诊断心衰时，为什么要查BNP或NT-proBNP？
<h2 style="font-weight: bold;white-space: normal;line-height: 1.6em;"><br/></h2><p><section data-support="96编辑器" data-style-id="31585"><section style="margin-top: 10px;margin-bottom: 10px;"><section style="margin-left: auto;width: 2em;"><br/></section><section style="margin-top: -30px;margin-right: 10px;padding: 14px;background-color: rgb(255, 251, 251);border-radius: 0px 20px 0px 0px;box-sizing: border-box;"><section style="line-height: 1.75em;letter-spacing: 2px;font-size: 15px;transform: rotateZ(0deg);-webkit-transform: rotateZ(0deg);-moz-transform: rotateZ(0deg);-ms-transform: rotateZ(0deg);-o-transform: rotateZ(0deg);"><p style="letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;color: rgb(0, 0, 0);"> 心衰是各种心脏疾病的严重表现或晚期阶段，死亡率和再住院率居高不下。发达国家的心衰患病率为1.5%～2.0%，≥70岁人群患病率≥10%。2003年的流行病学调查显示，我国35～74岁成人心衰患病率为0.9%。我国人口老龄化加剧，冠心病、高血压、糖尿病、肥胖等慢性病的发病呈上升趋势，医疗水平的提高使心脏疾病患者生存期延长，导致我国心衰患病率呈持续升高趋势。</span></p></section></section></section></section></p><p style="line-height: 2em;"></p><p><section data-support="96编辑器" data-style-id="33630"><section style="text-align: center;margin: 10px 0%;box-sizing: border-box;"><section style="display: flex;justify-content:space-between;align-items:center;"><section style="display: inline-block;vertical-align: middle;width: 42%;box-sizing: border-box;" data-width="42%"><section style="border-top: 1pxsolid #ff4747;box-sizing: border-box;height:1px;"><br/></section></section><section style="width:10%;" data-width="10%"><section></section><section style="width: 40px;height: 10px;background-color: rgb(225, 236, 255);border-radius: 50%;margin-top: -10px;margin-right: auto;margin-left: auto;box-sizing: border-box;"><br/></section></section><section style="display: inline-block;vertical-align: middle;width:42%;" data-width="42%"><section style="border-top: 1pxsolid #ff4747;box-sizing: border-box;height:1px;"><br/></section></section></section></section></section></p><p style="letter-spacing: 1px;line-height: 2em;"><span style="font-size: 16px;color: rgb(255, 76, 65);"> </span><span style="font-size: 16px;color: rgb(255, 76, 65);"> </span><span style="color: rgb(0, 0, 0);font-size: 16px;">那么有什么生物标志物指标来诊断心衰吗？答案是肯定的，</span><span style="color: rgb(255, 76, 65);"><span style="font-size: 16px;">利钠肽</span></span><span style="color: rgb(0, 0, 0);font-size: 16px;">测定推荐</span><span style="color: rgb(255, 76, 65);font-size: 16px;">用于心衰筛查、诊断和鉴别诊断、病情严重程度及预后评估。</span><span style="color: rgb(255, 76, 65);font-size: 16px;"></span><strong><span style="color: rgb(255, 76, 65);font-size: 16px;"></span><span style="color: rgb(255, 76, 65);font-size: 16px;"></span></strong></p><p style="letter-spacing: 1px;line-height: 2em;"><span style="font-size: 16px;"><span style="color: rgb(255, 76, 65);"><span style="color: rgb(0, 0, 0);"></span></span></span></p><p><section data-support="96编辑器" data-style-id="31585"><section style="margin-top: 10px;margin-bottom: 10px;"><section style="margin-left: auto;width: 2em;"><br/></section><section style="margin-top: -30px;margin-right: 10px;padding: 14px;background-color: rgb(255, 251, 251);border-radius: 0px 20px 0px 0px;box-sizing: border-box;"><section style="line-height: 1.75em;letter-spacing: 2px;font-size: 15px;transform: rotateZ(0deg);-webkit-transform: rotateZ(0deg);-moz-transform: rotateZ(0deg);-ms-transform: rotateZ(0deg);-o-transform: rotateZ(0deg);"><p style="letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;color: rgb(0, 0, 0);"> 心衰时心室容积扩张和压力负荷增加，心肌细胞受到张力及牵拉等刺激，首先分泌释放入血的是前利钠肽原，在酶的作用下降解为利钠肽原，利钠肽原在酶的作用下进一步降解为BNP及NT-proBNP，其中BNP是有生物活性的部分，NT-proBNP仅为剪切后的氮末端多肽，这与胰岛素和C-肽的关系类似。