B型利钠肽在慢性心力衰竭诊断中的应用价值研究

目的探讨B型利钠肽(BNP)在慢性心力衰竭(CHF)诊断中的应用价值。方法选择2011年1月—2013年7月阜南县人民医院门诊和住院CHF患者260例,按照纽约心脏协会(NYHA)心功能分级将患者分为心功能Ⅱ级组94例、心功能Ⅲ级组112例、心功能Ⅳ级组54例,另选择同期体检中心体检健康者60例作为空白组。比较各组受试者血清BNP水平和左心室射血分数(LVEF),分析CHF患者血清BNP水平与LVEF的相关性,并绘制血清BNP水平诊断CHF的受试者特征(ROC)曲线。结果血清BNP水平为心功能Ⅳ级组>心功能Ⅲ级组>心功能Ⅱ级组>空白组,LVEF为心功能Ⅳ级组<心功能Ⅲ级组<心功能Ⅱ级组<空白组(P<0.05)。Spearman等级相关分析结果显示,CHF患者血清BNP水平与LVEF呈负相关(r=-0.72,P<0.01)。以CHF患者血清BNP水平绘制ROC曲线,ROC曲线下面积(AUC)为0.966〔95%CI(0.935~1.010)〕,以98.6 ng/L作为CHF的诊断界值时其灵敏度为92.7%、特异度为94.5%、准确度为93.0%。结论 BNP诊断CHF具有较高的灵敏度、特异度及准确度,且安全、快捷、可靠,具有一定的临床应用价值。     

心力衰竭患者B型利钠肽的测定与评价

目的:研究B型利钠肽(BNP)在心力衰竭诊断中的应用。方法:采用双抗夹心免疫荧光法检测342例患者的BNP浓度。其中充血性心衰(CHF,心源性)组179例,肺源性心衰组27例,无心衰的对照组136例。结果:(1)在无心衰对照组中,年龄小于55岁组的心源性浓度均值为(35.10±31.93)pg/ml,55～64岁组为(42.85±34.55)pg/ml,65～74岁组为(58.23±25.37)pg/ml,≥75岁组为(60.66±48.95)pg/ml,各组间BNP浓度均值虽随年龄呈上升趋势但无显著差异;(2)对照组中男性BNP浓度为(42.83±38.01)pg/ml,女性为(49.47±48.14)pg/ml,两者无显著差异;(3)在342例患者中BNP以100pg/ml为CHF的判断值时,其敏感性达92.8%,特异性达83.2%,阳性预测值达86.2%,阴性预测值达91.2%;(4)CHF(心源性)患者的BNP浓度均值为(1019.13±972.88)pg/ml,肺源性心衰组为(299.88±275.5)pg/ml,对照组为(45.86±42.89)pg/ml,CHF(心源性)组BNP水平显著高于其他两组,肺源性心衰组又显著高于对照组(P均<0.001)。结论:BNP测定不仅可以作为CHF诊断的一个重要指标,还可用于参考性区分心源性心衰和肺源性心衰,为选择治疗方案提供依据。     

脑利钠肽对心力衰竭的治疗价值

充血性心力衰竭(congestive heart failure,CHF)的症状与组织灌流不足、液体潴留和神经激素反应有关。近年来,采用脑利钠肽(Brain natriuretic peptide,BNP)治疗急性心功能不全,取得了很好的疗效,对于高危的CHF失代偿期和肾功能异常的患者,BNP能明显减少住院天数、降低死亡倾向和减少肾功能恶化。现就BNP治疗急性心功能不全的机制综述如下。内生型人脑利钠肽(ehBNP)也叫B型利钠肽(B-type NP),是当心室内压力增大和容量超载时由心脏纤维母细胞     

