生化指标在心力衰竭诊断和治疗中地角色.pptVIP

生化指标在心力衰竭诊断和治疗中的角色 浙江大学医学院附属第二医院 心脏中心 王建安 项美香 心功能/心衰标志物的重要性 心衰主要实验室指标 常规生化指标：血气分析，电解质，肝肾功能，血常规等 BNP/NT-pro BNP 肌钙蛋白 其他：神经激素指标等 Diagnostic assessments supporting the presence of heart failure BNP/NT-pro BNP BNP/NT-pro BNP的诊断价值 阴性预测值 阳性预测值 BNP 97% 90% （100pg/ml) (500pg/ml) NT-proBNP 99% 98% (300pg/ml) (2000pg/ml) 影响BNP/NT-pro BNP的因素 BNP/NT-pro BNP升高 急性冠脉综合征 慢性肺部疾病 肺动脉高压 高血压 心房颤动 肾功能不全 高龄 感染 影响BNP/NT-proBNP的因素 肥胖者降低 在急性肺水肿或急性二尖瓣关闭不全的早期阶段，脑钠肽可保持“正常”。 Troponin 心肌缺血、心肌炎 严重心衰、心衰失代偿病人可有轻度升高 Neurohormonal markers Norepinephrine, renin, aldosterone, endothelin Although useful in research, evaluation of neuroendocrine activation is not required. 生化指标在心衰治疗和预后中的价值 根据生化指标调整治疗方案 生化指标对预后的预测 Plasma Brain Natriuretic Peptide-Guided Therapy to Improve Outcome in Heart Failure: The STARS-BNP Multicenter Study 220 NYHA II~III patients Multicenter Number of Changes in Medical Therapy During the First 3 Months----Compare clinical group vs. BNP group  Changes in Medical Therapy During the Titration Phase in BNP Group and Clinical group STARS-BNP Study Conclusion a BNP-guided strategy reduces the incidence of a combined end point (death and hospital stay related to heart failure) compared with a standard strategy. The result is mainly obtained through an increase in ACEI and beta-blocker dosages. 生化指标在心衰治疗和预后中的价值 根据生化指标调整治疗方案 生化指标对预后的预测 Conditions associated with a poor prognosis in heart failure Prediction of cardiac death or CV hospitalization:CART analysis 低钠与预后 MUSIC risk score:a simple method for predicting mortality in patients with chronic heart failure MUSIC Risk score for each type of mortality 2009美国成人慢性心力衰竭诊断和治疗指南 (更新版） 测定BNP和NTproBNP有助于评估HF诊断不确定的急诊