Daniels Lori B, Maisel Alan S
Division of Cardiology, University of California at San Diego, and Veteran's Affairs San Diego Healthcare System, San Diego, California 92037-1300, USA.
J Am Coll Cardiol. 2007 Dec 18;50(25):2357-68. doi: 10.1016/j.jacc.2007.09.021.
Natriuretic peptides (NPs) are released from the heart in response to pressure and volume overload. B-type natriuretic peptide (BNP) and N-terminal-proBNP have become important diagnostic tools for assessing patients who present acutely with dyspnea. The NP level reflects a compilation of systolic and diastolic function as well as right ventricular and valvular function. Studies suggest that using NPs in the emergency department can reduce the consumption of hospital resources and can lower costs by either eliminating the need for other, more expensive tests or by establishing an alternative diagnosis that does not require hospital stay. Caveats such as body mass index and renal function must be taken into account when analyzing NP levels. Natriuretic peptide levels have important prognostic value in multiple clinical settings, including in patients with stable coronary artery disease and with acute coronary syndromes. In patients with decompensated heart failure due to volume overload, a treatment-induced drop in wedge pressure is often accompanied by a rapid drop in NP levels. Knowing a patient's NP levels might thus assist with hemodynamic assessment and subsequent treatment titration. Monitoring NP levels in the outpatient setting might also improve patient care and outcomes.
利钠肽（NPs）在心脏因压力和容量负荷过重时释放。B型利钠肽（BNP）和N末端脑钠肽前体已成为评估急性呼吸困难患者的重要诊断工具。NP水平反映了收缩和舒张功能以及右心室和瓣膜功能的综合情况。研究表明，在急诊科使用NP可减少医院资源的消耗，并可通过消除对其他更昂贵检查的需求或通过确立无需住院的替代诊断来降低成本。分析NP水平时必须考虑诸如体重指数和肾功能等注意事项。利钠肽水平在多种临床情况下具有重要的预后价值，包括在稳定型冠状动脉疾病和急性冠状动脉综合征患者中。在因容量负荷过重导致失代偿性心力衰竭的患者中，治疗引起的楔压下降通常伴随着NP水平的快速下降。因此，了解患者的NP水平可能有助于进行血流动力学评估和后续治疗滴定。在门诊环境中监测NP水平也可能改善患者护理和治疗结果。