B型利钠肽对心力衰竭患者心源性事件的预测价值

目的:评价B型利钠肽(BNP)对左心衰竭患者的预后预测价值.方法:使用荧光免疫的方法测定心力衰竭患者的BNP,并进行随访.主要临床终点为:心源性死亡和再入院.根据随访结果将患者分为无再发事件组(162例),心源性再入院组(47例),心源性死亡组(54例).用Kaplan-Meier法计算生存率和无心脏事件生存率,多因素分析采用COX回归分析法.结果:300例患者平均随访(9.5±5.6)个月,心源性再入院组[482.0(227.0,793.0)pg/ml]及心源性死亡组[565.0(327.3,1192.5)pg/ml]的BNP水平均显著高于无再发事件组[146.5(51.7,374.3)pg/ml)(P均＜0.001).不论单因素还是多因素分析,包括年龄、性别、纽约心功能分级(NYHA)、超声心动图所测左心房前后径、左心室舒张末内径、左心室射血分数(LVEF)及Log BNP,仅Log BNP与心源性死亡时问及心源性再入院时间独立相关.当分别引入Log BNP,性别,年龄,NYHA,LVEF和左心室舒张末内径及是否伴有心房颤动、心房扑动、室性心动过速、糖尿病共10个因素,单因素分析中:Log BNP、性别、NYHA、LVEF和室性心动过速是心源性事件发生的预测因子.但进一步COX多元回归分析中,只有Log BNP(回归系数:0.9898;P=0.002)和室性心动过速(回归系数:0.893;P=0.005)是独立相关影响因素.两者中,又以Log BNP的相关性最强.根据受试者工作特征曲线(ROC),BNP 288 pg/ml为划分有无心源性事件发生的最佳阈值点.BNP≤288 pg/ml患者的无心源性事件生存时间约是＞288 pg/ml患者的两倍(18.06个月vs 9.94个月,P=0.000).结论:BNP对心力衰竭患者的预后预测价值好.Log BNP和室性心动过速是心源性死亡、再入院事件独立相关影响因素.     

血浆B型利钠肽水平对心力衰竭患者的临床评价

目的 采用超声心动图评价心力衰竭患者的心功能指标,探讨其与血浆B型利钠肽（BNP）的相关性,观察应用心脉隆注射液对心力衰竭患者血浆BNP的影响.方法 入选2010年10月至2013年3月我院心内科临床诊断为心力衰竭的住院患者96例,随机分为两组：观察组49例（常规应用传统抗心力衰竭药物基础上加用心脉隆注射液）和对照组47例（常规应用传统抗心力衰竭药物）,2周后比较两组治疗前后血浆BNP水平及左室射血分数（LVEF）、左室舒张末内径（LVDd）大小,评价BNP与左心室功能的相关性.结果 两组治疗2周后LVEF均较前提高,LVDd及血浆BNP均较前下降,观察组有效率为91.84％,对照组有效率为78.72％,两组疗效差异有统计学意义（P＜0.05）.心力衰竭患者血浆BNP水平与LVDd大小呈正相关（r=0.536,P＜0.05）,与LVEF呈明显负相关（r=-0.619,P＜0.05）.结论 血浆BNP水平是评价心力衰竭的良好指标,可作为心力衰竭治疗后疗效评估的一个重要指标.在传统治疗心力衰竭的基础上联合应用心脉隆注射液能显著改善心功能,降低心力衰竭患者的血浆BNP水平,值得临床推广应用.     

心力衰竭患者血清脑利钠肽水平与心功能的相关性

目的探讨心力衰竭患者血清脑利钠肽(BNP)与心功能的相关性及其临床意义。方法 70例心力衰竭住院患者,使用酶联免疫吸附法(ELISA)测定其血清BNP水平,超声心动图测定左心室射血分数(LVEF),56例完成6 min步行试验(6MWT)评估运动耐量,分析不同心功能分级患者BNP水平与上述指标的相关性。结果(1)心力衰竭患者各NYHA心功能不同分级组BNP水平差异有统计学意义,BNP水平与心功能分级呈正相关;(2)BNP值与LVEF呈负相关;(3)BNP值与6MWT结果呈显著负相关。结论 BNP测定是辅助诊断充血性心力衰竭的有效方法,可反映心功能不全的严重程度。     

