n端氨基酸在哪边(喘憋、BNP升高就是心衰吗？)

浣滆€咃細寮犱簯鐩?澶╂触鍖荤澶у鎬诲尰闄㈢┖娓尰闄?/span>

鐜扮梾鍙诧細濂虫€э紝65宀併€備富璇夛細涔忓姏銆佸挸鍡藉挸鐥颁即鍠樻唻5澶┿€?/span>

鎮ｈ€呬簬鍏ラ櫌鍓?澶╂劅鍐掑悗鍑虹幇涔忓姏銆佸挸鍡姐€佸挸鐥帮紝鐥颁负榛勭櫧鑹诧紝浼村枠鎲嬶紝澶滈棿鍙钩鍗т綅浼戞伅锛屽潗浣嶆垨渚у崸鍚庡枠鎲嬫暀濂借浆锛岃嚜杩板弻涓嬭偄姘磋偪澶氬勾锛屽翱閲忔棤鏄庢樉鍑忓皯锛屽灏?~5娆?鏅氾紝浼撮棿鏂ご鐥涳紝鏃犳槑鏄炬伓蹇冦€佸憰鍚愩€佽吂鐥涖€佽吂娉荤瓑锛屽氨璇婁簬褰撳湴璇婃墍锛岀粰浜堟姉鐢熺礌3澶╋紙鍏蜂綋涓嶈锛夛紝鐥囩姸鏈夋墍濂借浆銆傚悗灏辫瘖浜庢垜闄㈡€ヨ瘖锛屾煡BNP 3020 ng/ml锛屽績鑲岄叾銆佸績鑲屾崯浼ゆ爣蹇楃墿鏈鏄庢樉寮傚父銆傚績鐢靛浘绀猴細蹇冩埧棰ゅ姩銆傝€冭檻涓哄績鍔涜“绔敹鍏ユ垜绉戙€?/span>

鎮ｈ€呰嚜鍙戠梾浠ユ潵锛岀簿绁炴瑺浣炽€侀ギ椋熴€佺潯鐪犲皻鍙紝澶т究濡傚父锛屼綋閲嶆棤鏄庢樉鍙樺寲銆?/span>

鏃㈠線鍙诧細蹇冩埧棰ゅ姩鐥呭彶6骞达紝骞崇礌蹇冨鐜?0娆?鍒嗭紱鍚﹁楂樿鍘嬨€佺硸灏跨梾銆佽剳琛€绠＄梾銆佸摦鍠樸€侀潚鍏夌溂绛夌梾鍙诧紱鍚﹁鑲濈値銆佺粨鏍哥梾鍙诧紝鍚﹁瀹炵墿銆佽嵂鐗╄繃鏁忓彶锛屽惛鐑?0浣欏勾锛?~15鏀?澶╋紝鍋堕ギ閰掋€?/span>

瀹舵棌鍙诧細瀹舵棌涓惁璁ょ被浼兼偅鑰咃紝鍚﹁鍏朵粬閬椾紶鎬у鏃忕柧鐥呯梾鍙层€?/span>

鏌ヤ綋锛氱蹇楁竻妤氾紝鏌ヤ綋鍚堜綔锛屽叏韬毊鑲ゆ棤鐨柟鍙婂嚭琛€鐐广€傝兏寤撴甯革紝鍙岃偤鍛煎惛闊崇矖锛屽弻鑲哄彲闂诲強鍝福闊冲暟闊筹紝鍙充晶杈冨銆傚績鐣屽彥璇婃墿澶э紝蹇冮煶鍙€佸緥榻愶紝涓诲姩鑴夌摚绗竴鍚瘖鍖哄彲闂诲強2/6绾ц垝寮犳湡鍙规皵鏍锋潅闊筹紝鏈彲闂诲強蹇冨寘鎽╂摝闊炽€傝吂杞紝鏃犺吂澹侀潤鑴夋洸寮狅紝鑲濊劸鏈Е鍙婏紝绉诲姩鎬ф祳闊筹紙锛嶏級锛屽叏鑵硅蒋锛屾棤鍘嬬棝锛屾湭鎵強鍖呭潡锛岃剨鏌卞洓鑲㈡棤鐣稿舰锛屽弻涓嬭偄杞诲害姘磋偪锛岀敓鐞嗗弽灏勫瓨鍦紝鐥呯悊鍙嶅皠鏈紩鍑恒€?/span>

1. 闄㈠唴瀹為獙瀹ゆ鏌?

