Nayer Jamshed, Aggarwal Praveen, Galwankar Sagar
Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.
Department of Emergency Medicine, University of South Florida and Winter Haven Hospital, Florida, USA.
Int J Crit Illn Inj Sci. 2014 Jul;4(3):209-15. doi: 10.4103/2229-5151.141406.
Rapid and accurate diagnosis of a patient with an acute disease is a challenge for emergency physicians. Natriuretic peptides have emerged as important tools for diagnosis, risk stratification and therapeutic decision making for some categories of emergency patients. Brain natriuretic peptide (BNP) is a member of a four natriuretic peptides family that shares a common 17-peptide ring structure. Atrial natriuretic peptide, C-natriuretic peptide (CNP), and D-type natriuretic peptide are the other natriuretic peptide, which share the same common 17-peptide ring structure. The N-terminal fragment of pro-BNP, N-terminal pro-brain natriuretic peptide (NT-proBNP) consists of 76 amino acids, which is biologically inert, while the active component BNP contains 32 amino acids. BNP and NT-proBNP are secreted in the plasma in equimolar quantities and are frequently used in the diagnosis of congestive heart failure, and distinguishing between patients with dyspnea of cardiac or pulmonary origin. Both natriuretic peptides have also been evaluated for use in the assessment and management of several other conditions including sepsis, cirrhosis of liver and renal failure. However, one should remember that the values of natriuretic peptides are affected by age and weight of the patients, and presence of several comorbidities such as chronic renal failure, type 2 diabetes mellitus, anemia, pulmonary embolism, and acute coronary syndrome. Values of these peptides also vary depending on the type of test used. The performance characteristics of these natriuretic peptides vary depending on the patients on whom they are used. Therefore determination of reference values for these peptides represents a challenge.
对急症患者进行快速准确的诊断是急诊医生面临的一项挑战。利钠肽已成为诊断、风险分层以及某些类别的急诊患者治疗决策的重要工具。脑利钠肽（BNP）是一个由四种利钠肽组成的家族成员，它们具有共同的17肽环结构。心房利钠肽、C型利钠肽（CNP）和D型利钠肽是其他利钠肽，它们具有相同的17肽环结构。前脑利钠肽的N末端片段，即N末端前脑利钠肽（NT-proBNP）由76个氨基酸组成，无生物学活性，而活性成分BNP含有32个氨基酸。BNP和NT-proBNP以等摩尔量分泌到血浆中，常用于诊断充血性心力衰竭，并区分心源性或肺源性呼吸困难患者。这两种利钠肽也被评估用于其他几种疾病的评估和管理，包括脓毒症、肝硬化和肾衰竭。然而，应该记住，利钠肽的值受患者年龄、体重以及几种合并症的影响，如慢性肾衰竭、2型糖尿病、贫血、肺栓塞和急性冠状动脉综合征。这些肽的值也因所用检测类型而异。这些利钠肽的性能特征因使用它们的患者不同而有所差异。因此，确定这些肽的参考值是一项挑战。
