去糖基化提高脑钠肽的诊断及预后价值

<正>目前临床上常以心肌细胞来源的脑钠肽(BNP)以及脑钠肽前体N末端序列(NT-pro BNP)作为急性呼吸困难患者诊断心衰和评估预后的指标。虽然应用广泛,但仍有将近15%的急性呼吸困难患者无法做出心衰诊断。因此,提升这些生物标志物的诊断和预后准确性的改进措施是十分有必要的。     

脑钠肽对老年心衰所致急性呼吸困难的诊断价值

目的探讨快速测定血浆脑钠肽对老年充血性心力衰竭(心衰)所致急性呼吸困难的诊断价值。方法荧光免疫法测定158例以呼吸困难为主诉急诊入院或门诊老年患者血浆脑钠肽浓度,心脏超声和右心漂浮导管法分别测定心脏射血分数(LVEF)和肺毛细血管楔压(PCWP)。结果心衰患者血浆BNP浓度明显高于非心衰患者,BNP对于老年心衰有很强的预测价值。BNP≥100pg/ml诊断心衰的敏感性为96.6%,特异性为91.3%,阳性预测值为93.5%,阴性预测值为95.5%。CHF患者BNP浓度与PCWP呈正相关,与LVEF呈负相关。结论快速测定血浆脑钠肽有助于老年心源性抑或非心源性急性呼吸困难的鉴别。     

老年心力衰竭患者血浆脑钠肽水平变化及意义

目的探讨老年心力衰竭（心衰）患者血浆脑钠肽（BNP）水平变化的意义。方法采用双抗夹心免疫荧光法检测122例老年心衰患者（观察组）和60例健康者（对照组）血浆BNP水平。结果观察组血浆BNP水平显著高于对照组（P〈0．001）,且随心功能级别增加逐渐增加。结论BNP可用于心衰的早期诊断,能客观反映病情。     

关于心力衰竭标志物研究的进展

心力衰竭的过程中伴随着一系列生物学标记物的变化,涉及心肌牵张标志物、心肌纤维化和重构标志物、心肌损伤标志物、炎症因子、神经内分泌等,某些生物标记物,如脑钠肽(BNP)和氨基末端脑钠肽前体(NT-proBNP)在诊断心衰发挥重要作用,但其具有一定的局限性,因此探究其他生物标记物对于心衰的早期识别、危险评估和判断预后有重要意义。     

B型脑钠肽在左室舒张功能不全患者中的诊断价值

目的探讨B型脑钠肽（BNP）在左室舒张功能不全患者中的诊断价值。方法选择我院门诊及住院患者中符合标准的左室舒张功能不全患者36例，另选同期健康体检者28例，分别测定并比较其血浆BNP水平。结果两组研究对象BNP间差异有显著性意义（P〈0．05）。结论血浆左室舒张功能不全患者血浆BNP平均水平高于对照组，BNP升高反映出早期心功能的受损，对心衰的早期诊断，心衰疗效的监测有重要意义。     

肺炎合并心衰患儿脑钠肽检测的临床意义

检测并比较肺炎合并心力衰竭(心衰组)、肺炎患儿(肺炎组)及正常儿童(对照组)的脑钠肽(BNP)水平.结果显示,心衰组BNP水平明显高于肺炎组及对照组,且心衰组心衰期与早期及恢复期之间均有显著差异(P<0.01),心衰早期与恢复期无显著差异;肺炎组与对照组无显著差异.提示BNP可作为早期诊断肺炎合并心衰、判断病情严重程度及转归的指标.     

脑钠肽与内分泌疾病

脑钠肽(BNP)是一种主要由心脏分泌的多肽,近年研究发现其与内分泌疾病联系紧密。BNP治疗糖尿病合并心力衰竭或心肌肥大效果良好,对糖尿病合并心力衰竭的诊断和预后判断有重要价值。糖尿病肾病、甲状腺功能亢进、原发性醛固酮增多症均可促进BNP分泌,而肥胖可导致BNP降解增多。BNP与内分泌疾病的广泛联系提示其在内分泌疾病的临床应用中有着广阔前景。     

