Zakynthinos Epaminondas, Kiropoulos Theodoros, Gourgoulianis Konstantinos, Filippatos Gerasimos
Critical Care Department, School of Medicine, University Hospital of Thessaly, Thessaly, Greece.
Heart Lung. 2008 Jul-Aug;37(4):275-85. doi: 10.1016/j.hrtlng.2007.05.010.
Cardiac secretion of brain natriuretic peptide (BNP) increases with the progression of congestive heart failure (CHF). The plasma measurement of BNP emerged recently as a useful, cost-effective biomarker for the diagnosis and prognosis of CHF.
BNP assay is useful for evaluating patients with acute dyspnea, because a low level can help rule out CHF in primary care settings and reduce the demand for echocardiography. Equally, BNP level can be particularly useful in recognizing heart failure in a patient with acute dyspnea and a history of chronic obstructive pulmonary disease.
However, although the clinical use of BNP as a biomarker in CHF is increasing, the specificity of BNP in CHF is not strong, suggesting that other mechanisms beyond simple ventricular stretch stimulate BNP release. Multiple disorders in the intensive care unit, apart from CHF, cause elevated BNP levels, including cardiovascular disease states such as ischemia, arrhythmias, cardiac hypertrophy, and coronary endothelial dysfunction, as well as disorders of no cardiac origin, such as sepsis, septic shock, and acute respiratory distress syndrome. Moreover, the impact of increased BNP in patients with sepsis is not clear. The relationship between BNP and both left ventricular ejection fraction and left-sided filling pressures is weak, and data on the prognostic impact of high BNP levels in patients with sepsis are conflicting.
Nevertheless, this review highlights the potential benefits of BNP in the recognition and management of heart failure, and defines the gray zones of BNP levels; it also identifies conditions influencing BNP levels in relation to a certain heart failure and describes conditions of no cardiac origin with increased BNP.
脑钠肽（BNP）的心脏分泌量会随着充血性心力衰竭（CHF）的进展而增加。近期，血浆BNP检测已成为一种用于CHF诊断和预后评估的实用且具成本效益的生物标志物。
BNP检测对于评估急性呼吸困难患者很有用，因为低水平的BNP有助于在基层医疗环境中排除CHF，并减少超声心动图检查的需求。同样，BNP水平对于识别有急性呼吸困难且有慢性阻塞性肺疾病病史的患者的心力衰竭特别有用。
然而，尽管BNP作为CHF生物标志物的临床应用正在增加，但BNP在CHF中的特异性不强，这表明除了单纯的心室扩张之外，其他机制也会刺激BNP释放。重症监护病房中的多种疾病，除了CHF之外，都会导致BNP水平升高，包括心血管疾病状态，如缺血、心律失常、心脏肥大和冠状动脉内皮功能障碍，以及非心脏源性疾病，如败血症、感染性休克和急性呼吸窘迫综合征。此外，BNP升高对败血症患者的影响尚不清楚。BNP与左心室射血分数和左侧充盈压之间的关系较弱，关于高BNP水平对败血症患者预后影响的数据也相互矛盾。
尽管如此，本综述强调了BNP在心力衰竭识别和管理中的潜在益处，并界定了BNP水平的灰色区域；它还确定了与特定心力衰竭相关的影响BNP水平的情况，并描述了BNP升高的非心脏源性情况。
