Matunović Radomir, Stojanović Aleksandar, Mijailović Zdravko, Cosić Zoran
Klinika za kardiologiju, Vojnomedicinska akademija, Beograd.
Med Pregl. 2006 May-Jun;59(5-6):248-52. doi: 10.2298/mpns0606248m.
Brain natriuretic peptides (BNP) and N-terminal prohormone brain natriuretic peptides (N-proBNP) have been shown to provide important prognostic information in patients with acute coronary syndrome (ACS). Ischemia may be an important stimulus for BNP release. This does not imply, however, that BNP is useful for diagnosing ischemia, and BNP is unlikely to prove sensitive or specific enough for this purpose. SIGNIFICANCE OF NATRIURETIC PEPTIDES IN ASSESSING PROGNOSIS IN PATIENTS WITH ACUTE CORONARY SYNDROMES: In patients with ST-elevation and non-ST-elevation myocardial infarction, higher BNP and N-proBNP levels have been shown to predict a greater likelihood of death or heart failure, independent of other prognostic factors. THERAPEUTIC IMPLICATIONS OF BNP ELEVATION IN ACUTE CORONARY SYNDROMES: Patients with BNP or NT-proBNP elevation following ACS are clearly at high risk for death and for developement of heart failure, but specific therapeutic implications of BNP elevation have not been defined. In particular, it is not known how patients with BNP elevation should be treated considering the fact that they have normal troponin levels and no clinical evidence of heart failure. MULTIMARKER STRATEGIES FOR RISK STRATIFICATION IN ACUTE CORONARY SYNDROMES: It has been shown recently that in patients with acute coronary syndromes the risk increased sequentially among those with one, two or three elevated biomarkers. THERAPEUTIC APPLICATIONS OF CARDIAC BIOMARKERS IN ACUTE CORONARY SYNDROMES: Multimarker strategies, that incorporate panels of cardiac biomarkers, are likely to be used in the future for risk stratification and for pathophysiologically-guided treatment of patients with ACS.
脑利钠肽（BNP）和N末端脑利钠肽原（N-proBNP）已被证明可为急性冠脉综合征（ACS）患者提供重要的预后信息。缺血可能是BNP释放的重要刺激因素。然而，这并不意味着BNP可用于诊断缺血，而且BNP不太可能为此目的而被证明具有足够的敏感性或特异性。利钠肽在评估急性冠脉综合征患者预后中的意义：在ST段抬高型和非ST段抬高型心肌梗死患者中，较高的BNP和N-proBNP水平已被证明可预测死亡或心力衰竭的可能性更大，且独立于其他预后因素。急性冠脉综合征中BNP升高的治疗意义：ACS后BNP或NT-proBNP升高的患者显然处于死亡和发生心力衰竭的高风险中，但BNP升高的具体治疗意义尚未明确。特别是，考虑到这些患者肌钙蛋白水平正常且无心力衰竭的临床证据，尚不清楚应如何治疗BNP升高的患者。急性冠脉综合征风险分层的多标志物策略：最近的研究表明，在急性冠脉综合征患者中，有一个、两个或三个生物标志物升高的患者风险依次增加。心脏生物标志物在急性冠脉综合征中的治疗应用：包含多种心脏生物标志物的多标志物策略可能在未来用于ACS患者的风险分层和病理生理指导治疗。
