心力衰竭BNP-Hardy.Alere.pptVIP

BNP的临床意义：脑钠肽的分泌 心肌细胞 preproBNP (134 aa) 信号肽 (26 aa) proBNP (108 aa) 血液 BNP 77- 108 (1-32) NT-proBNP 1-76 分泌 摘自: J. Mair et al. Scand J Clin Lab Invest 1999; 59 (suppl 230) : 132-142 (生理活性部分) (无活性) BNP vs. NT-proBNP BNP NT-proBNP 分子结构 BNP77-108 NT-proBNP1-76 生物活性 有 无 半衰期 20min 60-120min 清除 主动清除和被动清除 被动清除 标本要求 EDTA抗凝血浆 血清、血浆、全血 试管 塑料管 玻璃管或塑料管 临床参考值 不受年龄限制、便于解读 与年龄相关，需结合患者年龄进行解读 不同温度保存不同时间对BNP与NT-proBNP在样本中的稳定性影响 摘自：王伟佳，张秀明，温冬梅，欧阳能良。不同抗凝剂、样本放置时问及保存温度对B型利钠肽和氨基末端B型利钠肽原检测的影响[J]，现代检验医学杂志2012，27（2）：83-87. * * 临床参考值 BNP Januzzi et al. Eur Heart J 2006; 27:330-7 (Roche method) PPV 95% NPV = 98% 500 Mehra et al. Crit Pathways in Cardiol 2005;4:10-20 (Alere method) 50 yrs 50-75 yrs 75 yrs HF Rule-in HF Rule-out HF Possible 100 No age distinction PPV = 88% NPV = 98% 450 300 900 1800 NT-proBNP 谢谢! * * * * * The Triage? BNP Test is indicated for use as an aid in the diagnosis of congestive heart failure. * In 325 patients presenting to the ED with dyspnea, BNP levels were determined. Patients were then followed for 6 months looking for the following endpoints: death (cardiac and non-cardiac), hospital admissions (cardiac), and repeat ED visits for CHF. Using Kaplan-Meyer plots for all CHF events, patients who left the emergency department with BNP levels 480 pg/ml had a 6-month cumulative probability of a CHF event of (43%). On the other hand, patients who left the emergency department with BNP levels 230 pg/ml had an excellent prognosis with only 2.5% incidence of CHF end-points. The odds ratio for 6-month CHF death in patients with BNP levels 230 was 46. BNP levels measured in patients presenting with dyspnea to the ED are highly predictive of future cardiac events. Utilization of BNP levels in patients presenting with symptoms of CHF should prove to be a cost-effective way to risk-stratify patients with HF. Study Objective: B-Type natriuretic peptide (BNP) is a neurohormone secreted from the cardiac ventricles in response to volume expansion and pressure