急性或者慢性肾功能衰竭 腹水性肝硬化 BNP在急诊室的临床应用 急性心衰的诊断和排除诊断 心源性与肺原性呼吸困难的鉴别诊断 心源性与肺原性水肿的鉴别诊断 BNP在心力衰竭的临床应用 心功能不全的早期诊断（还未出现血液动力学变化） 心力衰竭的排除诊断（高的阴性预测值） 心力衰竭的危险分层 心力衰竭的治疗决策 心力衰竭治疗效果的评估 B