心脏标志物与心脏疾病的实验室诊断课件.pptVIP

2008ESC心衰指南指出BNP和NT-proBNP是最好的诊断和排除HF的生物学标记物 根据年龄分层，诊断急性呼吸困难患者心力衰竭NT-proBNP的最优截断点 形式 年龄（年） 最优截定点（ng/L） 诊断（纳入HF） 50 450 50-70 900 70 1800 除外（排除HF） 非年龄依赖性 300 NT-proBNP对HF诊断和治疗的评估建议 慢性心力衰竭时：NT-proBNP 2000 pg/mL 急性心力衰竭时： NT-proBNP不同年龄最优截定点 450-900-1800pg/mL，300pg/mL(排除标准) 住院时急性心衰NT-proBNP下降达30%是治疗有效的目标 如果没有测基线值，急性期治疗的目标应为NT-ProBNP 4000 pg/mL 检测NT-proBNP最理想的两个时间点：基线/发作时和病情稳定后 心衰发作和经治后的NT-proBNP绝对值对心衰预后预测都有价值，经治后NT-proBNP改变的百分数更有价值 使用BNP与NT-ProBNP时的注意事项 在解释治疗后 BNP 或 NT-proBNP 测定值的变化时应考虑生物变异因素（如：肥胖；肾小球滤过功能；甲状腺功能；应用雌性激素等）。 BNP 在体外保存稳定性较差，加入精氨酸蛋白水解酶抑制剂或缓激肽抑制剂可减少降解，延长稳定保存时间。NT-proBNP 在体外较稳定。 重点 AMI的诊断中心肌标志物联合应用的概念与使用原则。 冠脉疾病的两级风险预测所涉及的指标以及结果分析。 急性心衰的实验室诊断常用指标以及使用的注意事项。 参考资料 Richard A. Mcpherson, Matthew R.Pincus. Henry’s Clinical Diagnosis and Management by Laboratory Methods(21st edition). Elevier Inc，2007 丛玉隆.检验医学.人民卫生出版社，2009.2 王建中.实验诊断学.北京大学医学出版社，2003 《冠状动脉疾病和心衰时心脏标志物临床应用建议》（第二版，2006年3月，上海 ） 2008 ESC heart failure guidelines Cardiovascular disease is a multifactorial disease. Metabolic disturbances like hyperlipidemia and hyperglycemia (diabetes) are well known to contribute to disease development; as well some genetic (e.g. familial hypercholesterinemia) and behavioral factors (smoking, physical inactivity) are known to drive the disease process, the final cardiac event being induced by activation of the hemostatic system resulting in thrombotic closure of an atheriosclerotic coronary vessel. New evidence gained in recent years has shown that inflammation is a further process basically involved in the pathomechanism and contributing to cardiovascular disease. Cardiovascular disease usually progresses stepwise. However, it is not mandatory that any cardiac symptoms occur before a (probably fatal) myocardial infarction (MI). Apparently healthy individuals can suddenly experience severe cardiac disease. Determination of risk factors helps to recognize such individuals of high risk, and stratification to a risk lowering preventive therapy. Atherosclerosis is th