{"id":32746,"date":"2023-05-13T14:44:01","date_gmt":"2023-05-13T07:44:01","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=32746"},"modified":"2023-05-13T14:44:01","modified_gmt":"2023-05-13T07:44:01","slug":"bnp-va-nt-probnp","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/13\/bnp-va-nt-probnp\/","title":{"rendered":"C\u1eadp nh\u1eadt d\u1ea5u \u1ea5n BNP v\u00e0 NT – proBNP trong suy tim"},"content":{"rendered":"

Nh\u1eefng ti\u1ebfn b\u1ed9 g\u1ea7n \u0111\u00e2y trong c\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 d\u1ea5u \u1ea5n sinh h\u1ecdc trong suy tim (HF) cho th\u1ea5y tri\u1ec3n v\u1ecdng t\u1eeb c\u00e1c d\u1ea5u \u1ea5n truy\u1ec1n th\u1ed1ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n b\u1ecb \u1ea3nh h\u01b0\u1edfng. Peptide l\u1ee3i ni\u1ec7u lo\u1ea1i B (BNP) v\u00e0 \u0111\u1ed1i t\u00e1c pro-peptide \u0111\u1ea7u cu\u1ed1i amino (NT-proBNP) \u0111\u00e3 nhanh ch\u00f3ng tr\u1edf th\u00e0nh m\u1ed9t th\u00e0nh ph\u1ea7n thi\u1ebft y\u1ebfu trong ch\u1ea9n \u0111o\u00e1n v\u00e0 x\u00e1c \u0111\u1ecbnh ti\u00ean l\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n HF.<\/strong><\/p>\n

1. T\u1ed5ng quan v\u1ec1 d\u1ea5u \u1ea5n sinh h\u1ecdc<\/strong><\/h1>\n

M\u1eb7c d\u00f9 c\u00f3 s\u1ef1 ch\u1ed3ng ch\u00e9o \u0111\u00e1ng k\u1ec3, c\u00e1c d\u1ea5u \u1ea5n sinh h\u1ecdc c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eafp x\u1ebfp m\u1ed9t c\u00e1ch l\u1ecfng l\u1ebbo th\u00e0nh c\u00e1c lo\u1ea1i sau:<\/p>\n

    \n
  • C\u0103ng th\u00e0nh\/t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim.<\/li>\n
  • K\u00edch ho\u1ea1t t\u1ebf b\u00e0o th\u1ea7n kinh.<\/li>\n
  • Thay \u0111\u1ed5i c\u1ea5u tr\u00fac\/ch\u1ee9c n\u0103ng.<\/li>\n
  • C\u00e1c b\u1ec7nh \u0111i k\u00e8m.<\/li>\n<\/ul>\n

    C\u00f3 qu\u00e1 nhi\u1ec1u th\u1ee9 \u0111\u1ec3 xem x\u00e9t trong m\u1ed9t b\u1ea3n t\u00f3m t\u1eaft ng\u1eafn; do \u0111\u00f3, ch\u1ec9 nh\u1eefng d\u1ea5u \u1ea5n sinh h\u1ecdc ph\u00f9 h\u1ee3p nh\u1ea5t v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng m\u1edbi \u0111\u01b0\u1ee3c th\u1ea3o lu\u1eadn<\/p>\n\n\n\n\n
    C\u0103ng th\u00e0nh\/t\u1ed5n th\u01b0\u01a1ng c\u01a1 tim<\/strong><\/p>\n

    \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 C\u0103ng\u00a0 c\u01a1<\/strong>: NT-proBNP, BNP, MR-proANP<\/p>\n

    \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 T\u1ed5n th\u01b0\u01a1ng c\u01a1 tim<\/strong>: Troponin T, troponin I, chu\u1ed7i nh\u1eb9 myosin I, protein axit b\u00e9o lo\u1ea1i tim, CK MB<\/p>\n

    \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Stress oxy h\u00f3a<\/strong>: Myeloperoxidase, axit uric, lipoprotein m\u1eadt \u0111\u1ed9 th\u1ea5p b\u1ecb oxy h\u00f3a, biopyrrin trong n\u01b0\u1edbc ti\u1ec3u, isoprostanes trong n\u01b0\u1edbc ti\u1ec3u v\u00e0 huy\u1ebft t\u01b0\u01a1ng, malondialdehyde huy\u1ebft t\u01b0\u01a1ng<\/td>\n

    		K\u00edch ho\u1ea1t th\u1ea7n kinh n\u1ed9i ti\u1ebft t\u1ed1<\/strong><\/p>\n

    \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 H\u1ec7 renin-angiotensin<\/strong>: Renin, angiotensin II, aldosteron<\/p>\n

    \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 H\u1ec7 th\u1ed1ng th\u1ea7n kinh giao c\u1ea3m<\/strong>: Norepinephrine, Chromogranin A, MR-proADM<\/p>\n

    \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 H\u1ec7 th\u1ed1ng arginine vasopressin<\/strong>: Arginine vasopressin, copeptin<\/p>\n

    \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 N\u1ed9i ti\u1ebft<\/strong>: ET-1, proET-1 l\u1edbn<\/td>\n<\/tr>\n

    Thay \u0111\u1ed5i c\u1ea5u tr\u00fac\/ch\u1ee9c n\u0103ng<\/strong><\/p>\n

    \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vi\u00eam<\/strong>: Protein ph\u1ea3n \u1ee9ng C, TNF-\u03b1, th\u1ee5 th\u1ec3 TNF h\u00f2a tan, Fas, interleukin (I, 6 v\u00e0 18), osteoprotegerin, adiponectin<\/p>\n