心力衰竭时N末端B型利钠肽原与B型利钠肽检测时受干扰的分析

目的 探讨心力衰竭(心衰)标志物N末端B型利钠肽原(NT-proBNP)与B型利钠肽(BNP)检测结果对心衰评价的潜在干扰因素,为临床医生正确选择分析物与合理分析检验结果提供依据.方法 采用美国临床与实验室标准化协会(CLSI)颁布的EP15-A2文件验证NT-proBNP与BNP常用检测仪器"电化学发光免疫检测系统罗氏Cobas E601"和"化学发光免疫检测系统西门子ADVIA Centaur"对NT-proBNP与BNP检测的精密度和准确度,评价由于仪器本身原因造成的检测结果偏离.对患者标本在不同标本采集管和不同放置时间的检测结果进行对比分析,并采用EP7-A2文件探讨内源性干扰物(溶血、黄疸和脂血)对标本NT-proBNP与BNP检测的干扰,评价由于标本不合格造成的检测结果偏离.在保证仪器运行及标本采集均符合要求的情况下,对203例单纯心衰与急性脑梗死合并心衰患者的NT-proBNP与BNP进行检测,探讨由于患者本身伴有其他疾病造成的检测结果干扰.结果 Cobas E601与ADVIA Centaur对NT-proBNP与BNP检测均具有良好的重复性,总不精密度分别小于2.9%与3.5%,与定值校准品的偏差分别小于2.38%与3.91%,符合临床检测要求.NT-proBNP与BNP的最适标本类型分别为血清和EDTA抗凝血浆,二者可室温稳定保存至少120 min;血红蛋白(2g/L)、直接胆红素(428μmol/L)、乳糜(2000 FIU)不会对NT-proBNP和BNP的检测造成影响.相对于单纯心衰患者,急性脑梗死患者NT-proBNP水平会明显抬高(P=0.003),而BNP仅在急性脑梗死合并Ⅲ级心衰患者体内明显升高(P＜0.01).结论 NT-proBNP与BNP的检测仪器性能应符合临床要求,虽然检测仪器具有较强的抗干扰能力,但合理选择标本类型仍然是正确获得检测结果的关键.在评价合并有其他疾病的心衰时,应客观分析NT-proBNP与BNP的诊断价值.

Abstract：

Objective To find the potential interference factors for the detection of NT-proBNP and BNP in patients with chronic heart failure. Methods EP15-A2 issued by Clinical and Laboratory Standards Institute (CLSI) was employed to compare the precision and accuracy of commercial NT-proBNP and BNP analyzer electrochemiluminescence immunoassay system Cobas E601 and chemiluminescence system ADVIA Centaur. Moreover, NT-proBNP and BNP were detected in different time interval and in different interfered sampling conditions (haematolysis, choloplania, lipemia). NT-proBNP and BNP of 203 patients with heart failure or heart failure complicated with acute cerebral infarction were analyzed to find the deviation caused by patients' endogenous factors. Results The precision and accuracy were comparable for NT-proBNP and BNP detection using Cobas E601 and ADVIA Centaur (total-CV below 2. 9% and 3.5%, the deviation from definite value below 2. 38% and 3.91% ). The most suitable sample type for NT-proBNP and BNP detection was serum and EDTA- anticoagulant plasma. The detection results of NT-proBNP and BNP were comparable for at least 120 min post sampling and not affected by Hb(2 g/L), DB(428 μmol/L) and chyle(2000FIU). NT-proBNP was significantly higher in heart failure patients complicated with cerebral infarction( P =0. 003) than in heart failure patients. BNP was significantly higher in heart failure grade Ⅲ patients complicated with cerebral infarction ( P ＜ 0. 01 ). Conclusions Cobas E601 and ADVIA Centaur supplied satisfactory detection of NT-proBNP and BNP in patients with chronic heart failure with strong anti-interference capacity. The diagnostic value of NT-proBNP and BNP for chronic heart failure should be analyzed objectively in the presence of complicating diseases.     

