BNPproBNP與心血管疾病.ppt

1、,BNP與心血管疾病,2,總 結(jié),BNP的臨床應(yīng)用,3,利鈉肽家族,利鈉肽家族是主要由心血管系統(tǒng)分泌的一組肽類的總稱。在人體最多的是以下三種： 心鈉肽（atrial natriuretic peptide, ANP） 腦 利 鈉 肽 ( brain natriuretic peptide or B-type natriuretic peptide,BNP) C 型 利 鈉 肽（C-type natriuretic peptide,CNP）,4,心室容量、壓力負(fù)荷增加 室壁張力的改變 BNP分泌 （炎癥、心肌缺血等） 心室肌細(xì)胞分泌 32個(gè)氨基酸組成的多肽,B型腦鈉肽,Prepro- BNP(1

2、34 aa),Pro- BNP (108 aa),信號(hào)肽 (26 aa),BNP 77-108,NT-proBNP 1-76,無(wú)活性,有活性 (32 aa),心肌細(xì)胞,血漿,裂解,77,108,BNP and NT-pro BNP,NT- pro BNP 無(wú)生理活性 血液半衰期較長(zhǎng)(120min) 血漿和血清穩(wěn)定性好 清除：腎臟 腎病病人水平相對(duì)高 BNP的1-10倍,BNP 有生理作用 血液半衰期短(22min) 血漿和血清穩(wěn)定性差 清除：C受體、腎臟及中性內(nèi)切酶 受腎功能影響小,BNP and NT-pro BNP,抑制腎素血管緊張素醛固酮的分泌， 提高腎小球?yàn)V過(guò)率，利鈉、利尿 舒張血管平

3、滑肌、擴(kuò)張動(dòng)靜脈 降低血壓、心臟 前負(fù)荷 抑制心肌纖維化、血管平滑肌增生、抗冠脈痙攣 阻斷交感神經(jīng)系統(tǒng) 、抑制腎上腺皮質(zhì)激素的釋放,心血管系統(tǒng)保護(hù)作用,BNP的生理作用,8,9,BNP主要由心室分泌，當(dāng)心室壓力增高時(shí)，促使其分泌，是心室障礙的敏感指標(biāo),10,BNP用于臨床診斷， 評(píng)估疾病的嚴(yán)重程度,BNP的臨床應(yīng)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 =左心房擴(kuò)大； LVH =左心室肥厚； 鈉尿肽水平升

5、高： BNP35 pg/ml和/或NT-proBNP125 pg/ml,心力衰竭的定義,14,1、有急性呼吸困難和疑診急性心衰患者均推薦檢測(cè)血漿利鈉肽水平，以幫助鑒別急性心衰和非心臟原因的急性呼吸困難。 NTproBNP300pg/ml、BNP100pg/ml（急性心衰） 2、對(duì)于慢性心衰患者, BNP和NT-pro BNP的檢測(cè)更多地用于排除心衰。 NT-proBNP125pg/ml、BNP35pg/ml（慢性心衰）,15,16,BNP 水平與HF嚴(yán)重性相關(guān),Triage BNP Package Insert , Data on file at Biosite, an IMA company

6、,17,？,BNP 有治療作用 當(dāng)心衰患者 BNP 相當(dāng)高的時(shí)候 為什么起不到治療效果,18,19,BNP用于臨床治療,BNP的臨床應(yīng)用,20,基因重組人腦鈉肽（rh BNP）,結(jié)構(gòu)上完全等同于內(nèi)源性的BNP 在體內(nèi)與血管平滑肌及內(nèi)皮細(xì)胞的鳥苷酸環(huán)化酶受體結(jié)合，激活細(xì)胞內(nèi)第二信使cGMP，使平滑肌松弛，動(dòng)脈和靜脈擴(kuò)張。,作用,1、擴(kuò)張小動(dòng)脈和小靜脈，迅速降低全身動(dòng)脈壓、肺毛細(xì)血管楔壓、右房壓，減輕心臟前后負(fù)荷。 2、在降低收縮壓時(shí)不引起反射性心率加快，能迅速改善血液動(dòng)力學(xué)狀態(tài)及呼吸困難等癥狀。 3、具有明顯的排鈉利尿作用，降低醛固酮和去甲腎上腺素水平，抑制腎素活性和內(nèi)皮素分泌。 4、選擇性的擴(kuò)

7、張血管、利尿排鈉、拮抗神經(jīng)內(nèi)分泌、抗心臟重塑、心肌細(xì)胞保護(hù)。,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,重組人腦利鈉肽既能擴(kuò)張血管，又可以促進(jìn)鈉的排泄，有利尿作用，還可抑制腎素血管緊張素醛固酮系統(tǒng)(RAAS) 和交感神經(jīng)系統(tǒng)，rhBNP可用于急性失代償心力衰竭等心血管疾病的治療,26,BNP用于預(yù)后分析,BNP的臨床應(yīng)用,27,BNP 和 NT-proBNP 的水平是與心衰嚴(yán)重程度相關(guān)，治療中如 BNP 和 NT-proBNP變化則反映病情的變化

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用于心血管疾病的風(fēng)險(xiǎn)預(yù)測(cè),BNP的臨床應(yīng)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