胰岛素有生物活性，而C-肽仅为剪切后的无活性片段，胰岛素和C-肽均可用于糖尿病的诊断和分型，BNP和NT-proBNP也均可用于心衰的诊断和严重程度评估。</span></p></section></section></section></section><section data-support="96编辑器" data-style-id="33630"><section style="text-align: center;margin: 10px 0%;"><section style="display: flex;justify-content:space-between;align-items:center;"><section style="display: inline-block;vertical-align: middle;width: 42%;" data-width="42%"><section style="border-top: 1px solid rgb(255, 71, 71);height: 1px;box-sizing: border-box;"><br/></section></section><section style="width:10%;" data-width="10%"><section></section><section style="width: 40px;height: 10px;background-color: rgb(225, 236, 255);border-radius: 50%;margin-top: -10px;margin-right: auto;margin-left: auto;box-sizing: border-box;"><br/></section></section><section style="display: inline-block;vertical-align: middle;width:42%;" data-width="42%"><section style="border-top: 1px solid rgb(255, 71, 71);height: 1px;box-sizing: border-box;"><br/></section></section></section></section></section><section data-support="96编辑器" data-style-id="32512"><section style="margin-top: 10px;margin-bottom: 10px;"><section><section data-support="96编辑器" data-style-id="27930"><section style="margin-top: 10px;margin-bottom: 10px;text-align: center;"><section style="display: inline-block;"><section></section></section></section></section></section></section></section><section data-support="96编辑器" data-style-id="31585"><section style="margin-top: 10px;margin-bottom: 10px;"><section style="margin-left: auto;width: 2em;"><br/></section><section style="margin-top: -30px;margin-right: 10px;padding: 14px;background-color: rgb(255, 251, 251);border-radius: 0px 20px 0px 0px;box-sizing: border-box;"><section style="line-height: 1.75em;letter-spacing: 2px;font-size: 15px;transform: rotateZ(0deg);-webkit-transform: rotateZ(0deg);-moz-transform: rotateZ(0deg);-ms-transform: rotateZ(0deg);-o-transform: rotateZ(0deg);"><p style="letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;color: rgb(0, 0, 0);"> 可以这么认为，BNP和NT-proBNP相当于心衰的“白细胞计数”指标，其水平与心衰严重程度相关，两者水平越高，心衰越严重。但BNP和NT-proBNP这对孪生兄弟的代谢途径却有着很大不同，BNP主要在肺、肾脏经内切酶降解或大血管内受体清除，而NT-proBNP主要经肾脏排泄，与肾功能密切相关。即使是健康人，随着年龄的增加，肾功能也会不断衰退，血中NT-proBNP水平会逐渐升高，因此它们的诊断数值要综合考量这些因素。《中国心力衰竭诊断和治疗指南2018》指出，</span><span style="font-size: 16px;color: rgb(255, 76, 65);">BNP<100ng/L、NT-proBNP<300ng/L时通常可排除急性心衰；BNP<35ng/L、NT-proBNP<125ng/L时通常可排除慢性心衰。</span><span style="font-size: 16px;color: rgb(0, 0, 0);">诊断急性心衰时NT-proBNP水平应根据年龄和肾功能进行分层：</span><span style="font-size: 16px;color: rgb(255, 76, 65);">50岁以下的患者NT-proBNP水平>450ng/L，50岁以上>900ng/L，75岁以上应>1800ng/L，肾功能不全（肾小球滤过率<60ml/min）时应>1200ng/L。