血浆B型脑钠肽水平与急性毛细支气管炎合并充血性心衰患儿心功能的相关性研究

目的探讨血浆B型脑钠肽(BNP)水平与毛细支气管炎合并急性充血性心力衰竭患儿心功能的相关性。方法选择2011年11月至2014年3月期间的住院患儿80例,其中诊断毛细支气管炎患儿40例作为对照组,诊断毛细支气管炎合并急性充血性心力衰竭患儿40例作为心衰组,分析两组患儿血清BNP、心脏彩超左室射血分数(LVEF)、左室短轴缩短率(LVFS)。结果心衰组与对照组患儿的BNP、LVEF、LVFS有显著差异,且心衰组患儿BNP与LVEF、LVFS均呈负相关。结论血浆脑钠肽可作为毛细支气管炎合并心衰患儿诊断及病情评估的客观指标。     

脑钠肽与充血性心力衰竭的治疗

临床研究证实 ,脑钠肽 (brainnatriureticpeptide ,BNP)对充血性心力衰竭 (congestiveheartfailure,CHF)的诊断及预后有重要价值[1 4] 。BNP是由心室分泌的一种调节心血管系统功能的多肽类激素 ,半衰期为 2 3min ,随CHF的加重而分泌增加。目前基因重组人脑钠肽已在临床上用于治疗CHF ,并显示出良好的效果。本文对重组人脑钠肽治疗CHF的进展综述如下。一、脑钠肽与充血性心力衰竭的概念现在认为CHF的病理生理学表现主要在于心室重构和神经 内分泌 细胞因子系统的激活。这些被激活的神经 内分泌 细胞因子系统主要包括 :肾上腺素能…     

脑利钠肽在小儿疾病诊治中的应用

脑利钠肽(BNP)是一种由心室合成和分泌的对血管收缩与舒张及水、电解质代谢有重要调节作用的内分泌素.由于BNP首先是从猪脑细胞内发现的,因而称为脑利钠肽.近年来,随着对BNP研究的不断深入,人们发现除心衰外,BNP对其它疾病也有重要诊断价值,而且BNP还可用于心衰的治疗.     

Receptor selectivity of natriuretic peptide family, atrial natriuretic peptide, brain natriuretic peptide, and C-type natriuretic peptide.

To elucidate the ligand-receptor relationship of the natriuretic peptide system, which comprises at least three endogenous ligands, atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and C-type natriuretic peptide (CNP), and three receptors, the ANP-A receptor or guanylate cyclase-A (GC-A), the ANP-B receptor or guanylate cyclase-B (GC-B), and the clearance receptor (C-receptor), we characterized the receptor preparations from human, bovine, and rat tissues and cultured cells with the aid of the binding assay, Northern blot technique, and the cGMP production method. Using these receptor preparations, we examined the binding affinities of ANP, BNP, and CNP for the C-receptor and their potencies for cGMP production via the ANP-A receptor (GC-A) and the ANP-B receptor (GC-B). These analyses revealed the presence of a marked species difference in the receptor selectivity of the natriuretic peptide family, especially among BNPs. Therefore, we investigated the receptor selectivity of the natriuretic peptide family using the homologous assay system with endogenous ligands and receptors of the same species. The rank order of binding affinity for the C-receptor was ANP greater than CNP greater than BNP in both humans and rats. The rank order of potency for cGMP production via the ANP-A receptor (GC-A) was ANP greater than or equal to BNP much greater than CNP, but that via the ANP-B receptor (GC-B) was CNP greater than ANP greater than or equal to BNP. These findings on the receptor selectivity of the natriuretic peptide family provide a new insight into the understanding of the physiological and clinical implications of the natriuretic peptide system.     

B-type natriuretic peptide

INTRODUCTION: B-type natriuretic peptide is a neurohormone synthesized in the cardiac ventricles upon ventricular pressure overload and ventricular dilatation. This peptide with many favourable physiological properties has emerged as important candidate for development of diagnosis and prognostic tools and therapeutic agents in cardiovascular disease. EXEGESIS: Literature published until now shows the interest to measure B-type natriuretic peptide in the diagnosis of ventricular dysfunction or congestive heart failure. B-type natriuretic peptide is also a prognostic marker in patients with congestive heart failure and acute coronary syndrome. It could even help to guide patient treatment management. It is easily and rapidly measured at a reasonable cost. In general, a level less than 50 ng/l has a strong negative predictive value for congestive heart failure. CONCLUSION: B-type natriuretic peptide is available in daily clinical practice. Future interest has focused on development of drugs that modulate its effects in treatment of decompensated congestive heart failure. Studies are in progress and first results seem to be promising.     

