Department of Internal Medicine and Metabolic Diseases, S Maria alle Scotte Hospital, University of Siena, Siena, Italy.
Intern Emerg Med. 2011 Feb;6(1):63-8. doi: 10.1007/s11739-010-0438-x. Epub 2010 Sep 18.
Tremendous advances have been made in understanding the pathophysiology and treatment of congestive heart failure (CHF). However, diagnosis still remains difficult, even with a comprehensive physical examination. Symptoms such as dyspnea are non-specific and poorly sensitive indicators for early CHF that can be largely undetected. The discovery of natriuretic peptides (BNP) as diagnostic biomarkers has been one of the most critical advances for heart failure diagnosis. Therefore, both B-type and N-terminal pro-B-type have potential role in the diagnosis of heart failure, as well as in prognostic risk assessment. A single determination of BNP at any time during the progression of chronic HF provides a clinically useful tool for risk stratification. The hypothesis that repeated measurements might carry prognostic information beyond a single measure was confirmed in different settings. One of the main interests is given to the values of repeated determinations for monitoring progression of disease, and for the evaluation of the clinical effects of medical therapy. Nevertheless, despite thousands of papers describing their potential utility, current guidelines have not endorsed the highest level of recommendation for their use, in part, because the application in clinical practice is often limited for the absence of well codified cut off. Recently, European guidelines emphasized the role of natriuretic peptides as potential laboratory markers. In the near future, algorithm building will take into consideration clinical and echocardiographic parameters as well as NP measurements, and this may lead to a correct diagnosis and identification of patients at high risk. The purpose of this review is to discuss the clinical approaches and future applications of natriuretic peptides in heart failure and coronary disease.
在理解充血性心力衰竭（CHF）的病理生理学和治疗方面已经取得了巨大进展。然而，即使进行全面的体格检查，诊断仍然很困难。呼吸困难等症状是非特异性的，对早期 CHF 的敏感性较差，很容易被忽视。利钠肽（BNP）作为诊断生物标志物的发现是心力衰竭诊断最关键的进展之一。因此，B 型和 N 末端 pro-B 型都在心力衰竭的诊断以及预后风险评估中具有潜在作用。在慢性 HF 进展过程中的任何时间点单次测定 BNP 都为风险分层提供了一种有用的临床工具。在不同的环境中证实了重复测量可能具有比单次测量更具预后意义的假设。主要关注点之一是重复测定值在监测疾病进展和评估药物治疗的临床效果方面的价值。尽管有成千上万篇论文描述了它们的潜在用途，但当前的指南并未对其使用给予最高级别的推荐，部分原因是由于缺乏良好的编码截止值，因此在临床实践中的应用常常受到限制。最近，欧洲指南强调了利钠肽作为潜在实验室标志物的作用。在不久的将来，算法构建将考虑临床和超声心动图参数以及 NP 测量值，这可能导致正确的诊断和确定高风险患者。本文的目的是讨论利钠肽在心力衰竭和冠心病中的临床应用和未来应用。