琛? 琛€甯歌妫€鏌?/span>

蹇冭倢閰?鍏ラ櫌CK 43 U/L锛孋K-MB 18 U/L锛孴NI<0.012 ng/ml锛孨T-proBNP 3020 ng/ml鈫戙€?/span>

鑲濆姛鑳斤細ALB71 g/L銆丟LO 35 g/L銆丄LT 18 U/L锛孉ST 14 U/L銆?/span>

鎬昏儐鍥洪唶6.30 mmol/L锛岀敇娌逛笁閰?.44 mmol/L锛孒DL 1.88 mmol/L锛孡DL 3.82 mmol/L锛岀┖鑵硅绯?.6 mmol/L銆?/span>

鍑濊鍔熻兘锛欴-Dimer 501 ng/ml銆丗IB 3.31 g/L銆丳T 10.5s銆丳T-INR 0.96銆丄PTT 33.4 s銆乀T 21.8 s銆?

鐢佃В璐ㄣ€佹父绂荤敳鍔熸湭瑙佸紓甯革紱CRP 2.01 mg/dl銆?/span>

2. 鍏朵粬杈呭姪妫€鏌?/span>

鍥? 蹇冪數鍥剧ず锛氬績鎴块ⅳ鍔紝蹇冨鐜?61娆?鍒嗭紝V1~V6瀵艰仈ST娈靛帇浣?.05~0.2 mV锛孴娉㈠€掔疆

鍥? 瓒呭０蹇冨姩绀猴細LA 43 mm锛孡V 50 mm锛孯A 37 mm锛孯V 30 mm锛孖VS 9 mm锛孡VPW 9 mm锛孍F 0.60锛屽乏鎴垮澶э紝浜屽皷鐡ｅ弽娴侊紙杞诲害锛夛紝涓夊皷鐡ｅ弽娴侊紙杞诲害锛夛紝涓诲姩鑴夌摚鍙嶆祦锛堣交搴︼級

鍥? 鑳搁儴CT鑰冭檻鏀皵绠＄値锛屼袱鑲洪€氭皵琛€娴佸垎甯冧笉鍧囧寑锛屽奖鍍忓彲瑙佸埌澧炲ぇ宸﹀績鎴匡紙绾㈣壊绠ご鎵€鎸囷級

3. 璇婃不缁忚繃

鍏ラ櫌鍚庣粰浜堥潤鑴夋姉鐢熺礌銆佸皬閲忓埄灏垮墏鏀瑰杽蹇冨姛鑳斤紝闆惧寲锛岄潤鑴夊钩鍠樸€佸寲鐥扮瓑娌荤枟锛屾偅鑰呯浜屽ぉ鐥囩姸鏄庢樉鏀瑰杽锛岃偤閮ㄥ摦楦ｉ煶鏁欏墠鍑忓皯銆傛嫨鏈熻鑲哄姛鑳芥樉绀轰竴绉掔巼67%锛岃€冭檻鎱㈡€ч樆濉炴€ц偤鐤剧梾锛岀粡10澶╂姉鎰熸煋銆佸钩鍠樼瓑娌荤枟鐥囩姸鏄庢樉濂借浆锛岃偤閮ㄥ摦楦ｉ煶娑堝け銆?/span>

璇ユ偅鑰呯3澶╁弻涓嬭偄鑵垮畬鍏ㄦ秷鑲垮悗鎾ら櫎鍒╁翱鍓傘€?澶╁悗澶嶆煡NT-proBNP 385 ng/ml锛屽懠鍚哥浼氳瘖鍔犵敤ICS/LABA鍚稿叆鍓傘€?/span>

鎴块ⅳ鏂归潰缁廋HA2DS2-VASC璇勫垎璇勪及鍚庣粰浜堟硶姣斿姞缇ゆ姉鍑濇不鐤楋紝鍙︾粰浜堝彛鏈嶈皟鑴傜瓑娌荤枟銆傛偅鑰呬笉鎺掗櫎鍐犲績鐥呭彲鑳斤紝寤鸿鎮ｈ€呰鍐犺剦妫€鏌ワ紝鎮ｈ€呮嫆缁濓紝鐥囩姸濂借浆鍚庢嫨鏈熷嚭闄€?/span>