血浆B型利钠肽水平对老年腹膜透析患者心功能的评估价值

目的初步观察不同心功能状态下的老年CAPD患者血浆BNP变化，并判断其对心脏组织结构及功能改变的影响。方法收集2006年1月至2007年3月在我院腹膜透析门诊随访的90例老年腹膜透析患者的血浆标本，采用免疫荧光法检测其BNP的水平，以彩色多普勒超声心动图测定患者的左室射血分数（LVEF）、左心室心肌质量指数（LVMl）等指标。依据NYHA分级方案对心衰患者进行心功能分级。探讨BNP水平与心功能LVEF、LVMI等之间的关系。结果（1）腹膜透析患者C组的BNP巾位数（908pg／ml）高于B组（290pg／ml）和A组（195.5pg／ml），（P〈0.05）。（2）相关性分析提示BNP与LVMI呈正相关（r=0.3153，P〈0.05），BNP与LVEF呈负相关（r=-0.4756，P〈0.05）。（3）ROC曲线分析发现BNP诊断CAPD患者心衰的诊断界值（cutoff值）为224pg／ml，其诊断心衰的灵敏度和特异度分别为84.6％和78.9％。结论老年腹膜透析患者的血浆BNP水平随着心功能的减退逐渐增高，血浆BNP的浓度与心室重塑以及左心室功能密切相关，其心衰诊断的灵敏度和特异度较高，作为初步评价老年腹膜透析患者心功能，客观性预测临床心衰发生的实验室指标有其临床应用价值。     

携带人B型利钠肽基因重组腺病毒对慢性心力衰竭大鼠心功能的影响

目的 观察外源基因人B型利钠肽对慢性心力衰竭(心衰)大鼠心功能的影响.方法 30只入选心衰大鼠,随机分为携带人B型利钠肽基因重组腺病毒组(Ad-hBNP组)、重组空白腺病毒组(Ad-Track组)、生理盐水组(NS组),另设不予任何治疗的假手术组作为对照;分别经腹腔注射予以相应治疗,每周1次,共4周.4周后实验动物行超声心动图、血流动力学检测,酶联免疫吸附试验检测血清外源基因人B型利钠肽水平,全心质量指数检测.结果 间断Ad-hBNP治疗后,Ad-hBNP组心衰大鼠室间隔厚度、左室后壁厚度、左室舒张末径、左室收缩末径[(2.34±0.29)mm、(2.28±0.18)mm、(6.50±0.42)mm、(3.54±0.59)mm]显著低于Ad-Track组[(2.71±0.35)mm、(3.02±0.85)mm、(7.71±0.83)mm、(4.72±0.80)mm,均为P＜0.05]和NS组[(2.78±0.23)mm、(2.83±0.53)mm、(7.34±0.97)mm、(4.55±0.77)mm,均为P＜0.05],而左室射血分数、左室短轴缩短率[(79.27±7.01)%、(43.38±6.73)%]显著高于Ad-Track组[(70.85±4.81)%、(35.72±3.68)%,均为P＜0.01]和NS组[(69.67±6.90)%、(34.91±5.10)%,均为P＜0.01].Ad-hBNP组与Ad-Track组和NS组比较:心率显著降低,左室收缩压显著升高[为(131.79±15.76)mm Hg(1 mm Hg=0.133 kPa)、(112.99±32.35)mm Hg、(117.13±15.26)mm Hg],左室内压最大上升速率显著升高[分别为(5037.20±430.41)mm Hg/s、(4217.40±1354.15)mm Hg/s、(4310.50±1293.97)mm Hg/s;P＜0.05];左室内压最大下降速率显著升高[分别为(-4382.00±1304.79)mm Hg/s、(-3725.00±791.34)mm Hg/s、(-3890.00±1043.73)mm Hg/s,均为P＜0.05];左室舒张末压降低[分别为(-4.24±4.00)mm Hg、(21.99±6.80)mm Hg、(18.00±12.25)mm Hg,均为P＜0.01];心脏质量及全心质量指数均降低.结论 间断给予Ad-hBNP能够有效地改善心衰大鼠心脏结构和功能.

