BNPNT-pro-BNP在心衰诊断及治疗中的应用.pptVIP

BNP/NT-pro-BNP在心衰诊断及治疗中的应用 B-Type Natriuretic Peptides(BNP)B型利钠肽 人的心肌细胞合成的BNP 是由134个氨基酸组成的前激素经过二次裂变而成： 第一次分裂为108个氨基酸的前BNP （proBNP) 进一步裂解为无活性的NT-pro-BNP(aa 1 to 76) 和有活性的BNP(aa 77 to 108) NT-pro-BNP 的半衰期较长——60-120分  ESC Guidelines for the diagnosis and treatmentof acute and chronic heart failure 2012 How obesity affects the cut-points for B-type natriureticpeptide in the diagnosis of acute congestive heart failure The grey zone Other causes of a modest rise in NP level Use of natriuretic peptide levels in patients presenting with acute dyspnoea 引用文献 Troughton RW, Richards AM.B-type natriuretic peptides and echocardiographic measures of cardiac structure and function. JACC Cardiovasc Imaging. 2009 Feb;2(2):216-25. Daniels LB, Clopton P, Bhalla V, et al.How obesity affects the cut-points for B-type natriuretic peptide in the diagnosis of acute heart failure. Results from the Breathing Not Properly Multinational Study. Am Heart J. 2006 May;151(5):999-1005. Roland van Kimmenade,JohnLainchbury,Antoni Bayes-Genis,et al.NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients. European Heart Journal (2006)27, 330–337 John J.V. McMurray,Stamatis Adamopoulos , Stefan D. Anker , Angelo Auricchio,et al.ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012.European Heart Journal (2012)33, 1787–1847 * Cut-off point NT-proBNP BNP MR-proANP Acute onset or 300 pg/mL 100 pg/mL 120 pmol/L worsening of symptoms Non-acute onset 125 pg/mL 35 pg/mL 在无急性发作的患者中，BNP和NT-proBNP 诊断心衰的敏感性和特异性相对较低 NP阈值随年龄增大而增加，但随体重指数增加而减少 Am Heart J. 2006 May;151(5):999-1005. Am Heart J. 2006 May;151(5):999-1005 BNP 100~400 pg/ml NT-proBNP 50 years old 300~450 pg/ml 50~75 years 300~90