[利钠肽在社区医学心力衰竭早期诊断中的地位]

[Place of natriuretic peptides in the early diagnosis of heart failure in community medicine].

作者信息

Galinier Michel, Cariou Eve, Lairez Olivier, Fournier Pauline, Delmas Clément, Biendel-Picquet Caroline, Roncalli Jérôme

机构信息

CHU Toulouse-Rangueil, fédération des services de cardiologie, 31059 Toulouse, France; UMR UT3 CNRS 5288 Evolutionary Medicine, Obesity and heart failure: molecular and clinical investigations, INI-CRCT F-CRIN, GREAT Networks, 31059 Toulouse, France; Université Paul Sabatier-Toulouse III, faculté de médecine, 31062 Toulouse, France.

CHU Toulouse-Rangueil, fédération des services de cardiologie, 31059 Toulouse, France.

出版信息

Presse Med. 2018 Sep;47(9):804-810. doi: 10.1016/j.lpm.2018.09.003. Epub 2018 Oct 4.

DOI:10.1016/j.lpm.2018.09.003

PMID:30293850

Abstract

Diagnosis of heart failure is too late. Symptoms of heart failure are non-specific. Brain natriuretic peptides allow the diagnosis of heart failure in pauci-symptomatic patients, with a threshold of 35pg/mL for BNP and 125pg/mL for NT-proBNP. Left ventricular dysfunction, either diastolic or systolic, remains asymptomatic for a long time. In diabetic and/or hypertensive patients, natriuretic peptides, can be used to diagnose asymptomatic left ventricular dysfunction, with a threshold of 125pg/mL NT-proBNP. Treatment blocking the renin-angiotensin-aldosterone system in diabetic patients with NT-proBNP levels of 125pg/mL can prevent onset of heart failure. Screening of subjects at risk of heart failure (diabetics, hypertensive) is possible thanks to natriuretic peptides.

摘要

心力衰竭的诊断为时已晚。心力衰竭的症状不具有特异性。脑钠肽可用于诊断症状轻微的患者是否患有心力衰竭，BNP的阈值为35pg/mL，NT-proBNP的阈值为125pg/mL。左心室功能障碍，无论是舒张功能障碍还是收缩功能障碍，在很长一段时间内都没有症状。在糖尿病和/或高血压患者中，利钠肽可用于诊断无症状的左心室功能障碍，NT-proBNP的阈值为125pg/mL。对于NT-proBNP水平为125pg/mL的糖尿病患者，阻断肾素-血管紧张素-醛固酮系统的治疗可预防心力衰竭的发生。借助利钠肽可以对有心力衰竭风险的人群（糖尿病患者、高血压患者）进行筛查。