BNPproBNP与心血管疾病.ppt

1、,BNP与心血管疾病,2,总 结,BNP的临床应用,3,利钠肽家族,利钠肽家族是主要由心血管系统分泌的一组肽类的总称。在人体最多的是以下三种： 心钠肽（atrial natriuretic peptide, ANP） 脑 利 钠 肽 ( brain natriuretic peptide or B-type natriuretic peptide,BNP) C 型 利 钠 肽（C-type natriuretic peptide,CNP）,4,心室容量、压力负荷增加 室壁张力的改变 BNP分泌 （炎症、心肌缺血等） 心室肌细胞分泌 32个氨基酸组成的多肽,B型脑钠肽,Prepro- BNP(1

2、34 aa),Pro- BNP (108 aa),信号肽 (26 aa),BNP 77-108,NT-proBNP 1-76,无活性,有活性 (32 aa),心肌细胞,血浆,裂解,77,108,BNP and NT-pro BNP,NT- pro BNP 无生理活性 血液半衰期较长(120min) 血浆和血清稳定性好 清除：肾脏 肾病病人水平相对高 BNP的1-10倍,BNP 有生理作用 血液半衰期短(22min) 血浆和血清稳定性差 清除：C受体、肾脏及中性内切酶 受肾功能影响小,BNP and NT-pro BNP,抑制肾素血管紧张素醛固酮的分泌， 提高肾小球滤过率，利钠、利尿 舒张血管平

3、滑肌、扩张动静脉 降低血压、心脏 前负荷 抑制心肌纤维化、血管平滑肌增生、抗冠脉痉挛 阻断交感神经系统 、抑制肾上腺皮质激素的释放,心血管系统保护作用,BNP的生理作用,8,9,BNP主要由心室分泌，当心室压力增高时，促使其分泌，是心室障碍的敏感指标,10,BNP用于临床诊断， 评估疾病的严重程度,BNP的临床应用,11,We conducted a prospective study of 1586 patients who came to the emergency department with acute dyspnea and whose B-type natriuretic pep

4、tide was measured with a bedside assay.,12,Conclusions ： Used in conjunction with other clinical information, rapid measurement of B-type natriuretic peptide is useful in establishing or excluding the diagnosis of congestive heart failure in patients with acute dyspnea,LAE =左心房扩大； LVH =左心室肥厚； 钠尿肽水平升

5、高： BNP35 pg/ml和/或NT-proBNP125 pg/ml,心力衰竭的定义,14,1、有急性呼吸困难和疑诊急性心衰患者均推荐检测血浆利钠肽水平，以帮助鉴别急性心衰和非心脏原因的急性呼吸困难。 NTproBNP300pg/ml、BNP100pg/ml（急性心衰） 2、对于慢性心衰患者, BNP和NT-pro BNP的检测更多地用于排除心衰。 NT-proBNP125pg/ml、BNP35pg/ml（慢性心衰）,15,16,BNP 水平与HF严重性相关,Triage BNP Package Insert , Data on file at Biosite, an IMA company

6、,17,？,BNP 有治疗作用 当心衰患者 BNP 相当高的时候 为什么起不到治疗效果,18,19,BNP用于临床治疗,BNP的临床应用,20,基因重组人脑钠肽（rh BNP）,结构上完全等同于内源性的BNP 在体内与血管平滑肌及内皮细胞的鸟苷酸环化酶受体结合，激活细胞内第二信使cGMP，使平滑肌松弛，动脉和静脉扩张。,作用,1、扩张小动脉和小静脉，迅速降低全身动脉压、肺毛细血管楔压、右房压，减轻心脏前后负荷。 2、在降低收缩压时不引起反射性心率加快，能迅速改善血液动力学状态及呼吸困难等症状。 3、具有明显的排钠利尿作用，降低醛固酮和去甲肾上腺素水平，抑制肾素活性和内皮素分泌。 4、选择性的扩

7、张血管、利尿排钠、拮抗神经内分泌、抗心脏重塑、心肌细胞保护。,21,22,CONCLUSIONS ：The rapid and sustained benecial hemodynamic effects of nesiritide observed in this study support its use as a rst-line IV therapy for patients with symptomatic decompensated HF,23,Conclusions：When added to standard care in patients hospitalized with

8、 acutely decompensated CHF, nesiritide improves hemodynamic function and some self-reported symptoms more effectively than intravenous nitroglycerin or placebo.,24,Conclusions: Early intravenous rh BNP administration after PCI significantly lowered the serum concentrations of c TnT and NT-pro BNP, i

9、ncreased LVEDd, SV and LVEF, and reduced MACEs, including cardiac death, in patients with acute anterior MI undergoing PCI.,25,重组人脑利钠肽既能扩张血管，又可以促进钠的排泄，有利尿作用，还可抑制肾素血管紧张素醛固酮系统(RAAS) 和交感神经系统，rhBNP可用于急性失代偿心力衰竭等心血管疾病的治疗,26,BNP用于预后分析,BNP的临床应用,27,BNP 和 NT-proBNP 的水平是与心衰严重程度相关，治疗中如 BNP 和 NT-proBNP变化则反映病情的变化

10、,28,CONCLUSIONS： In patients admitted with decompensated CHF, changes in BNP levels during treatment arestrong predictors for mortality and early readmission. The results suggest that BNP levelsmight be used successfully to guide treatment of patients admitted for decompensated CHF,29,conclusions: I

11、n HF patients, therapy-induced reduction of BNP or NT-pro BNP levels is associated with reduced risk of hospitalization for HF worsening,30,BNP用于心血管疾病的风险预测,BNP的临床应用,31,32,33,34,conclusion ：Among patients at risk of heart failure, BNP-based screening and collaborative care reduced the combined rates

12、of LV systolic dysfunction, diastolic dysfunction, and heart failure.,35,Conclusion: Combining ECG changes and pro-BNP improves risk prediction in persons without known heart disease.,36,Conclusions: In spite of moderate heterogeneity across the enrolled studies, our meta-analysis suggests that increased NT-pro BNP levels are associated with greater risk of new-onset AF with ACS, which indicates that NT-pro BNP levels may be a