Michigan State University, College of Osteopathic Medicine, East Lansing, MI, USA.
Michigan State University, College of Osteopathic Medicine (Macomb University College-MUC, and Detroit Medical Center-DMC), Department of Pharmacology and Toxicology, Clinton Township, MI, USA.
Yale J Biol Med. 2023 Mar 31;96(1):137-149. doi: 10.59249/NCST6937. eCollection 2023 Mar.
Natriuretic peptides (NPs) encompass a family of structurally related hormone/paracrine factors acting through the natriuretic peptide system regulating cell proliferation, vessel tone, inflammatory processes, neurohumoral pathways, fluids, and electrolyte balance. The three most studied peptides are atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and C-Type natriuretic peptide (CNP). ANP and BNP are the most relevant NPs as biomarkers for the diagnosis and prognosis of heart failure and underlying cardiovascular diseases, such as cardiac valvular dysfunction, hypertension, coronary artery disease, myocardial infarction, persistent arrhythmias, and cardiomyopathies. Cardiac dysfunctions related to cardiomyocytes stretching in the atria and ventricles are primary elicitors of ANP and BNP release, respectively. ANP and BNP would serve as biomarkers for differentiating cardiac versus noncardiac causes of dyspnea and as a tool for measuring the prognosis of patients with heart failure; nevertheless, BNP has been shown with the highest predictive value, particularly related to pulmonary disorders. Plasma BNP has been reported to help differentiate cardiac from pulmonary etiologies of dyspnea in adults and neonates. Studies have shown that COVID-19 infection also increases serum levels of N-terminal pro b-type natriuretic peptide (NT-proBNP) and BNP. This narrative review assesses aspects of ANP and BNP on their physiology, and predictive values as biomarkers. We present an overview of the NPs' synthesis, structure, storage, and release, as well as receptors and physiological roles. Following, considerations focus on ANP versus BNP, comparing their relevance in settings and diseases associated with respiratory dysfunctions. Finally, we compiled data from guidelines for using BNP as a biomarker in dyspneic patients with cardiac dysfunction, including its considerations in COVID-19.
利钠肽（NPs）包括一组结构相关的激素/旁分泌因子，通过利钠肽系统发挥作用，调节细胞增殖、血管张力、炎症过程、神经激素途径、液体和电解质平衡。研究最多的三种肽是心钠肽（ANP）、脑利钠肽（BNP）和 C 型利钠肽（CNP）。ANP 和 BNP 是心力衰竭和潜在心血管疾病诊断和预后的最相关标志物，如心脏瓣膜功能障碍、高血压、冠状动脉疾病、心肌梗死、持续性心律失常和心肌病。与心房和心室心肌细胞拉伸相关的心脏功能障碍是 ANP 和 BNP 释放的主要激发因素。ANP 和 BNP 可作为区分呼吸困难的心脏和非心脏原因的生物标志物，并可用于测量心力衰竭患者的预后；然而，BNP 具有最高的预测价值，特别是与肺部疾病相关。已有研究报告称，血浆 BNP 有助于区分成人和新生儿呼吸困难的心脏和肺部病因。研究表明，COVID-19 感染也会增加 N 端脑利钠肽前体（NT-proBNP）和 BNP 的血清水平。本综述评估了 ANP 和 BNP 在生理学和作为生物标志物的预测价值方面的相关内容。我们概述了 NPs 的合成、结构、储存和释放，以及受体和生理作用。接下来，重点关注 ANP 与 BNP 的比较，比较它们在与呼吸功能障碍相关的疾病和环境中的相关性。最后，我们汇总了使用 BNP 作为心力衰竭呼吸困难患者生物标志物的指南中的数据，包括在 COVID-19 中的考虑因素。
