Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Wort's Causeway, Cambridge, England CB1 8RN.
Circulation. 2009 Dec 1;120(22):2177-87. doi: 10.1161/CIRCULATIONAHA.109.884866. Epub 2009 Nov 16.
Measurement of B-type natriuretic peptide (BNP) concentration or its precursor (N-terminal fragment [NT-proBNP]) is recommended in patients with symptoms of left ventricular dysfunction and in other settings, but the relevance of these peptides to cardiovascular disease (CVD) in general populations or in patients with stable vascular disease is uncertain.
Data were collated from 40 long-term prospective studies involving a total of 87 474 participants and 10 625 incident CVD outcomes. In a comparison of individuals in the top third with those in the bottom third of baseline values of natriuretic peptides, the combined risk ratio (RR), adjusted for several conventional risk factors, was 2.82 (95% confidence interval [CI], 2.40 to 3.33) for CVD. Analysis of the 6 studies with at least 250 CVD outcomes (which should be less prone to selective reporting than are smaller studies) yielded an adjusted RR of 1.94 (95% CI, 1.57 to 2.39). RRs were broadly similar with BNP or NT-proBNP (RR, 2.89 [95% CI, 1.91 to 4.38] and 2.82 [95% CI, 2.35 to 3.38], respectively) and by different baseline vascular risk (RR, 2.68 [95% CI, 2.07 to 3.47] in approximately general populations; RR, 3.35 [95% CI, 2.38 to 4.72] in people with elevated vascular risk factors; RR, 2.60 [95% CI, 1.99 to 3.38] in patients with stable CVD). Assay of BNP or NT-proBNP in addition to measurement of conventional CVD risk factors yielded generally modest improvements in risk discrimination.
Available prospective studies indicate strong associations between circulating concentration of natriuretic peptides and CVD risk under a range of different circumstances. Further investigation is warranted, particularly in large general population studies, to clarify any predictive utility of these markers and to better control for publication bias.
B 型利钠肽（BNP）浓度或其前体（N 端片段[NT-proBNP]）的测量推荐用于有左心室功能障碍症状的患者和其他情况下，但这些肽与一般人群或稳定血管疾病患者的心血管疾病（CVD）的相关性尚不确定。
从总共 87474 名参与者和 10625 例 CVD 事件的 40 项长期前瞻性研究中收集了数据。在比较基线值时处于前三分位的个体与处于后三分位的个体的情况下，联合风险比（RR），调整了几个常规危险因素后，CVD 的 RR 为 2.82（95%置信区间[CI]，2.40 至 3.33）。对至少有 250 例 CVD 结局的 6 项研究（其应该比较小的研究更少受到选择性报告的影响）进行分析，调整后的 RR 为 1.94（95%CI，1.57 至 2.39）。BNP 或 NT-proBNP 的 RR 大致相似（RR，2.89 [95%CI，1.91 至 4.38]和 2.82 [95%CI，2.35 至 3.38]），基线血管风险不同（RR，约一般人群中为 2.68 [95%CI，2.07 至 3.47]；血管危险因素升高的人群中为 3.35 [95%CI，2.38 至 4.72]；稳定 CVD 患者中为 2.60 [95%CI，1.99 至 3.38]）。除了测量传统 CVD 危险因素外，BNP 或 NT-proBNP 的测定通常可以适度提高风险区分度。
现有前瞻性研究表明，在多种不同情况下，循环利钠肽浓度与 CVD 风险之间存在强烈关联。需要进一步研究，特别是在大型一般人群研究中，以阐明这些标志物的预测效用，并更好地控制发表偏倚。