Abstract：

Objective To evaluate the therapeutic effect of hBNP on rats with chronic heart failure (CHF). Methods Thirty CHF rats defined by echocardiography at 12 weeks post abdominal aortic constriction were randomly divided into Ad-hBNP group (2. 5 × 1010 VP/ml NS Ad-hBNP 1 ml/week ×4,n = 14), Ad-Track group ( n = 8 ), placebo group ( NS, n = 8 ), 10 sham-operated rats served as control group. After 4 weeks treatment, cardiac function was evaluated by echocardiography and hemodynamic measurements. Heart weight (HW) and HW/body weight (BW) ratio were determined. Results IVS,LVPW, LVEDD and LVESD were significantly reduced in the Ad-hBNP group [(2. 34 ±0. 29)mm, (2. 28 ± 0. 18)mm, (6. 50 ±0. 42)mm, (3.54 ±0. 59) mm] than those in the Ad-Track group[(2. 71 ±0. 35) mm,(3.02 ±0.85)mm, (7.71 ±0.83)mm, (4.72 ±0.80)mm] and in the NS group [(2.78 ±0.23)mm,(2. 83 ± 0. 53 ) mm, (7. 34 ± 0. 97 ) mm, (4. 55 ± 0. 77 ) mm, all P ＜ 0. 05]. The LVEF and LVFS of the Ad-hBNP group [(79. 27 ±7.01 )%, (43.38 ±6. 73)%] were significantly higher than in the Ad-Track group[(70.85±4.81)%, (35.72 ±3.68)%] and in the NS group[(69.67 ±6.90)%, (34.91 ±5.10)%, all P ＜0. 01]. HR[(417.48 ±32. 57) beats/min, (446. 85 ±61.49) beats/min, P ＜0. 05;(440. 83 ±32. 18) beats/min , P ＜0. 05], LVEDP[( - 4. 24 ±4. 00) mm Hg( 1 mm Hg =0. 133 kPa);(21.99 ±6. 80) mm Hg, P ＜0. 01; ( 18.00 ± 12. 25)mm Hg, P＜0. 01] were significantly decreased and while LVSP[(131.79 ±15.76) mm Hg; (112.99 ±32.35) mm Hg, P＜0.05; (117.13 ±15.26)mmHg], +dP/dtmax[(5037.20 ±430.41) mm Hg/s; (4217.40 ± 1354. 15)mm Hg/s, P ＜0.05;(4310. 50 ± 1293.97 ) mm Hg/s, P ＜ 0. 05] and - dP/dtmax [( - 4382. 00 ± 1304. 79 ) mm Hg/s;(-3725.00±791.34) mm Hg/s, P ＜ 0.05; ( - 3890.00 ± 1043.73) mm Hg/s, P ＜ 0.05] were significantly increased in Ad-hBNP group than in Ad-Track group and NS group ( all P ＜ 0. 05 ). HW and HW/BW were also decreased in Ad-hBNP group than in the Ad-Track group and the NS group. Conclusion Exogenous hBNP improved the cardiac function and attenuated remodeling in CHF rats.     

