脑钠肽bnp与心力衰竭研究进展幻灯.pptx
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1、第1页/共39页Outcomes in Patients Hospitalized With HFJong P et al.Arch Intern Med.2002;162:1689025507510020%50%30days6moHospital Readmissions025507510012%50%30days12moMortality33%5yrMedian hospital LOS:6 daysAnnual mortality rate-NYHA class III HF-12%COPERNICUS DATANYHA class II HF-7%SCD-HeFT DATA第2页/共3
2、9页在美国,因心衰入院人数=每年一百万。总费用=560亿美元住院治疗花费中,70-75%直接用于患者护理心衰住院治疗后再入院=6个月内达45%心衰的治疗负担心衰的治疗负担第3页/共39页Increased morbidityand mortalityDiuretic therapyImpaired renalfunctionDecreased renal perfusionDiuretic resistanceDiminishedblood flowNeurohormonalactivationPotential Deleterious Effects of Diuretics and Car
3、diorenal Syndrome of HFNeurohormonalactivationVasoconstrictionCongestionPathologicremodeling第4页/共39页HemodynamicHemodynamic(balanced vasodilation)(balanced vasodilation)llveinsveinsllarteriesarteriesllcoronary arteriescoronary arteriesB-Type Natriuretic Peptide(BNP)NeurohumoralNeurohumoral aldosteron
4、e aldosterone endothelin endothelin norepinephrine norepinephrineRenalRenal diuresis diuresis natriuresis natriuresis GFR GFRDRIMKRGSSSSGLGFCCSSGSGQVMKVLRRHKPSCardiac Cardiac lllusitropiclusitropicllantifibroticantifibroticllanti-remodelinganti-remodeling第5页/共39页Jamieson and Palade.J Cell Biol.1964;
5、23:151.Natriuretic Peptides:The Heart as a Secretory OrganAtrial stretch receptors link blood volume to renal functionDistension of a balloon catheter in atria of dogs resulted in diuresisHenry et al(1956)Secretory granules discovered in the atriaKisch(1956)Jamieson and Palade(1964)BNP was character
6、ized by amino acid sequence and DNA clones Sudoh et al(1988)Seilhamer et al(1989)第6页/共39页Natriuretic Peptides第7页/共39页Adapted from Burnett JC.J Hypertens.2000;17(Suppl 1):S37-S43.ANP=Atrial Natriuretic PeptideBNP=B-type Natriuretic PeptideCNP=C-type Natriuretic PeptidePeptidePrimary OriginStimulus of
7、 ReleaseANPCardiac atriaAtrial distensionBNPVentricular myocardium Ventricular overloadCNPEndothelium Endothelial stressNatriuretic Peptides:Origin and Stimulus of Release第8页/共39页H2NH2NCOOHCOOHCOOHpro-BNP(aa1-aa108)CleavageBNP(aa77-aa108)NT-proBNP(aa1-aa76)HPLGSPGSASYTLRAPRSPKMVQGSGCFCRKMDRISSSSGLCC
8、KVLRRHHPLGSPGSASYTLR APRSPKMVQGSGCFCRKMDRISSSSGLCCKVLRRHH2N110707680901001081107076MyocardMyocardBloodBloodpre-proBNP 1-134(134 Aa)Signal peptide(26 Aa)第9页/共39页28171463kDa Rec.A B C D E blank Rec.Clinical BNP Results pg/mL:A BCDEMaisel3920 3720 4010 2090 127in-house Triage 1140 1440 1260 1570 584在心衰
9、患者中BNP主要的形式是proBNPproBNP BNP5 CHF patients:Liang,Maisel et al.,JACC 2007第10页/共39页All55-6465-7475+AgeAll non-CHFNon-CHF MaleNon-CHF FemaleBNP Levels in Non-CHF PatientsBNP(pg/mL)050100(n=478)第11页/共39页ADHFADHF中的中的BNPBNP水平和院内死亡率水平和院内死亡率 BNP水平的分布(pg/mL)在初期评估中,77,467例患者中有 48,629 例(63%)作了BNP评估.在ADHERE项目中仅
10、 3.3%的患者 初始 BNP水平 100 pg/mLFonarow et al,JACC 2007 in press第12页/共39页Baseline BNP and Mortality in HF:Val-HeFT Study1.00.80.60.50024123648SurvivalMonthQ1 238P0.0001RR 95%CI1.01.47(1.15-1.89)2.27(1.80-2.86)3.95 3.18-4.92)第13页/共39页BNP Levels Independently Predict Mortality in Patients with ESRD on Hemo
11、dialysis246 patients on hemodialysis without clinical CHF diagnosisJ Am Soc Nephr.2001;12:1508-1515.7.14012345678Mortality ORBNP tertile 1BNP tertile 2BNP tertile 3Mortality OR 7.14(95%CI 2.83-18.0)P0.000013.201.00第14页/共39页BNP Predicts Sudden Death in Patients with Chronic Heart Failure452 pts with
12、HF,LVEF 13 0 pg/mL only multivariate predictor of SD(P=0.0006)Berger.Circulation.2002;105:2392-2397.第15页/共39页连续BNP测定能指导住院治疗吗?Courtesy of Damien Logeart.第16页/共39页住院期间BNP值Logeart D,et al,JACC,18 February 2004,Volume 43,Issue 4 Pages 635-641第17页/共39页BNPBNP在急性充血性心力衰竭在急性充血性心力衰竭 住院治疗和结果评价住院治疗和结果评价05001000
13、150020002500admission follow-up(pg/mL)n=22Endpoints:13 deaths 9 re-admissions(30d)n=50No EndpointsBNP+233 pg/mLBNP-215 pg/mLCheng,Maisel.JACC 2001;37:386-91第18页/共39页入院和出院前BNP值(pg/mL)和住院时间(天)121086420BNP onadmissionBNP ondischargeLength of stay39812348112710377292.26.86.9020040060080010001200BNP1BNP2
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