BNPNT-pro对BNP监测在心力衰竭诊治中的应用.pptVIP

BNP/NT-proBNP监测在心力衰竭诊治中的应用 中国医学科学院 中国协和医科大学 心血管病研究所 阜外心血管病医院 心力衰竭诊治中心 张 健 BNP/NT-proBNP在心衰中的作用 诊断 预后判定 有效监测 人群筛选 治疗 NP: 起源和应激反应 BNP/NT-proBNP的分泌和释放 Biology of the Natriuretic Peptides The natriuretic peptide system has complex genetic regulation Synthesis of an intracellular precursor, proBNP1-108, precedes release of BNP1-32 and NT-proBNP1-76 BNP1-32 rapidly undergoes processing and degradation into several circulating forms, including BNP3-32 and BNP7-32 proBNP1-108 and NT-proBNP1-76 have absent biologic activity, while BNP3-32 and BNP7-32 have less biologic activity than BNP1-32 Optimal “rule out” cut point=253 ng/L Optimal “rule in” cut point=973 ng/L Expected NT-proBNP values in Apparently Healthy Individuals (n=2264)* Age-stratified “Rule In” Cut Point Final Diagnoses Results: NT-proBNP Levels NT-proBNP Levels and HF Symptom Severity Natriuretic Peptides and LVEF NT-proBNP in Aortic Stenosis Prognostic Evaluation of Patients with Acute Acutely Destabilized Heart Failure Outcomes Following Acute HF as a Function of Change in NT-proBNP 阜外心血管病医院的一些初步研究 以288 pg/ml为BNP的分割点，BNP≤288 pg/ml组的平均无心源性事件生存时间为18.06个月 BNP288 pg/ml组的平均无心源性事件生存时间为9.94个月 BNP≤288 pg/ml组的无心源性事件生存时间显著长于BNP288 pg/ml组（P0.0001），约为其2倍。 BNP and LVEF- Scintigraphy Source: Clerico et al. J.Endocrinol. Invest 1998 ; 21:170-179. 4 3 2 1 Concentrations Log BNP ( ng/l) 0 10 20 30 40 50 60 70 % LVEF 0 10 20 30 40 50 60 70 80 90 100 0 10 20 30 40 50 60 70 80 90 100 1 - Specificity (%) Sensitivity (%) 82 118 205 --- BNP ED diagnosis AUC 0.884 0.9790 --- ROC Curve: BNP and ED Diagnosis Diagnosis in All 250 Patients Dao, Q. et al. J. American College of Cardiology, Vol 37, No. 2, 2001 ZJ Cumulative survival rates in CHF patients with LVD Tsutamoto T. et al. Circulation 1997;96:509-516 0 20 40 60 80 100 0 10 20 30 40 50 BNP