N末端B型利钠肽原对单纯主动脉瓣狭窄心力衰竭患者的诊断价值

目的 评价N末端B型利钠肽原(NT-proBNP)对单纯主动脉瓣狭窄(AS)心力衰竭(心衰)患者的诊断价值.方法 使用酶联免疫的方法对40例AS心衰患者(AS心衰组)和76例正常对照者(正常组)行NT-pmBNP测定,评价其对AS心衰的诊断价值.结果 与正常组相比,AS心衰组NT-proBNP水平显著增高(P<0.01)且在纽约心功能分级(NYHA分级)Ⅱ、Ⅲ和Ⅳ级者呈逐级显著升高(均为P<0.01);其中,临床代偿心衰差异无统计学意义(P>0.05),而临床失代偿心衰升高8倍(P<0.01);在左室舒张期末内径(LVEDD)>50 mm组显著高于LVEDD≤50mm组(P<0.05),左室射血分数(LVEF)≤60%组显著高于LVEF>60%组(P<0.01);在合并心房颤动组显著高于窦性心律组(P<0.05).NT-pmBNP阈值在1360 ng/L时,是诊断心衰(ROC曲线下面积=0.762,P<0.01)及失代偿心衰(ROC曲线下面积=0.997,P<0.01)的最佳阈值;心衰与失代偿心衰诊断的敏感性分别为67.50%和100.00%,特异性均为96.05%,准确性分别为86.21%和95.83%.单因素和多元逐步回归分析一致显示,Log(NT-proBNP)与NYHA分级和LVEF呈显著正、负相关(P<0.05),且呈独立相关.结论 NT-pwBNP对单纯As心衰患者也有重要诊断价值.建议临床采用1360 ng/L作为阈值,诊断单纯AS伴心衰者准确性高达86.21%,尤其对失代偿者准确性高达95.83%.     

重组人脑利钠肽在老年重度心力衰竭患者中的疗效分析

目的探讨国产重组人脑利钠肽在老年重度心力衰竭患者中的疗效及安全性。方法回顾分析我院71例接受重组人脑利钠肽治疗的重度心力衰竭患者的临床资料,按照年龄分为≥70岁组(37例)和<70岁组(34例)。两组患者均接受48 h重组人脑利钠肽治疗,观察用药前后患者呼吸困难症状改善情况,检测患者血清肌酐(Cr)、B型尿钠肽激素前体(NT-proBNP)水平,采用彩色超声心动仪检测LVEF,记录患者30天及3个月的死亡事件。结果≥70岁组2例患者用药期间出现非药物相关性死亡,其余患者均完成48 h药物治疗,无低血压等不良反应的发生;与用药前比较,两组患者用药后呼吸困难症状有缓解(P<0.05);血清NT-proBNP明显减低(P<0.01);但两组患者用药后血清Cr、NT-proBNP及LVEF比较,差异无统计学意义(P>0.05)。两组患者用药后30天及3个月的病死率比较,差异无统计学意义(16.2% vs 11.8%;29.7% vs 29.4%,P>0.05)。结论老年重度心力衰竭患者静脉使用重组人脑利钠肽是安全、有效的。     

重组人脑利钠肽治疗急性心力衰竭患者的临床观察

目的:观察重组人脑利钠肽(recombinant human brain natriuretic peptide,rhBNP)治疗急性心力衰竭(acute heart failure,AHF)患者的临床疗效、血流动力学效应及药物安全性。方法:入选住院的102例AHF患者,随机分为rhBNP治疗组和硝普钠(NIP)对照组。2组在常规抗心衰治疗的基础上,rhBNP组加用新活素,NIP组加用硝普钠,持续静脉滴注24 h。分组后再于rhBNP组中选取15例(G1组),NIP组中选取16例(G2组),应用Swan-Ganz导管行血流动力学监测,比较患者用药前后临床症状、心功能及血流动力学参数的变化。结果:1.治疗24 h后患者呼吸困难均减轻,rhBNP组好转程度优于NIP组(P<0.05)。2.rhBNP组和NIP组肺部湿啰音均有改善,rhBNP组改善更明显(P<0.05)。3.2组心率(HR)均明显下降(P<0.05),但组间比较差异无统计学意义。4.治疗后rhBNP组尿量较NIT组有增多趋势,差异无统计学意义(P>0.05)。5.患者左心室射血分数(LVEF)均有提高(P<0.05),rhBNP组升高更明显(P<0.05);但2组治疗前后左心室舒张末期内径(LVDD)无明显变化(P>0.05)。6.2组PCWP、PAP均降低,G1组明显优于G2组(P<0.01),在用药后30 min 2组差异有统计学意义(P<0.05)。7.rhBNP组的不良事件主要是低血压,但与NIP组相比差异无统计学意义(P>0.05)。结论:rhBNP治疗急性AHF患者疗效显著,短期效果优于常规硝普钠治疗,且临床应用中安全可行。     

B-type natriuretic peptide levels in obese patients with advanced heart failure.