B型利钠肽和 N-末端B型利钠肽原水平的影响因素及其不同点

目的 探讨与B型利钠肽(BNP)相关的临床因素,及这些因素对BNP和N-末端B型利钠肽原(N7-proBNP)的不同影响.方法 对1983名体检者进行常规血液检查,血压测量,心电图检查,并检测BNP和NT-proBNP水平,后用多变量回归分析分别检验血浆BNP和NT-proBNP水平与各因素的相关性.结果 BNP和NT-proBNP呈正相关.与BNP显著相关的因素依次为:年龄、血红蛋白、脉搏、收缩压、总胆固醇、性别、甘油三酯、肌酐.与NT-proBNP显著相关的因素依次为:年龄、肌酐、血红蛋白、性别、甘油三酯、总胆固醇、收缩压、脉搏.这些因素对BNP和NT-proBNP的影响有所不同:NT-proBNP受肾功能及性别影响较大,而BNP可能受自主神经影响较明显.在收缩压亚组,BNP和NT-proBNP水平在各组间差异有统计学意义.在年龄亚组,组间比较差异也有统计学意义.性别与.BNP水平密切相关,女性的BNP水平显著高于男性.结论 BNP和NT-proBNP与年龄、血压、肌酐、脉搏、性别及血脂密切相关.然而,这些因素对两者的影响有所不同.     

Discordant atrial natriuretic peptide and brain natriuretic peptide levels in lone atrial fibrillation

OBJECTIVES: We sought to characterize natriuretic peptide levels in a cohort of rigorously characterized subjects with lone atrial fibrillation (AF). BACKGROUND: Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are sensitive biomarkers of cardiac contractile dysfunction. Both peptides have been reported to be elevated in cohorts with AF, but previous studies have included subjects with underlying structural heart disease. We studied these hormones in 150 subjects with lone AF. METHODS: Study subjects had electrocardiographic evidence of at least one episode of AF and a structurally normal heart on echocardiography. Subjects were excluded if they had a history of a myocardial infarction, rheumatic heart disease, cardiomyopathy, significant valvular disease, hyperthyroidism, or hypertension that preceded the onset of AF. Control subjects were obtained from a healthy outpatient primary care population. Plasma pro-ANP and N-terminal pro-BNP (nt-pro-BNP) levels were determined using commercially available immunoassays. RESULTS: A total of 150 serial subjects with lone AF were enrolled and studied, the majority during normal sinus rhythm. Median levels of nt-pro-BNP were significantly elevated in subjects with lone AF as compared with control subjects (166 vs. 133 fmol/ml, p=0.0003). There was no significant difference in pro-ANP levels between subjects with lone AF and control subjects (1,730 vs. 1,625 fmol/ml, p=0.90). CONCLUSIONS: Discordant natriuretic peptide levels were observed in this homogeneous population of subjects with lone AF. This biomarker pattern, which is present even in sinus rhythm, may represent an underlying subclinical predisposition to this common arrhythmia.     

脑利钠肽和心律失常

脑利钠肽 (brainnatriureticpeptide ,BNP)是一种由心脏分泌的循环激素 ,是利钠肽家族的重要成员之一 ,近年来国内外日益重视BNP对心血管疾病的诊断和预后价值。本文重点就BNP与心律失常的相关研究进展作一综述。一、脑利钠肽的特性和释放机制BNP在 1 988年首先由Sudoh等[1 ] 从猪脑组织中分离出来 ,随后被证实在人类心肌组织中也大量存在。BNP由 32个氨基酸组成 ,其多肽结构和药理学活性与心房利钠肽(atrialnatriureticpeptide,ANP)极为相似 ,也具有利钠、利尿、扩张血管、抑制肾素、醛固酮分泌的作用。在体和离体实验表明 60 %～ …     

Chimeric natriuretic peptide ACNP stimulates both natriuretic peptide receptors,the NPRA and NPRB

Here, we investigated the receptor profile of the newly designed natriuretic peptide (NP) ACNP consisting of the N- and C-terminus of human ANP and the ring structure of CNP, its potency/efficacy in stimulating cGMP generation in primary cells, and its stability towards peptidase activity. ACNP stimulated both human natriuretic peptide receptors (NPRs), NPRA and NPRB, as potent as their native ligands in receptor transfected cells. Consequently, ACNP was more efficient in generating cGMP compared to ANP, BNP, and CNP, in primary cells expressing both NPRs. All NPs have been similarly degraded by neprilysin, except the neprilysin-resistant BNP. However, ACNP was fastest degraded in serum, while CNP was most stable. Congruently, CNP but not ACNP reduced blood pressure most significantly after acute peptide infusion in normotensive mice. Our data identify ACNP as the first compound being able to stimulate both natriuretic receptors with similar potency and efficacy as their respective ligands.