</span></p></section></section></section></section><section data-support="96编辑器" data-style-id="33630"><section style="text-align: center;margin: 10px 0%;"><section style="display: flex;justify-content:space-between;align-items:center;"><section style="display: inline-block;vertical-align: middle;width: 42%;" data-width="42%"><section style="border-top: 1px solid rgb(255, 71, 71);height: 1px;box-sizing: border-box;"><br/></section></section><section style="width:10%;" data-width="10%"><section></section><section style="width: 40px;height: 10px;background-color: rgb(225, 236, 255);border-radius: 50%;margin-top: -10px;margin-right: auto;margin-left: auto;box-sizing: border-box;"><br/></section></section><section style="display: inline-block;vertical-align: middle;width:42%;" data-width="42%"><section style="border-top: 1px solid rgb(255, 71, 71);height: 1px;box-sizing: border-box;"><br/></section></section></section></section></section></p><p style="letter-spacing: 1px;line-height: 2em;"></p><p><section data-support="96编辑器" data-style-id="31585"><section style="margin-top: 10px;margin-bottom: 10px;"><section style="margin-left: auto;width: 2em;"><br/></section><section style="margin-top: -30px;margin-right: 10px;padding: 14px;background-color: rgb(255, 251, 251);border-radius: 0px 20px 0px 0px;box-sizing: border-box;"><section style="line-height: 1.75em;letter-spacing: 2px;font-size: 15px;transform: rotateZ(0deg);-webkit-transform: rotateZ(0deg);-moz-transform: rotateZ(0deg);-ms-transform: rotateZ(0deg);-o-transform: rotateZ(0deg);"><p style="letter-spacing: 1px;line-height: 2.5em;"><span style="font-size: 16px;color: rgb(0, 0, 0);"> BNP的半衰期较短，需要快速送检，而NT-ProBNP虽然相对稳定，但仍需在一定的时间内送检。另外心衰患者使用脑啡肽酶抑制剂如诺欣妥时会使BNP降解减少，而NT-proBNP则不受影响。因此临床工作中应注意结合患者的病史及用药情况进行综合分析。</span></p></section></section></section></section><section data-support="96编辑器" data-style-id="32423" style="white-space: normal;"><section><section><section><section><section><section><br/></section><section></section></section></section></section></section></section></section><section style="white-space: normal;font-family: -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;letter-spacing: 0.544px;"><section data-support="96编辑器" data-style-id="23830" style="letter-spacing: 0.544px;text-align: center;"><section style="display: inline-block;"><section style="margin: 15px 5px;"><section style="margin-left: 10px;border-left: 2px dotted rgb(255, 76, 65);height: 3em;box-sizing: border-box;"><br/></section></section></section></section></section><section style="white-space: normal;letter-spacing: 0.544px;font-family: -apple-system-font, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif;"><section><section style="margin-top: 10px;margin-bottom: 10px;"><section style="padding-left: 11px;display: inline-block;width: 676.994px;vertical-align: top;box-sizing: border-box;"><section><section style="display: inline-block;width: 665.997px;vertical-align: top;background-color: rgba(255, 255, 255, 0);border-style: solid;border-width: 1px;border-radius: 0px;border-color: rgb(7, 48, 196);box-sizing: border-box;"><section><section style="margin-top: 10px;display: flex;flex-flow: row nowrap;text-align: left;justify-content: flex-start;transform: translate3d(-8px, 0px, 0px);"><section style="display: inline-block;vertical-align: top;width: auto;line-height: 0;letter-spacing: 0px;flex: 0 0 0%;height: auto;align-self: flex-start;"><section style="text-align: right;justify-content: flex-end;"><section style="display: inline-block;width: 8px;height: 45px;vertical-align: top;overflow: hidden;"><section style="text-align: center;"><section style="vertical-align: middle;display: inline-block;line-height: 0;width: 7.8267px;height: auto;"><svg xmlns="http://www.w3.org/2000/svg" x="0px" y="0px" viewbox="0 