Although recent studies show that obesity, or elevated body mass index (BMI), is associated with lower levels of B-type natriuretic peptide (BNP), it is unknown whether BMI affects the prognostic value of BNP in heart failure (HF). This study confirms the relationship between high BMI and low BNP in patients with advanced systolic HF. Despite relatively lower levels of BNP in overweight and obesity, BNP predicts worse symptoms, impaired hemodynamics, and higher mortality in HF at all levels of BMI.OBJECTIVES: This study aimed to examine the influence of obesity on the predictive value of the B-type natriuretic peptide (BNP) assay in heart failure (HF). BACKGROUND: Recent studies show that obesity, or elevated body mass index (BMI), is associated with lower circulating levels of BNP both in the general population and in patients with HF. METHODS: We analyzed data from 316 systolic HF (left ventricular ejection fraction [LVEF] < or =40%) patients [age, 53 +/- 13 years; mean LVEF, 24 +/- 7%; 48% ischemic] followed up at a university HF center. Patients were divided into categories of BMI: lean (BMI <25 kg/m2), overweight (BMI = 25 to 29.9 kg/m2), and obese (BMI > or =30 kg/m2). RESULTS: The BNP levels were significantly lower in overweight and obese compared with lean patients (p = 0.0001); median BNP (interquartile range) for the lean (n = 131), overweight (n = 99), and obese (n = 86) groups was 747 (272 to 1,300), 380 (143 to 856), and 332 (118 to 617) pg/ml, respectively. In each BMI category, elevated BNP was significantly associated with worse symptoms and higher pulmonary capillary wedge pressure. Higher BNP was also a significant independent predictor of survival independent of BMI. Optimal BNP cutoff for prediction of death or urgent transplant in lean, overweight, and obese HF patients was 590, 471, and 342 pg/ml, respectively. CONCLUSIONS: Although BNP levels are relatively lower in overweight and obese HF patients, BNP predicts worse symptoms, impaired hemodynamics, and higher mortality at all levels of BMI.     

B-type natriuretic peptide in heart failure

PURPOSE OF REVIEW: This review focuses on recent literature pertaining to the role of B-type natriuretic peptide (BNP) in heart failure. RECENT FINDINGS: Heart failure is a common disorder that is associated with significant mortality and morbidity. The diagnosis of heart failure may at times be difficult when using conventional tools. The cardiac natriuretic peptides, particularly BNP, have evolved to be useful biomarkers in heart failure and other cardiovascular disorders. Recent studies have established a close association between plasma BNP and the amino-terminal fragment of the BNP prohormone (NT-proBNP) with the diagnosis of heart failure and independent prediction of mortality and heart failure events. Furthermore, preliminary data from randomized controlled trials suggest that knowledge of BNP and/or NT-proBNP level may optimize the management of patients with heart failure. Exogenous natriuretic peptide in the form of recombinant human BNP (nesiritide) has been shown to improve hemodynamics and dyspnea and is approved in the USA and several other countries for the management of patients with acute decompensated heart failure. The effect of nesiritide on clinical outcome, however, remains unclear. SUMMARY: When used in the appropriate clinical settings, BNP or NT-proBNP testing is extremely useful in establishing diagnosis and predicting prognosis in heart failure. Nesiritide holds promise in the management of patients with acute decompensated heart failure. Large-scale randomized controlled trials to evaluate BNP/NT-proBNP-guided therapy are currently in progress and studies of the impact of exogenous BNP on clinical outcomes in heart failure are likely to be forthcoming.     

