Rodeheffer Richard J
Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
J Am Coll Cardiol. 2004 Aug 18;44(4):740-9. doi: 10.1016/j.jacc.2004.03.082.
Elevated plasma brain natriuretic (BNP) concentrations correlate with increased cardiac filling pressures. Therefore, increased BNP has been proposed as a marker for asymptomatic ventricular dysfunction, as an aid in the diagnosis of cardiac dyspnea, as an end point to assess the efficacy of heart failure therapy, and as a prognostic marker in heart failure. An understanding of the utility of BNP requires an appreciation of the sensitivity, specificity, and diagnostic accuracy of BNP in each of these clinical situations. At this time, there is strong evidence for the value of BNP in the evaluation of dyspnea of uncertain cause. Further population studies will need to be performed to refine the application of BNP to community cohorts and to determine its clinical value and cost-effectiveness as a screening tool in the early diagnosis of ventricular dysfunction. To make optimal use of BNP for the assessment of heart failure therapy and prognosis in individual patients, physicians will require additional information on the biological variability of BNP. Studies comparing the sensitivity, specificity, and predictive value of the available BNP and N-terminal pro-BNP assays need to be conducted in each of these clinical settings.
血浆脑钠肽（BNP）浓度升高与心脏充盈压升高相关。因此，BNP升高已被提议作为无症状性心室功能障碍的标志物，辅助诊断心源性呼吸困难，作为评估心力衰竭治疗疗效的终点，以及作为心力衰竭的预后标志物。要了解BNP的效用，需要认识到BNP在每种临床情况下的敏感性、特异性和诊断准确性。目前，有强有力的证据支持BNP在评估病因不明的呼吸困难方面的价值。还需要进行进一步的人群研究，以完善BNP在社区队列中的应用，并确定其作为心室功能障碍早期诊断筛查工具的临床价值和成本效益。为了在个体患者中最佳地利用BNP评估心力衰竭治疗和预后，医生将需要关于BNP生物学变异性的更多信息。需要在每种临床环境中进行研究，比较现有BNP和N末端前脑钠肽检测的敏感性、特异性和预测价值。
