1、BNPproBNP与心血管疾病与心血管疾病1 背背 景景23总总 结结BNPBNP的的临临床床应应用用利钠肽家族利钠肽家族是主要由心血管系统分泌的一组肽类的总称。在人体最多的是以下三种：心钠肽（atrial natriuretic peptide,ANP）脑 利 钠 肽(brain natriuretic peptide or B-type natriuretic peptide,BNP)C 型 利 钠 肽（C-type natriuretic peptide,CNP）心室容量、压力负荷增加 室壁张力的改变 BNP分泌 （炎症、心肌缺血等）心室肌细胞分泌 32个氨基酸组成的多肽 B型型脑钠肽脑
2、钠肽Prepro-BNP(134 aa)Pro-BNP (108 aa)信号肽(26 aa)BNP 77-108NT-proBNP 1-76无活性无活性有活性有活性 (32 aa)心肌心肌细细胞胞血血浆浆裂解裂解H2N176COOHCOOHH2N77108BNP and NT-pro BNPlNT-pro BNP无生理活性血液半衰期较长(120min)血浆和血清稳定性好清除：肾脏肾病病人水平相对高BNP的1-10倍BNP有生理作用血液半衰期短(22min)血浆和血清稳定性差清除：C受体、肾脏及中性内切酶受肾功能影响小BNP and NT-pro BNP u 抑制肾素血管紧张素醛固酮的分泌，提高
3、肾小球滤过率，利钠、利尿u 舒张血管平滑肌、扩张动静脉 降低血压、心脏 前负荷u 抑制心肌纤维化、血管平滑肌增生、抗冠脉痉挛u 阻断交感神经系统、抑制肾上腺皮质激素的释放心血管系统心血管系统保护作用保护作用BNP主要由心室分泌，当心室压力增高时主要由心室分泌，当心室压力增高时，促使其分泌，是心室障碍的敏感指标，促使其分泌，是心室障碍的敏感指标BNP用于临床诊断，评估疾病的严重程度BNP的的临临床床应应用用We conducted a prospective study of 1586 patients who came to the emergency department with acut
4、e dyspnea and whose B-type natriuretic peptide was measured with a bedside assay.Conclusions：Used in conjunction with other clinical information,rapid measurement of B-type natriuretic peptide is useful in establishing or excluding the diagnosis of congestive heart failure in patients with acute dys
5、pnea LAE=LAE=左心房扩大；左心房扩大；LVH=LVH=左心室肥厚；左心室肥厚；钠尿肽水平升高：钠尿肽水平升高：BNPBNP35 pg/ml35 pg/ml和和/或或NT-proBNPNT-proBNP125 pg/ml125 pg/ml心力衰竭的定义心力衰竭的定义1、有急性呼吸困难和疑诊急性心衰患者均推荐检测血浆利钠肽水平，以帮助鉴别急性心衰和非心脏原因的急性呼吸困难。NTproBNPNTproBNP300pg/ml300pg/ml、BNPBNP100pg/ml100pg/ml（急性心衰）（急性心衰）2、对于慢性心衰患者对于慢性心衰患者,BNP,BNP和和NT-pro BNPNT-
6、pro BNP的检测更多的检测更多地用于排除心衰。地用于排除心衰。NT-proBNP125pg/mlNT-proBNP125pg/ml、BNP35pg/mlBNP35pg/ml（慢性心衰）（慢性心衰）BNP BNP 水平与水平与HFHF严重性相关严重性相关Class I:身体活动不受限，普通体力活动不会造成不必要的疲劳，心悸，或呼吸困难BNP 95 pg/mLClass II:轻微的身体活动受限，休息时舒适，但是普通的体力活动导致疲劳，心悸或呼吸困难BNP 221 pg/mLClass III:明显的身体活动受限，休息是舒适，但是不能进行普通的体力活动，因可能导致疲劳，心悸或呼吸困难;BNP
7、459 pg/mL Class IV无法进行任何身体不适的情况下进行身体活动，休息时有症状，如果进行任何的体力活动，不适感增加BNP 1.006 pg/mL Triage BNP Package Insert,Data on Biosite,an IMA company？BNP 有治疗作用当心衰患者 BNP 相当高的时候为什么起不到治疗效果BNP用于临床治疗BNP的的临临床床应应用用基因重组人脑钠肽（基因重组人脑钠肽（rh BNPrh BNP）结构上完全等同于内源性的BNP 在体内与血管平滑肌及内皮细胞的鸟苷酸环化酶受体结合，激活细胞内第二信使cGMP，使平滑肌松弛，动脉和静脉扩张。作用作用1
