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Mintacm szerkesztse,Mintaszveg szerkesztse,Msodik szint,Harmadik szint,Negyedik szint,tdik szint,*,Mintacm szerkesztse,Mintaszveg szerkesztse,Msodik szint,Harmadik szint,Negyedik szint,tdik szint,*,Mintacm szerkesztse,Mintaszveg szerkesztse,Msodik szint,Harmadik szint,Negyedik szint,tdik szint,*,Mintacm szerkesztse,Mintaszveg szerkesztse,Msodik szint,Harmadik szint,Negyedik szint,tdik szint,*,Mintacm szerkesztse,Mintaszveg szerkesztse,Msodik szint,Harmadik szint,Negyedik szint,tdik szint,*,Mintacm szerkesztse,Mintaszveg szerkesztse,Msodik szint,Harmadik szint,Negyedik szint,tdik szint,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,心梗心衰心标准BNP临床进展,主要内容,心血管的学科发展背景,BNP,发展史,BNP,在心血管科的应用,病例分析,心血管科的发展与困惑,大发展的三个年代,介入时代,循证时代,预防时代,心血管医生的思考,医学的意义,意义的基石,早预防,早救治,早诊断,拜斯汀事件分析,诊断,治疗,检验医学,心血管标志物快速发展的原因,巨大优势在心血管疾病发展的各个阶段快速诊断,炎症,:,心,血管疾病,(CVD):,主要,的心脏标志物,心,肌损伤,:,左心室,肥大,充血性,心衰,MPO , hs-CRP,BNP,cTnI,Myo, CK-MB mass,高血压,及坏死,心脏,重塑,末期,心衰,心血管检验中的主要标志物,心肌损伤标志物,心力衰竭标志物,心肌炎性标志物,BNP,发展史,1981, de Bold et al. first reported a potent,diuretic,and,natriuretic,factor in rat atrial extracts,1984, Kangawa et al. identified atrial natriuretic peptide (ANP),1988, B-type or brain natriuretic peptide (BNP),1990, C-type natriuretic peptide (CNP),Natriuretic peptide family:,ANP,BNP,CNP,DNP(dendroaspis),Urodilatin,BNP,是心衰定量标志物,促进排尿利钠,抑制,RAA,ANP,BNP =,CNP,体积,压力,左室收缩功能障碍,+,左室舒张功能障碍,+,瓣膜功能障碍,+,右室功能障碍,降低外周血管抵抗,(,降低血压,),Iwanaga Y,et al,. JACC.,2006;47:742-8.,肌细胞,Pre-proBNP (134 aa),proBNP (108 aa),信号缩氨酸,(26 aa),分泌物,NT-proBNP (1-76),BNP (77-108),BNP/NT-proBNP,的分泌和释放,ZJ,ZJ,BNP,的形成和分解,pre-proBNP,1-134,Meprin,A,BNP,7-32,DPP-IV = dipeptidyl peptidaseIV,DPP-IV,BNP,3-32,proBNP,1-108,BNP,1-32,NT-proBNP,1-76,proBNP,1-108,Signal peptide,(26 amino acids),BNP levels in patients with diagnosis of CHF and baseline left ventricular dysfunction. Diagnosis of CHF was based on independent assessment by 2 cardiologists blinded to BNP values. Values are expressed as mean +/- SEM,Dao, Q., Maisel, A. et al.,J. American College of Cardiology, No. 2, 2001,.,ZJ,BNP Concentration (pg/ml),186 22,791 165,2013 266,N = 27,N = 34,N = 36,BNP concentrations for the degree of CHF severity,Mild,Moderate,Severe,0,500,1000,1500,2000,2500,J. Cardiac Failure 7(2):183-9 2001,ZJ,Lg BNP (pmol/l),LVEF (%),0,20,40,60,80,100,0,1.0,2.0,3.0,y=-0.7, p0.001,Davis et al. Lancet 1994; 343:440-444.,BNP vs. EF by Echocardiography,ZJ,BNP Levels in patients with dyspnea caused by CHF or chronic obstructive pulmonary disease,J. Cardiac Failure 7(2):183-9 2001,ZJ,How BNP affects,Influences on BNP Levels,diuretics,ACEI,angiotensin-II receptor blockers reduce BNP,concentrations,Medications,used in HF,digoxin and some beta blockers appear to increase BNP,concentrations,Exercise causes a short-,term increase in BNP levels,BNP,方法学发展,放射免疫法,免疫荧光法,免疫夹心法,电化学发光法,快速微粒体免疫荧光法,(RAMP),日本,盐野义,BNP,检测首创者,1878,年，盐野义成立于日本,大阪,，致力于医药研究,1993,年，盐野义推出,BNP,检测,(Biosite 2000,年,),2006,年，盐野义与加拿大,Response,合作，推出,Shionogi BNP POCT,现在，,O&D,与,Response,将之引入国内，即,RAMP BNP,检测,BNP,方法学发展,放射免疫法,免疫荧光法,免疫夹心法,电化学发光法,快速微粒体免疫荧光法,(RAMP),BNP,的地位,划时代的意义，心衰诊断的“金标准,”,；,2000,年通过,FDA,、,CE,和,SFDA,的认证；,2002,年,BNP,检测被评为国际医学十大新闻之一；,2004,年,NACB,和,ACC,分别推出,BNP,临床应用的指南或专家共识；,2007,年推出中国,BNP,专家共识；,2008,年推出北美欧洲,BNP,专家共识。,可能的优点,稳定性好,重复性好,与中心检验的相关性好,低值精度好,多级质量控制,利于,POCT,的开展,病例报告,5 Days ago Case,45,岁男性，突发胸痛伴发呼吸困难,5,小时,吸烟,肥胖,高血压,5 Days ago Case,诊断步骤,胸痛的鉴别诊断,应筛查的疾病,危险分层,预后判断,治疗决策,物理检查,心率增快,血压升高,心脏杂音,Diagnosis ECG - STEMI,Acute inferior myocardial infarction.,Diagnosis ECG - STEMI,Hyperacute phase of extensive antero-lateral myocardial infarction.,Acute mitral flail,occlusion,stent implantation,Pulmonary Edema due to Heart Failure,Measuring Jugular Venous Pressure,Today,What is the acut,e,coronary syndrome?,acute,life-threating,coronary event,The clinical presentation of the ischaemic heart disease,asymptomatic,(silent ischaemia!),CHF,stable angina pectoris,malignant arrhythmia / sudden death,ST elevation myocardial infarction,(,STEMI),Non-ST elevation,ACS,Unstable angina,Non-ST elevation myocardial infarction (NSTEMI),Acute Coronary Syndrome,(ACS),病理生理,斑块破裂,血栓形成,炎性病变,Plaque rupture and,platelet activation,thrombus formation,current complaint:,pain,there are a lot of importment data of the pain:,localisation,radiation,onset of the pain,the type (press, smart,cutting),dinamic of the pain (continouosly, ongoing, undulaiting),answer to the medical therapy,临床症状,In case of STEMI,Very important the,quick,diagnosis!,TIME=MYOCARDIUM=LIFE!,If the time window 12 h,open artery theory =,open the occluded coronary artery, save the myocardium!,If the patient has typical chest pain + typical ECG with acut STEMI ,it is enough to diagnosis!,心脏标志物的检测,TNI,MYO,CK-MB,BNP,CRP,In the CCU a lot of technical devices (IABP,respirator, dialysator) are necessary,谢 谢,
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