Maisel Alan S, Daniels Lori B, Anand Inder S, McCullough Peter A, Chow Sheryl L
a Coronary Care Unit and Heart Failure Program , Veterans Affairs San Diego Healthcare System , San Diego , CA , USA.
b Sulpizio Cardiovascular Center , University of California , San Diego, La Jolla , CA , USA.
Postgrad Med. 2018 Apr;130(3):299-307. doi: 10.1080/00325481.2018.1440873. Epub 2018 Mar 29.
Levels of natriuretic peptides (NPs), such as B-type NP (BNP) and the N-terminal fragment of its prohormone (NT-proBNP), are well-established biomarkers for patients with heart failure (HF). Although these biomarkers have consistently demonstrated their value in the diagnosis and prognostication of HF, their ability to help clinicians in making treatment decisions remains debated. Moreover, some new HF drugs can affect concentrations of NPs, such as the prevention of BNP degradation by angiotensin receptor/neprilysin inhibitors (ARNIs), and may present a challenge in the interpretation of levels of BNP. Use of NT-proBNP measurement has been suggested in the context of ARNI therapy because its concentrations are not affected by neprilysin inhibition. As biomarkers are reconsidered in the context of ARNI therapy, cutoff levels and the effects of individual patient characteristics, such as renal function and age, on biomarker concentrations should be reassessed.
利钠肽（NP）水平，如B型利钠肽（BNP）及其前体激素的N端片段（NT-proBNP），是心力衰竭（HF）患者公认的生物标志物。尽管这些生物标志物在HF的诊断和预后评估中一直显示出其价值，但它们在帮助临床医生做出治疗决策方面的能力仍存在争议。此外，一些新型HF药物会影响NP浓度，如血管紧张素受体/中性肽链内切酶抑制剂（ARNI）可防止BNP降解，这可能对BNP水平的解读带来挑战。由于ARNI治疗时NT-proBNP浓度不受中性肽链内切酶抑制的影响，因此有人建议在ARNI治疗中使用NT-proBNP检测。随着在ARNI治疗背景下对生物标志物的重新审视，应重新评估临界值水平以及个体患者特征（如肾功能和年龄）对生物标志物浓度的影响。
