摘要
利钠肽(natriuretic peptides,NPs)的发现已有30年历史,其中B型利钠肽(B-type natriuretic peptide,BNP)及氨基末端脑钠肽前体(N-terminal pro-B type natriuretic peptide,NT-proBNP)的临床应用对心血管疾病诊治具有里程碑意义,特别是对心衰的综合价值最高。BNP具备强大的心血管保护效应,但心衰后BNP水平大幅升高,却没展现出相应的活性,被称为“利钠肽悖论”。近几年,随着质谱、核磁共振技术的运用,逐渐从代谢途径和检测技术上解开了“利钠肽悖论”这一谜题:外周循环中存在多种不同生物活性的BNP亚型且心衰后的BNP代谢与生理状态下不同。所以,纵然检测到心衰后BNP大幅升高,但本质上是由于传统检测技术的瓶颈,使各类BNP亚型与检测试剂交叉反应,活性成分被高估而造成假阳性。因此,要加强对BNP在病理生理等不同情况下的认识,还要借助生物化学手段建立具有敏感性和特异性的检测方法来识别BNP_(1-32)、BNP_(1-30)、BNP_(3-32)及B型利钠肽原(pro-B-type natriuretic peptide,proBNP)等特殊形式。从而有助于探索心衰更深层次的病理生理机制,还可协助临床对心衰的诊断及预后做出更准确的判断。
Natriuretic peptides(NPs)have been discovered for 30 years,and the clinical use of B-type natriuretic peptides(BNP)and N-terminal pro-B type natriuretic peptide(NT-proBNP)precursors have been a landmark in the management of cardiovascular disease,particularly in heart failure.The BNP has a powerful cardioprotective effect,but the BNP that rises dramatically after heart failure does not show corresponding activity,which is known as the“natriuretic peptide paradox”.In recent years,with the use of mass spectrometry and nuclear magnetic resonance techniques,“natriuretic peptide paradox”is being revealed through novel metabolic findings and testing technology.There are many different biologically active BNP isoforms in the peripheral circulation,and BNP metabolism after heart failure is different from that in the physiological state.Although the significant increase of BNP is detected after heart failure,it is essentially false positive due to bottlenecks in conventional the assay reagents of cross-react to various BNP isoforms,and therefore the bioactive levels of BNPs have been overestimated.So,we believe that it is necessary to strengthen the understanding of BNP in different pathophysiological conditions,and establish sensitive and specific detection methods by biochemical means to identify BNP_(1-32),BNP_(1-30),BNP_(3-32) and pro-B-type natriuretic peptide(proBNP).Accurate detection of BNPs will help us understand the deeper pathophysiological mechanisms of heart failure,and make precise clinical decision on the diagnosis and treatment.
作者
余怡嫔
谭朵廷
杨柳
钟俐芹
盛丹
黄汝佳
胡志希
梁昊
YU Yi-Pin;TAN Duo-Ting;YANG Liu;ZHONG Li-Qin;SHENG Dan;HUANG Ru-Jia;HU Zhi-Xi;LIANG Hao(Graduate School,Hunan University of Chinese Medicine,Changsha 410208,China;Institute of TCM Diagnostics,Hunan University of Chinese Medicine,Changsha 410208,China;School of Integrated Chinese and Western Medicine,Hunan University of Chinese Medicine,Changsha 410208,China)
出处
《生物化学与生物物理进展》
SCIE
CAS
CSCD
北大核心
2023年第3期486-496,共11页
Progress In Biochemistry and Biophysics
基金
国家自然科学基金(81774208)
中国博士后科学基金(2020M682578)
广东省重点领域研发项目(2020B1111100001)
湖南省自然科学基金(2022JJ40300)
湖南省教育厅科学研究项目(21B0366)资助。
