Rubattu Speranza, Triposkiadis Filippos
Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy.
Heart Fail Rev. 2017 May;22(3):279-288. doi: 10.1007/s10741-017-9605-8.
The natriuretic peptide (NP) system, which includes atrial natriuretic peptide, B-type natriuretic peptide, and C-type natriuretic peptide, has an important role in cardiovascular homeostasis, promoting a number of physiological effects including diuresis, vasodilation, and inhibition of the renin-angiotensin-aldosterone system. Heart failure (HF) is associated with defects in NP processing and synthesis, and there is a strong relationship between NP levels and disease state. NPs are useful biomarkers in HF, and their use in diagnosis and evaluation of prognosis is well established, particularly in patients with HF with reduced ejection fraction (HFrEF). There has also been interest in their use to guide disease management and therapeutic decision making. An understanding of NPs in HF has also resulted in interest in synthetic NPs for the treatment of HF and in treatments that target neprilysin, a protease that degrades NPs. A novel drug, the angiotensin receptor neprilysin inhibitor sacubitril/valsartan (LCZ696), which simultaneously inhibits neprilysin and blocks the angiotensin II type I receptor, was shown to have a favorable efficacy and safety profile in patients with HFrEF and has been approved for use in such patients in Europe and the USA. In light of the development of treatments that target neprilysin and of recent data in relation to synthetic NPs, it is timely to review the current understanding of the role of NPs in HF and their use in diagnosis, evaluating prognosis and guiding treatment, as well as their place in HF therapy.
利钠肽（NP）系统包括心房利钠肽、B型利钠肽和C型利钠肽，在心血管稳态中发挥重要作用，可促进多种生理效应，包括利尿、血管舒张以及抑制肾素-血管紧张素-醛固酮系统。心力衰竭（HF）与NP加工和合成缺陷有关，NP水平与疾病状态之间存在密切关系。NP是HF中有用的生物标志物，其在诊断和预后评估中的应用已得到充分确立，尤其是在射血分数降低的心力衰竭（HFrEF）患者中。人们也对其用于指导疾病管理和治疗决策感兴趣。对HF中NP的了解还引发了对用于治疗HF的合成NP以及针对中性肽链内切酶（一种降解NP的蛋白酶）的治疗方法的兴趣。一种新型药物，血管紧张素受体脑啡肽酶抑制剂沙库巴曲/缬沙坦（LCZ696），可同时抑制脑啡肽酶并阻断血管紧张素II 1型受体，在HFrEF患者中显示出良好的疗效和安全性，已在欧洲和美国获批用于此类患者。鉴于针对脑啡肽酶的治疗方法的发展以及与合成NP相关的最新数据，及时回顾目前对NP在HF中的作用及其在诊断、评估预后和指导治疗中的应用，以及它们在HF治疗中的地位是很有必要的。