0 1.5 8.7" style="vertical-align: middle;width: 100%;" width="100%" data-width="100%"><g><path d="M1.5,0.2C0.8,0.2,0.2,0.6,0.2,1v6.2C0.5,6.9,1,6.8,1.5,6.8V0.2z" fill="rgb(255,255,255)"></path></g><g><path d="M0.2,7.7H0V1c0-0.5,0.7-1,1.5-1v0.2C0.8,0.2,0.2,0.6,0.2,1v6.2C0.5,6.9,1,6.8,1.5,6.8V7C0.8,7,0.2,7.3,0.2,7.7 z" fill="rgb(7,48,196)"></path></g><g><path d="M1.5,8.7C0.7,8.7,0,8.3,0,7.7s0.7-0.9,1.5-0.9V7C0.8,7,0.2,7.3,0.2,7.7s0.6,0.7,1.3,0.7V8.7z" fill="rgb(7,48,196)"></path></g><g><path d="M1.5,7C0.8,7,0.2,7.3,0.2,7.7s0.6,0.7,1.3,0.7V7z" fill="#5f9cef"></path></g></svg></section></section></section></section></section><section style="margin-left: -1px;display: inline-block;vertical-align: top;width: auto;flex: 100 100 0%;align-self: flex-start;height: auto;"><section style="justify-content: flex-start;"><section style="padding-right: 20px;padding-left: 10px;display: inline-block;vertical-align: top;overflow: hidden;height: 36px;width: auto;min-width: 10%;border-width: 1px;border-bottom-right-radius: 100px;border-style: solid solid solid none;border-color: rgb(7, 48, 196) rgb(7, 48, 196) rgb(7, 48, 196) rgb(138, 50, 222);border-top-right-radius: 100px;border-bottom-left-radius: 0px;box-sizing: border-box;"><section style="color: rgb(7, 48, 196);text-align: center;letter-spacing: 2px;line-height: 2.2;"><p><strong>联系方式</strong></p></section></section></section></section></section></section><section style="margin-bottom: 10px;"><section style="padding-right: 20px;padding-left: 20px;letter-spacing: 1.8px;line-height: 1.8;box-sizing: border-box;"><p style="color: rgb(62, 62, 62);"><span style="font-size: 16px;">1、咨询株洲恺德心血管病医院订阅号<strong><span style="color: rgb(7, 48, 196);">在线客服；</span></strong><br/>2、咨询电话：<strong><span style="color: rgb(7, 48, 196);">0731-28263456</span></strong></span></p><p style="color: rgb(62, 62, 62);"><span style="font-size: 16px;">3、住院部地址：株洲恺德心血管病医院<span style="color: rgb(7, 48, 196);"><strong>第二住院大楼4楼（心衰中心）</strong></span></span></p><p><span style="font-size: 16px;"><span style="color: rgb(0, 0, 0);">4、</span><strong style="color: rgb(7, 48, 196);">心衰门诊地址</strong><span style="color: rgb(0, 0, 0);"><strong>：</strong></span><strong style="color: rgb(7, 48, 196);">新华西路门诊部2号诊室</strong><span style="color: rgb(0, 0, 0);">（<span style="color: rgb(62, 62, 62);letter-spacing: 1.8px;">华润万家对面</span>）</span></span></p></section></section></section></section></section></section></section><section><section style="border-top: 1px solid rgb(7, 48, 196);line-height: 0;box-sizing: border-box;"><section style="line-height: 0;width: 0px;"><svg viewbox="0 0 1 1" style="vertical-align:top;"></svg></section></section><section style="margin-top: 3px;border-top: 4px solid rgb(7, 48, 196);line-height: 0;box-sizing: border-box;"><section style="line-height: 0;width: 0px;"><svg viewbox="0 0 1 1" style="vertical-align:top;"></svg></section></section></section><section><p style="text-align: right;"><span style="font-size: 12px;letter-spacing: 0.544px;">文案：任承潜</span><span style="letter-spacing: 0.544px;text-align: justify;"></span></p></section></section></p><p style="white-space: normal;"><br/></p><p><br/></p><link rel="stylesheet" href="//bbs.zhuzhou.com/source/plugin/wcn_editor/public/wcn_editor_fit.css?v134_JEa" id="wcn_editor_css"/>
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