Department of Internal Medicine, UOS Cardiology, S. Maria alle Scotte Hospital Siena, University of Siena, Italy.
Clin Chim Acta. 2012 Nov 20;413(23-24):1832-8. doi: 10.1016/j.cca.2012.07.010. Epub 2012 Jul 20.
In recent years there has been growing interest in the development of new diagnostic tools and particularly in laboratory tests for the identification of heart failure (HF) patients. Because of the rise in HF occurrence, it is necessary to use simple and reliable method to recognize those patients at risk before the onset of the clinical symptoms. To date HF diagnosis remains difficult: its symptoms and signs are often non specific as well as being poor sensitive indicators for HF severity. Throughout the last 10 years published literature has highlighted a boom in the use of biomarkers for HF. Both B-type and N-terminal pro-B-type natriuretic peptides have demonstrated specific role in heart failure diagnosis, as well as risk assessment. A single determination of BNP at any time during the development of chronic heart failure (CHF) provides a clinically useful tool to establish the outcome. Renal dysfunction is often associated with heart failure and predicts adverse clinical outcomes. Many studies have recently suggested the clinical use of serum neutrophil gelatinase-associated lipocalin (NGAL) levels in patients admitted to the hospital for acute HF can be used to estimate the risk of early worsening renal function. This could be potentially applied in clinical practice for early identification of renal dysfunction development in patients with HF. NGAL levels appear also to predict renal dysfunction in patients with chronic HF and preserved renal function. For all these reasons, BNP and NGAL are two emerging tools useful for diagnosis and prognosis in HF. The combination of two laboratory biomarkers could potentially identify patients with more elevated risks of both cardiac hemodynamic impairment and kidney dysfunction.
近年来，人们对开发新的诊断工具越来越感兴趣，特别是对用于识别心力衰竭 (HF) 患者的实验室检测方法。由于 HF 发生率的上升，有必要在临床症状出现之前，使用简单可靠的方法识别那些有风险的患者。迄今为止，HF 的诊断仍然很困难：其症状和体征通常不具有特异性，并且对 HF 严重程度的敏感性指标较差。在过去的 10 年中，发表的文献强调了 HF 生物标志物的使用呈爆发式增长。B 型利钠肽和 N 末端 pro-B 型利钠肽在 HF 诊断以及风险评估中均具有特定作用。在慢性心力衰竭 (CHF) 发展过程中的任何时间点单次测定 BNP 都为确定结局提供了一种具有临床应用价值的工具。肾功能不全通常与心力衰竭相关，并预测不良的临床结局。最近的许多研究表明，在因急性 HF 住院的患者中，血清中性粒细胞明胶酶相关脂质运载蛋白 (NGAL) 水平的临床应用可用于估计早期肾功能恶化的风险。这在临床实践中可能有助于早期识别 HF 患者肾功能的发展。NGAL 水平似乎也可预测慢性 HF 合并肾功能正常患者的肾功能不全。基于所有这些原因，BNP 和 NGAL 是 HF 诊断和预后的两种新兴工具。两种实验室生物标志物的组合可能可以识别出具有更高的心脏血流动力学障碍和肾功能障碍风险的患者。
