Fu Shihui, Ping Ping, Zhu Qiwei, Ye Ping, Luo Leiming
Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China.
Department of Cardiology and Hainan Branch, Chinese People's Liberation Army General Hospital, Beijing, China.
Front Physiol. 2018 Jun 5;9:692. doi: 10.3389/fphys.2018.00692. eCollection 2018.
Heart failure (HF) is a primary cause of morbidity and mortality worldwide. As the most widely studied and commonly applied natriuretic peptide (NP), B-type natriuretic peptide (BNP) has the effects of diuresis, natriuresis, vasodilation, anti-hypertrophy, and anti-fibrosis and it inhibits the renin-angiotensin-aldosterone and sympathetic nervous systems to maintain cardiorenal homeostasis and counteract the effects of HF. Both BNP and N-terminal pro B-type natriuretic peptide (NT-proBNP) are applied as diagnostic, managing, and prognostic tools for HF. However, due to the complexity of BNP system, the diversity of BNP forms and the heterogeneity of HF status, there are biochemical, analytical, and clinical issues on BNP not fully understood. Current immunoassays cross-react to varying degrees with pro B-type natriuretic peptide (proBNP), NT-proBNP and various BNP forms and cannot effectively differentiate between these forms. Moreover, current immunoassays have different results and may not accurately reflect cardiac function. It is essential to design assays that can recognize specific forms of BNP, NT-proBNP, and proBNP to obtain more clinical information. Not only the processing of proBNP (corin/furin) and BNP (neprilysin), but also the effects of glycosylation on proBNP processing and BNP assays, should be targeted in future studies to enhance their diagnostic, therapeutic, and prognostic values.
心力衰竭（HF）是全球发病和死亡的主要原因。作为研究最广泛且应用最普遍的利钠肽（NP），B型利钠肽（BNP）具有利尿、利钠、血管舒张、抗肥大和抗纤维化作用，它抑制肾素-血管紧张素-醛固酮系统和交感神经系统以维持心肾稳态并抵消HF的影响。BNP和N末端前B型利钠肽原（NT-proBNP）均被用作HF的诊断、管理和预后工具。然而，由于BNP系统的复杂性、BNP形式的多样性以及HF状态的异质性，关于BNP仍存在一些尚未完全理解的生化、分析和临床问题。当前的免疫测定法与前B型利钠肽原（proBNP）、NT-proBNP及各种BNP形式存在不同程度的交叉反应，无法有效区分这些形式。此外，当前的免疫测定法结果各异，可能无法准确反映心脏功能。设计能够识别BNP、NT-proBNP和proBNP特定形式的测定法以获取更多临床信息至关重要。未来研究不仅应针对proBNP（corin/弗林蛋白酶）和BNP（中性内肽酶）的加工过程，还应关注糖基化对proBNP加工和BNP测定的影响，以提高它们的诊断、治疗和预后价值。