8、、扩张小动脉和小静脉，迅速降低全身动脉压、肺毛细血管楔压、右房压，减轻心脏前后负荷。2、在降低收缩压时不引起反射性心率加快，能迅速改善血液动力学状态及呼吸困难等症状。3、具有明显的排钠利尿作用，降低醛固酮和去甲肾上腺素水平，抑制肾素活性和内皮素分泌。4、选择性的扩张血管、利尿排钠、拮抗神经内分泌、抗心脏重塑、心肌细胞保护。CONCLUSIONS：The rapid and sustained beneficial hemodynamic effects of nesiritide observed in this study support its use as a first-line IV
9、 therapy for patients with symptomatic decompensated HFConclusions：When added to standard care in patients hospitalized with acutely decompensated CHF,nesiritide improves hemodynamic function and some self-reported symptoms more effectively than intravenous nitroglycerin or placebo.Conclusions:Early
10、 intravenous rh BNP administration after PCI significantly lowered the serum concentrations of c TnT and NT-pro BNP,increased LVEDd,SV and LVEF,and reduced MACEs,including cardiac death,in patients with acute anterior MI undergoing PCI.重组人脑利钠肽既能扩张血管，又可以促进钠的排泄，有利尿作用，还可抑制肾素血管紧张素醛固酮系统(RAAS)和交感神经系统，rhBN
11、P可用于急性失代偿心力衰竭等心血管疾病的治疗BNPBNP用于预后分析用于预后分析BNP的的临临床床应应用用BNP 和 NT-proBNP 的水平是与心衰严重程度相关，治疗中如 BNP 和 NT-proBNP变化则反映病情的变化CONCLUSIONS：In patients admitted with decompensated CHF,changes in BNP levels during treatment arestrong predictors for mortality and early readmission.The results suggest that BNP levels
12、might be used successfully to guide treatment of patients admitted for decompensated CHFconclusions:In HF patients,therapy-induced reduction of BNP or NT-pro BNP levels is associated with reduced risk of hospitalization for HF worseningBNPBNP用于心血管疾病的用于心血管疾病的风险风险预测预测BNP的的临临床床应应用用conclusion：Among pati
13、ents at risk of heart failure,BNP-based screening and collaborative care reduced the combined rates of LV systolic dysfunction,diastolic dysfunction,and heart failure.Conclusion:Combining ECG changes and pro-BNP improves risk prediction in persons without known heart disease.Conclusions:In spite of
14、moderate heterogeneity across the enrolled studies,our meta-analysis suggests that increased NT-pro BNP levels are associated with greater risk of new-onset AF with ACS,which indicates that NT-pro BNP levels may be a useful biomarker in predicting new-onset AF in patients with ACS.需进一步研究需进一步研究总结总结1、BNP可用于心力衰竭的诊断、病情评估。2、外源性BNP可用于心力衰竭的治疗3、BNP 在慢性 CHF、心梗后等情况，可提供有用的预后信息4、BNP可能成为心血管疾病的风险预测指标5、关于BNP的更多临床应用还需大量的研究Thank You世界触手可及世界触手可及携手共进，齐创精品工程携手共进，齐创精品工程
