Gallegos Patrick J, Maclaughlin Eric J, Haase Krystal K
Department of Pharmacy, Akron General Medical Center, Akron, Ohio, USA.
Pharmacotherapy. 2008 Mar;28(3):343-55. doi: 10.1592/phco.28.3.343.
Heart failure is a major problem in the Unites States. Despite the availability of and increasing adherence to evidence-based guidelines, the morbidity and mortality from this disease remain significant. Strides have been made in the last several years to develop objective tools to aid in the diagnosis of heart failure and in the prognosis of the affected patients. Brain natriuretic peptide (BNP) and the N-terminal prohormone of BNP are neurohormones released in response to ventricular wall stress and/or tension. As objective laboratory measures, both peptides have similar utility in the treatment of patients with heart failure. Currently, these laboratory tests are approved only to aid in diagnosis. However, data are beginning to emerge that suggest the utility of serial BNP monitoring for the management of chronic heart failure in patients with left ventricular dysfunction. Preliminary studies have shown that when added to traditional management combined with adherence to evidenced-based national guidelines, serial monitoring of BNP levels with adjustment of therapy based on the results may improve outcomes in patients with chronic heart failure compared with traditional clinical management alone. Factors that may limit the use or confound interpretation of the laboratory test results include the effects of demographics (e.g., sex, age, body mass index), concurrent diseases, and drug therapies. Several large, outcomes-based studies are under way to examine the use of serial BNP monitoring to decrease morbidity, mortality, and overall health care costs in patients with heart failure.
心力衰竭在美国是一个重大问题。尽管有循证指南且对其遵循度不断提高，但这种疾病的发病率和死亡率仍然很高。在过去几年里，已经在开发客观工具以辅助心力衰竭的诊断和受影响患者的预后评估方面取得了进展。脑钠肽（BNP）和BNP的N末端前体激素是响应心室壁压力和/或张力而释放的神经激素。作为客观的实验室检测指标，这两种肽在心力衰竭患者的治疗中具有相似的效用。目前，这些实验室检测仅被批准用于辅助诊断。然而，越来越多的数据表明，连续监测BNP对左心室功能不全患者的慢性心力衰竭管理有用。初步研究表明，在遵循循证国家指南并结合传统管理的基础上，根据结果调整治疗方案并连续监测BNP水平，与单纯传统临床管理相比，可能改善慢性心力衰竭患者的预后。可能限制实验室检测结果使用或混淆其解释的因素包括人口统计学因素（如性别、年龄、体重指数）、并发疾病和药物治疗的影响。目前正在进行几项基于结果的大型研究，以检验连续监测BNP在降低心力衰竭患者发病率、死亡率和总体医疗费用方面的作用。
