BNP-临床诊断的突破.pdfVIP

Generated by Foxit PDF Creator © Foxit Software For evaluation only. B-Type Natriuretic Peptides: A Diagnostic Breakthrough for Clinicians BNP—临床诊断的突破 Peter A McCullough, MD, MPH, FACC, FACP, FAHA, ØTorbjrn Omland, † ‡ MD, PhD, MPH, Alan S. Maisel, MD ØDivisions of Cardiology, Nutrition, and Preventive Medicine, William Beaumont Hospital, Royal Oak, Ml; † Ulleval University Hospital, Oslo, Norway; ‡ Divisions of Cardiology, University of California, San Diego, Veterans Affairs Medical Center, San Diego, CA B-Type Natriuretic Peptide (BNP), a neurohormone synthesized in the cardiac ventricles, is released as preproBNP and then enzymatically cleaved to the N-terminal-proBNP(NT-proBNP) and BNP upon ventricular myocyte stretch. Blood measurements of BNP and NT-proBNP have been used to identify patients with congestive heat failure (CHF). Important considerations for these tests include their half-lives in plasma, dependence on real function for clearance, and the interpretation of their units of measure. The BNP assay currently available in North American markets, approved for use as a diagnostic aid in CHF and a prognostic marker in acute coronary syndromes (ACS), has particular advantages because it is available at the point of care and has had considerable use in clinical studies. In general, a BNP levels less than 100pg/mL has strong negative predictive value for CHF. In addition, BNP levels can be used to gauge the effect of short-term treatmen of acutely decompensated CHF. BNP has been shown to be a reliable and independent predictor of sudden cardiac death. In the abs