蹇冭倢缁嗚優鍙楀埌鍘嬪姏/鐗垫媺鍒烘縺鍚庯紝鍗冲績瀹ゅ绉墿寮犮€佸帇鍔涜礋鑽峰鍔犳椂锛岄鍏堝舰鎴愪竴涓惈134涓皑鍩洪吀鐨凚鍨嬪埄閽犺偨鍘熷墠浣擄紙pre-proBNP锛夛紝闅忓悗铔嬬櫧閰跺垏鎺塏绔?6涓皑鍩洪吀鐨勪俊鍙疯偨鍙樻垚鍚湁108涓皑鍩洪吀鐨凚鍨嬪埄閽犺偨鍘燂紙proBNP锛夈€侭NP鐨勬竻闄ゆ湁3绉嶉€斿緞锛岄€氳繃涓嶯PR-C缁撳悎琚竻闄ゃ€侀€氳繃涓€у唴鑲介叾鍒嗚В娓呴櫎銆佽鑲捐剰绛夐珮琛€娴侀噺鍣ㄥ畼鎺掓硠銆侼T-proBNP缂轰箯涓诲姩娓呴櫎鏈哄埗锛屼富瑕侀€氳繃鑲捐剰銆佽倢鑲夈€佽倽鑴忕瓑楂樿娴侀噺鍣ㄥ畼琚姩娓呴櫎銆侭NP鐨勫崐琛版湡绾︿负20 min锛孨T-proBNP鐨勫崐琛版湡绾︿负60锝?20 min銆?/span>

BNP鍙楀勾榫勩€佹€у埆銆佷綋閲嶄互鍙婅偩鍔熻兘褰卞搷銆傝偩鍔熻兘涓嶅叏鏃讹紝BNP/NT-proBNP琛€娴嗘按骞充細鍗囬珮锛屽缓璁甧GFR<60 ml鈥in-1鈥?.73 m虏鏃讹紝璋冩暣NT-proBNP璇婃柇鎬ユ€у績琛扮殑鐣屽€间负>1200 pg/ml銆?/span>

璇婃柇鎬ユ€у績琛扮殑鐣屽€硷細BNP>500 ng/L锛岄槼鎬ч娴嬪€?0%锛涘缓璁甆T-proBNP鏍规嵁骞撮緞鍒嗗眰璁惧畾璇婃柇鐣屽€硷紝闃虫€ч娴嬪€?8%銆?/span>

琛? 鏍规嵁骞撮緞鍜岃偩鍔熻兘姘村钩杩涜鍒嗗眰

鎺掗櫎鎬ユ€у績琛拌瘖鏂噰鐢ㄧ殑鐣屽€硷細BNP<100 ng/L锛岄槾鎬ч娴嬪€?0%锛汵T-proBNP<300 ng/L锛岄槾鎬ч娴嬪€?8%锝?9%銆傚瓨鍦ㄨ偩鍔熻兘涓嶅叏鏃讹紝閲囩敤NT-proBNP<1200 ng/L锛岄槾鎬ч娴嬪€?4%銆?/span>

姝ゅ锛屽紩璧峰績鎴挎墿寮犮€佽瀹归噺澧炲姞銆佽閽犵瀛愭祿搴﹀楂樸€佽绠＄揣寮犵礌澧炲鐨勭柧鐥呬篃浼氬埡婵€蹇冭剰閲婃斁BNP/NT-proBNP锛屽鍐犲績鐥呫€佸乏蹇冨鑲ュ帤銆佸绔嬫€у績鎴块ⅳ鍔ㄣ€丆OPD銆佽偤鏍撳銆佽偤鍔ㄨ剦楂樺帇绛夌己姘х姸鎬併€佽触琛€鐥囥€佹€ユ€у懠鍚哥獦杩患鍚堝緛銆佸崚涓€佽偩鍔熻兘涓嶅叏銆佽倽纭寲銆佹劅鏌撱€佽触琛€鐥囥€侀珮鐑瓑銆?

