Richards Mark, Troughton Richard, Lainchbury John, Doughty Rob, Wright Sue
Christchurch Cardioendocrine Research Group, Christchurch, New Zealand.
Scand J Clin Lab Invest Suppl. 2005;240:129-37. doi: 10.1080/00365510500236317.
The cardiac natriuretic peptides, and in particular plasma levels of the B-type natriuretic peptides, are acknowledged biomarkers of cardiac function and prognosis in cardiovascular disease. A growing body of evidence confirms plasma BNP and/or NT-proBNP are independent predictors of mortality and/or heart failure events in acute heart failure, established chronic heart failure, acute coronary syndromes and even in asymptomatic but at risk populations. Alongside this large body of associative observational data, there is a growing evidence base from controlled trials which indicates that knowledge of plasma B-type natriuretic peptide levels can be translated into improved clinical outcomes. Measurements of NT-proBNP improve diagnostic accuracy in patients presenting with heart failure in the community. Provision of plasma BNP data improves speed of diagnosis and reduces rates of hospital admission in patients with heart failure presenting with breathlessness (all whilst reducing overall costs). A randomised pilot study demonstrates serial measurements of NT-proBNP can assist in more effective optimisation of heart failure pharmacotherapy with a concomitant improvement in outcome. This finding has been corroborated by a recently reported multicentre study. Screening for left ventricular systolic dysfunction in the general population or in asymptomatic subjects at high risk of cardiovascular events appears to be cost-effective. This developing evidence base from controlled trials encourages further implementation of plasma BNP and/or NT-proBNP in diagnosis, risk stratification and management, not only of acute and chronic heart failure but also in those with coronary disease and asymptomatic subjects with cardiovascular risk factors.
心脏利钠肽，尤其是B型利钠肽的血浆水平，是公认的心血管疾病心功能和预后的生物标志物。越来越多的证据证实，血浆BNP和/或NT-proBNP是急性心力衰竭、已确诊的慢性心力衰竭、急性冠状动脉综合征甚至无症状但有风险人群死亡率和/或心力衰竭事件的独立预测指标。除了大量的相关性观察数据外，来自对照试验的证据基础也在不断增加，这表明血浆B型利钠肽水平的知识可以转化为改善临床结果。NT-proBNP的测量提高了社区中出现心力衰竭患者的诊断准确性。提供血浆BNP数据可提高诊断速度，并降低因呼吸困难而就诊的心力衰竭患者的住院率（同时降低总体成本）。一项随机试点研究表明，NT-proBNP的系列测量可以帮助更有效地优化心力衰竭药物治疗，并同时改善预后。这一发现得到了最近报道的一项多中心研究的证实。在普通人群或有心血管事件高风险的无症状受试者中筛查左心室收缩功能障碍似乎具有成本效益。来自对照试验的这一不断发展的证据基础鼓励在诊断、风险分层和管理中进一步应用血浆BNP和/或NT-proBNP，不仅用于急性和慢性心力衰竭，也用于冠心病患者和有心血管危险因素的无症状受试者。