脑钠肽对心力衰竭患者发生心房颤动的预测价值

目的通过测定心力衰竭(心衰)患者的血清脑钠肽(BNP)浓度,探讨BNP对心衰患者并发心房颤动(房颤)的预测价值。方法入选2010年7月至2013年12月在河南省安阳地区医院心内二科住院的心衰患者169例,152例完成随访,失访17例,其中男性79例,女性73例,年龄37~71岁,平均年龄(48±11)岁,根据随访结果将患者分为两组,房颤组(n=29)和窦性心律组(n=123)。所有患者在入选前以及随访1年均行Holter检查,同时检测患者血清BNP水平。结果随访1年后,152例患者完成随访,其中有29例患者记录到房颤。房颤组[(312.21±52.78)pg/ml]BNP水平明显高于窦性心律组[(218.24±67.45)pg/ml],差异具有统计学意义(P0.01)。多因素分析结果显示,年龄OR值为4.162,95%CI:1.521-7.132;LVEF OR值为1.027,95%CI:0.939-1.058。年龄和左室射血分数(LVEF)是心衰患者并发房颤的独立危险因素。结论血清BNP水平对心衰患者是否发生房颤有重要的预测价值。     

Obesity and suppressed B-type natriuretic peptide levels in heart failure

OBJECTIVES: This investigation evaluated the relationship between obesity and B-type natriuretic peptide (BNP) in heart failure. BACKGROUND: Obesity is a major risk factor for the development of heart failure, but the precise mechanisms remain uncertain. Physiologically, natriuretic peptides and lipolysis are closely linked. METHODS: A total of 318 patients with heart failure were evaluated between June 2001 and June 2002. Levels of BNP were compared in obese (body mass index [BMI] > or =30 kg/m(2)) and nonobese (BMI <30 kg/m(2)) patients with respect to New York Heart Association functional class and lean body weight-adjusted peak aerobic oxygen consumption. In a subset of 36 patients, plasma levels of tumor necrosis factor-alpha, interleukin-6, and soluble intercellular adhesion molecule-1 were measured. RESULTS: The population's BMI was 29.4 +/- 6.6 kg/m(2); 24% were lean (BMI <25 kg/m(2)), 31% overweight (BMI > or =25 to 29.9 kg/m(2)), and 45% obese (BMI > or =30 kg/m(2)). Obese patients were younger, more often African American, and more likely to have a history of antecedent hypertension, but less likely to have coronary artery disease and with only a trend toward diabetes mellitus. Levels of BNP were significantly lower in obese than in nonobese subjects (205 +/- 22 and 335 +/- 39 pg/ml, respectively; p = 0.0007), despite a similar severity of heart failure and cytokine levels. Multivariate regression analysis identified BMI as an independent negative correlate of BNP level. There were no differences in emergency department visits, heart failure hospitalization, or death between the obese and nonobese patients at 12-month follow-up. CONCLUSIONS: Our investigation indicates that a state of reduced natriuretic peptide level exists in the obese individual with heart failure.     

B-type natriuretic peptide serum levels in acute heart failure.

We read with great interest the article by Cowie et al.¹ onclinical applications of the assessment of B-type natriureticpeptide (BNP). This is an important subject and the articlealso helps to     

急性心力衰竭患者应用重组人脑钠肽治疗的临床研究

目的分析重组人脑钠肽(recombinant human brain natriuretic peptide,rh-BNP)在急性心力衰竭患者中的临床疗效。方法选取2011年1月至2014年1月在西安市第五医院诊断为急性心力衰竭的患者98例,按是否给予rh-BNP分为观察组52例和对照组46例。使用rh-BNP 7 d后,观察两组患者的心率、血压、氨基末端脑利钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、左心室射血分数(left ventricular ejection fraction,LVEF)以及因心力衰竭再次住院率,并比较两组治疗的疗效。结果两组患者在人院时血压、心率、NT-proBNP、LVEF比较,差异无统计学意义(P0.05);在应用rh-BNP 7 d后再次进行比较,两组上述指标比较,差异有统计学意义(P0.05);并且观察组治疗总体有效率高于对照组,差异有统计学意义(P0.05)。两组在抗心力衰竭治疗好转出院后,1年内因心力衰竭再次入院率相比较,差异无统计学意义(P0.05),但观察组患者住院率相对要低于对照组。结论 rh-BNP能够明显缓解心力衰竭患者症状,改善心功能:进一步降低NT-proBNP浓度,对于治疗急性心力衰竭具有良好的疗效,值得临床推广。