琛? 寮曡捣BNP/NT-proBNP鍗囬珮鐨勫師鍥?/span>

璇ユ偅鑰呮槸鍚﹀瓨鍦ㄥ績琛帮紝鏄敮姘旂鍝枠杩樻槸蹇冩簮鎬у摦鍠橈紝鍒氬叆闄㈡椂鐨勭‘鏈変簺涓€绛硅帿灞曪紝鍥犳锛屽叆闄㈠悗鎴戜滑涓ゆ柟闈㈠悓鏃舵不鐤椼€傛不鐤?澶╁悗锛岀粨鍚堟偅鑰呯殑鐥囩姸涓庝綋寰侊紝鍏跺疄鏇村€惧悜浜庢敮姘旂鍝枠銆?/span>

閭ｄ箞锛屾偅鑰呭叆闄T-proBNP涓轰粈涔堜細鍗囬珮鍛紵鎴戜滑鑰冭檻鏄疌OPD鍥犳劅鏌撳悗鎬ユ€у姞閲嶏紝浠ュ強鍚堝苟鎸佺画鎬у績鎴块ⅳ鍔ㄣ€傛參鎬ф埧棰ゆ偅鑰呭績鎴跨粍缁囦細鍑虹幇涓ラ噸鑲ュ帤銆佺氦缁村寲鍜岀値鐥囧弽搴旂瓑鐥呯悊鍙樺寲锛屽彲浠ュ鑷村績瀹よ倢浜х敓BNP澧炲姞銆傝鎮ｈ€呭洜涓鸿偤閮ㄨ娴佹敼鍙樺鑷村績鑴忓閲忚礋鑽峰鍔狅紝蹇冭倢鍙楀埌鐗靛紶鎴栧澹佸帇鍔涘澶у鑷碆NP鍗囬珮銆?/span>

杩欎釜鐥呬緥缁欐垜浠甫鏉ヤ竴浜涘疂璐电殑缁忛獙锛氱粡鐮旂┒锛孊NP鏈寮傚父锛?5%鑳芥帓闄ゅ績琛帮紱浣嗘槸锛屽ぇ閲忓績鍖呯Н娑层€佸皠琛€鍒嗘暟淇濈暀鐨勫績琛板ぇ澶氫笉瑙丅NP鍗囬珮锛屽嵈瀛樺湪蹇冭“锛岃寮曡捣瓒冲閲嶈銆傚弽涔嬶紝BNP鍗囬珮涔熸湭蹇呭氨涓€瀹氬瓨鍦ㄥ績琛般€?/span>

鎬讳箣锛屾湁浜涚柧鐥呭湪璇婃柇涓婂瓨鍦ㄥ瑙傝瘉鎹笉瓒崇殑鎯呭舰锛屾槑纭瘖鏂浉瀵瑰洶闅俱€傛鏃跺簲鑰冭檻杈规不鐤楄竟璇婃柇锛屽叾涓€锛屽彲浠ョ紦瑙ｆ偅鑰呯殑涓嶉€傦紱鍏朵簩锛岃繖绉嶈繎浼艰瘯楠屾€ф不鐤楀彲浠ヨ繘涓€姝ヤ负鏄庣‘璇婃柇鎻愪緵渚濇嵁銆傝繖绉嶁€滆瘖鏂€濅笌鈥滄不鐤椻€濆吋椤撅紝涓嶄粎鏈夊埄浜庢偅鑰呯殑搴峰锛屼篃鍙互瀹屾垚瀵圭梾鍥犵殑鎺㈢储銆?/span>

鍙傝€冩枃鐚細

[1] 鐧芥, 鏉ㄦ澃瀛? 琛€娴嗚剳閽犺偨涓庡績鎴块ⅳ鍔╗J]. 涓崕蹇冨緥澶卞父瀛︽潅蹇? 2006, 10(2):157-9.

[2] Wieczorek SJ, Wu AH, Christenson R, et al. A rapid B-type natriuretic peptide assay accurately diagnoses left ventricular dysfunction and heart failure: a multicenter evaluation[J]. Am Heart J锛?002, 144(5):834-839.

[3] Jourdain P, Jondeau G, Funck F, et al. Plasma brain natriuretic peptide-guided therapy to improve outcome in heart failure: the STARS-BNP Multicenter Study[J]. J Am Coll Cardiol, 2007, 49(16):1733-1739.

[4] Beck-da-Silva L, de Bold A, Fraser M, et al. Brain natriuretic peptide predicts successful cardioversion in patients with atrial fibrillation and maintenance of sinus rhythm[J]. Can J Cardiol, 2004, 20:1245-8.