NT-proBNP 临床应用汕大二院心内科转化医学中心心血管实验室张勇刚 教授/主任医师
1 概述1988年,日本学者Tetsuji Sudoh首次从猪脑内分离得到一种具有强力的利钠、利尿、扩血管和降压作用的多肽,命名为脑T-proBNP 在急性呼吸困难鉴别诊断、 预后判断和指导治疗中的应用
Cost-effective, clinically validated algorithm for amino-terminal pro–B-type natriuretic peptide (NT-proBNP)–based evaluation and triage of the
patient with acute dyspnea. *NT-proBNP gray zone refers to value between 300 ng/L and age-adjusted value. †Age-adjusted value refers to NT-proBNP level of 450, 900, and 1,800 ng/L for ages <50, 50–75, and >75 years, respectively. For NT-proBNP, 1 ng/L = pmol/L. CXR = chest x-ray; d/c = discharge; ECG = electrocardiography; HF = heart failure.
无论新发急性还是慢性心力衰竭病情恶化,NT-proBNP 水平均会显著上升, 幅度与心衰严重程度平行;病情缓解后回降,但难以完全恢复到健康人水平。 NT-proBNP 在急性呼吸困难鉴别诊断中的应用 急性心力衰竭患者的 NT-proBNP 水平明显高于其他原因所致的急性呼吸困难(COPD、肺炎、哮喘、肺癌并发症、肺栓塞、间质性肺病等)患者
西班牙 Barcelona 研究(2004)提出双截点策略
即NT-proBNP 值<253 pg/ml 可“排除”急性心力衰竭(即测值低于此则急性心力衰竭所致呼吸困难的可能性很小);
NT-proBNP 值>973 pg/ml 可“诊断”急性心力衰竭(即测值高于此则急性心力衰竭所致呼吸困难的可能性很大)。
PRIDE 研究(2005) 指出急性心衰患者NT-proBNP 水平远高于非急性心衰引起的呼吸困难者(4435 pg/ml比 131 pg/ml),NT-proBNP 水平与心衰严重程度相平行, 是急性心衰最强的预测指标。 该研究评价急性心力衰竭的最佳截点,<300 mg/l 用于排除诊断,阴性预测值 99%;>900 pg/ml 可诊断急性心力衰竭, 阳性预测值为79%。 与健康人群的情况不同,用于急性呼吸困难人群时,NT-proBNP 的最适截点不受性别的影响。
Median NT-proBNP levels among patients who had acute CHF (n = 209) and those who did not (n = 390; p < for difference). Boxes, interquartile ranges; whiskers, 5th and 95th percentiles
Januzzi JL Jr, et al. The N-terminal Pro-BNP investigation of dyspnea in the emergency department (PRIDE) study. Am J Cardiol. 2005 Apr 15;95(8):948-54. /
Correlation between median NT-proBNP levels and symptom severity based on New York Heart Association symptom classification. Boxes, interquartile ranges; whiskers, 5th and 95th percentiles.
Januzzi JL Jr, et al. The N-terminal Pro-BNP investigation of dyspnea in the emergency department (PRIDE) study. Am J Cardiol. 2005 Apr 15;95(8):948-
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