课件：N端脑利钠肽.ppt

* 有报道表明,无心衰房颤患者BNP主要由左房而非左室分泌，房颤电复律及射频消融后BNP水平的降低都表明房颤与BNP升高有直接关系 * * * While the use of BNP for screening in the general population is not currently warranted, targeted screening of individuals at high risk of developing left ventricular systolic dysfunction would lead to more economical use of more expensive cardiac imaging procedures such as echocardiography or ultrasound. Many studies have shown that fewer than 30% of symptomatic patients referred for echocardiography turned out to have heart failure. A reliable rule-out test for CHF, with an Negative Predicative Value (NPV) of 98% or better, when used on the above population could eliminate unnecessary testing in ~68% of the symptomatic population. Additionally, a number of other utilities can be envisioned wherein BNP could be used to predict outcome, progression or response to therapy of disorders characterized by impaired cardiac function. BNP is a very active research topic today. There is no doubt that future studies will focus much time on these other potential uses of BNP. BNP has also been shown to be a useful prognostic indicator. BNP values increase as CHF progresses in severity. Increasing BNP values also correlate with the NYHA Classes and left ventricular ejection fraction. These are discussed in greater detail in slides 9-11. Since BNP appears to be the most powerful neurohormonal predictor of left ventricular function, a new area of clinical research is supporting the use of BNP in selecting patients for specific drug therapy. Studies are also being conducted to provide guidance to physicians in determining the proper dosage of these various drugs. * （二）BNP和急性心肌梗死 反映心肌缺血程度、左室功能受损程度（正相关） 预测AMI后左室重构情况（正相关） 评估早期再灌注疗效 (再灌注治疗,BNP低） 用于AMI的危险分层，预测AMI预后 BNP：预测ACS远期预后 美国Morrow 等人研究ACS患者随访BNP的预测价值 1999-2003年 、大规模多中心前瞻性研究（4497例） 主要终点：2年内全因死亡或新发充血性心力衰竭 结果： (1). 死亡230例，新发CHF163例 (2). BNP升高(80ng/L)与死亡或新发CHF相关 (3). 4个月时新发BNP升高，死亡和新发CHF风险升高 (4). 进入试验时BNP水平升高而4个月时BNP低于80ng/L,