脑钠肽(bnp)与心力衰竭的研究进展-教学课件，幻灯，PPT

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1、脑钠肽(BNP)与心力衰竭的研究进展北京世纪坛医院北京大学第九临床医学院杨水祥教授2009年8月20日OutcomesinPatientsHospitalizedWithHFJongPetal.ArchInternMed.2002;162:1689025507510020%50%30days6moHospitalReadmissions025507510012%50%30days12moMortality33%5yrMedianhospitalLOS:6daysAnnualmortalityrate-NYHAclassIIIHF-

2、12%[COPERNICUSDATA]NYHAclassIIHF-7%[SCD-HeFTDATA]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IncreasedmorbidityandmortalityDiuretictherapyImpairedrenalfunctionDecreasedrenalperfusionDiureticresistanceDiminishedbloodflowNeurohormonalactiv

3、ationPotentialDeleteriousEffectsofDiureticsandCardiorenalSyndromeofHFNeurohormonalactivationVasoconstrictionCongestionPathologicremodelingHemodynamic(balancedvasodilation)veinsarteriescoronaryarteriesB-TypeNatriureticPeptide(BNP)Neurohumoralaldosteroneendothelinnorepi

4、nephrineRenaldiuresisnatriuresisGFRDRIMKRGSSSSGLGFCCSSGSGQVMKVLRRHKPSCardiaclusitropicantifibroticanti-remodelingJamiesonandPalade.JCellBiol.1964;23:151.NatriureticPeptides:TheHeartasaSecretoryOrganAtrialstretchreceptorslinkbloodvolumetorenalfunctionDistensionofaballo

5、oncatheterinatriaofdogsresultedindiuresisHenryetal(1956)SecretorygranulesdiscoveredintheatriaKisch(1956)JamiesonandPalade(1964)BNPwascharacterizedbyaminoacidsequenceandDNAclonesSudohetal(1988)Seilhameretal(1989)NatriureticPeptidesAdaptedfromBurnettJC.JHypertens.2000;17

6、(Suppl1):S37-S43.ANP=AtrialNatriureticPeptideBNP=B-typeNatriureticPeptideCNP=C-typeNatriureticPeptidePeptidePrimaryOriginStimulusofReleaseANPCardiacatriaAtrialdistensionBNPVentricularmyocardiumVentricularoverloadCNPEndotheliumEndothelialstressNatriureticPeptides:Origi

7、nandStimulusofReleaseH2N—H2N——COOH—COOH—COOHpro-BNP(aa1-aa108)CleavageBNP(aa77-aa108)NT-proBNP(aa1-aa76)HPLGSPGSASYTLRAPRSPKMVQGSGCFCRKMDRISSSSGLCCKVLRRHHPLGSPGSASYTLRAPRSPKMVQGSGCFCRKMDRISSSSGLCCKVLRRHH2N—110707680901001081107076MyocardBloodpre-proBNP1-134(134Aa)Sign

8、alpeptide(26Aa)28171463kDaRec.ABCDEblankRec.ClinicalBNPResultspg/mL:ABCDEMaisel3920372040102090127in-houseTriage1140