B型钠尿肽的临床意义-培训课件.ppt

* * * 我首先简单介绍一下新活素的处方资料。新活素是国产的基因重组人脑钠肽(rhBNP)，是人体分泌的一种内源性利钠肽，它是在各种病理因素诱导下发生心功能受损时，人体产生的一种代偿性心脏保护因子。 简单介绍一下结构式 * 重点强调两点：①起效快，降低肺毛压和缓解呼吸困难比硝酸甘油起效更快，效果更好；②特殊的代谢途径：不通过肾脏排泄，适用于肾功能不全患者； 新活素药代动力学的有三个个特点：一是起效快，临床应用缓解呼吸困难最快2分钟起效，二是不通过肾脏代谢，由于本品具有扩张肾血管、提高肾小球滤过率和有效滤过面积，特别适用于心衰合并肾功能不全者，或速尿耐药患者； * 主要适应急、慢性失代偿性心力衰竭、急性冠脉综合征（ACS）、心脏导管手术、心胸外科手术、血浆脑利钠肽浓度升高的其他疾病治疗 * Hemodynamic Effects of Nesiritide vs Placebo vs IV NTG The onset of nesiritide effects on PCWP were rapid. PCWP decreased by ?3.5 mm Hg within the first 15 minutes of nesiritide infusion. The reduction in PCWP with nesiritide was statistically greater than with placebo at every timepoint. In addition, the reduction in PCWP with nesiritide was statistically greater than with NTG at every point except at 2 hours. 1. Publication Committee for the VMAC Investigators. JAMA. 2002;287:1531 * VMAC: Dyspnea Improvement In the VMAC trial, patients treated with nesiritide reported significant improvements in dyspnea, compared with those treated with placebo, after 3 hours of therapy. Patients treated with NTG also reported improved dyspnea at 3 hours but to a lesser extent than with nesiritide; the difference in improvements between the NTG group and placebo group was not significant. Publication Committee for the VMAC Investigators. JAMA. 2002;287:1531 * 其主要机制如下：第一，早期心肌细胞缺血坏死已经诱发心室功能不全，虽然在24小时内尚未引起血流动力学异常，但已使心室壁张力增加，从而诱发了BNP的快速增高。第二，心肌缺血直接导致了BNP的增高。 大面积心室重构和急性心梗后心功能不全 * 以往的研究发现经皮冠状动脉腔内成形术后血浆BNP会出现一过性升高，术中球囊扩张暂时性阻断了冠脉血流，这提示短暂心肌缺血引起BNP水平升高。 * * 有报道表明,无心衰房颤患者BNP主要由左房而非左室分泌，房颤电复律及射频消融后BNP水平的降低都表明房颤与BNP升高有直接关系 * * 有报道表明,无心衰房颤患者BNP主要由左房而非左室分泌，房颤电复律及射频消融后BNP水平的降低都表明房颤与BNP升高有直接关系 * * * While the use of BNP for screening in the general population is not currently warranted, targeted screening of individuals at high risk of developing left ventricular systolic dysfunction would lead to more economical use of more expensive cardiac imaging procedures such as echocardiography or ultrasound. Many studies have shown that fewer