    \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ph\u00ec \u0111\u1ea1i\/x\u01a1 h\u00f3a<\/strong>: Matrix metalloproteinases, collagen propeptides, galectin-3, ST2 h\u00f2a tan<\/p>\n

    \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 S\u1ef1 ch\u1ebft t\u1ebf b\u00e0o<\/strong>: GDF-15<\/p>\n

    \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Kh\u00e1c<\/strong>: MicroARN, quiescin Q6, VEGFR-1<\/td>\n

    		B\u1ec7nh \u0111i k\u00e8m<\/strong><\/p>\n

    \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ch\u1ee9c n\u0103ng th\u1eadn<\/strong>: Creatinine, BUN, eGFR, cystatin C, protein v\u1ebft<\/p>\n

    \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 D\u1ea5u hi\u1ec7u t\u1ed5n th\u01b0\u01a1ng th\u1eadn<\/strong>: NGAL, KIM-1, NAG, protein li\u00ean k\u1ebft v\u1edbi axit b\u00e9o lo\u1ea1i gan, IL-18<\/p>\n

    \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 D\u1ea5u \u1ea5n sinh h\u1ecdc huy\u1ebft h\u1ecdc<\/strong>: Hemoglobin, RDW, thi\u1ebfu s\u1eaft (ferritin, transferrin sat)<\/p>\n

    \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 X\u00e9t nghi\u1ec7m ch\u1ee9c n\u0103ng gan<\/strong>: albumin<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    2. BNP and NT-proBNP<\/strong><\/h2>\n

    T\u00e1c nh\u00e2n g\u00e2y ra phi\u00ean m\u00e3 gen BNP m\u1ea1nh nh\u1ea5t l\u00e0 s\u1ef1 c\u0103ng ra c\u1ee7a th\u00e0nh th\u1ea5t tr\u00e1i (LV) do t\u0103ng \u00e1p su\u1ea5t ho\u1eb7c th\u1ec3 t\u00edch. M\u1ed9t prohormone (proBNP) \u0111\u01b0\u1ee3c ph\u00e2n c\u1eaft th\u00e0nh BNP v\u00e0 NT-proBNP, d\u1eabn \u0111\u1ebfn b\u1eb1ng ch\u1ee9ng huy\u1ebft thanh h\u1ecdc v\u1ec1 BNP, NT-proBNP v\u00e0 proBNP. C\u00e1c x\u00e9t nghi\u1ec7m th\u00f4ng th\u01b0\u1eddng \u0111\u1ed1i v\u1edbi BNP ph\u00e1t hi\u1ec7n proBNP v\u00e0 BNP, c\u0169ng nh\u01b0 c\u00e1c \u0111o\u1ea1n BNP b\u1ecb ph\u00e2n h\u1ee7y kh\u00e1c nhau, trong khi x\u00e9t nghi\u1ec7m NT-proBNP ph\u00e1t hi\u1ec7n NT-proBNP v\u00e0 proBNP.<\/p>\n

    K\u00edch th\u00edch th\u1ee5 th\u1ec3 natriuretic peptide b\u1eb1ng BNP g\u00e2y ra natriuresis, l\u1ee3i ti\u1ec3u, gi\u00e3n m\u1ea1ch, \u1ee9c ch\u1ebf renin v\u00e0 aldosterone v\u00e0 \u1ee9c ch\u1ebf x\u01a1 h\u00f3a. BNP b\u1ecb lo\u1ea1i b\u1ecf kh\u1ecfi d\u00f2ng m\u00e1u theo c\u01a1 ch\u1ebf qua trung gian th\u1ee5 th\u1ec3 c\u0169ng nh\u01b0 b\u1ecb ph\u00e2n h\u1ee7y b\u1edfi c\u00e1c endopeptidase trung t\u00ednh nh\u01b0 neprilysin (c\u00f9ng lo\u1ea1i enzyme b\u1ecb \u1ee9c ch\u1ebf b\u1edfi lo\u1ea1i thu\u1ed1c m\u1edbi, LCZ696). \u0110i\u1ec1u quan tr\u1ecdng l\u00e0 vi\u1ec7c s\u1eed d\u1ee5ng LCZ696 l\u00e0m t\u0103ng \u0111\u00e1ng k\u1ec3 BNP (nh\u01b0ng kh\u00f4ng l\u00e0m t\u0103ng NT-proBNP) gi\u00e1 tr\u1ecb nh\u01b0 l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c. Do \u0111\u00f3, vi\u1ec7c gi\u1ea3i th\u00edch BNP \u1edf b\u1ec7nh nh\u00e2n d\u00f9ng LCZ696 s\u1ebd l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c, n\u1ebfu kh\u00f4ng mu\u1ed1n n\u00f3i l\u00e0 kh\u00f4ng th\u1ec3. Ngo\u00e0i c\u00e1c ph\u01b0\u01a1ng th\u1ee9c thanh th\u1ea3i n\u00e0y, c\u1ea3 BNP v\u00e0 NT-proBNP \u0111\u1ec1u \u0111\u01b0\u1ee3c thanh th\u1ea3i th\u1ee5 \u0111\u1ed9ng b\u1edfi m\u1ed9t s\u1ed1 c\u01a1 quan bao g\u1ed3m c\u1ea3 th\u1eadn. Th\u1eddi gian b\u00e1n h\u1ee7y c\u1ee7a BNP ng\u1eafn h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi NT-proBNP (kho\u1ea3ng 20 so v\u1edbi 60-120 ph\u00fat).<\/p>\n

     <\/p>\n

    \"\"
    Ngu\u1ed3n: BNP and NT-proBNP as Diagnostic Biomarkers for Cardiac Dysfunction in Both Clinical and Forensic Medicine<\/strong><\/figcaption><\/figure>\n

    2.1. \u0110\u00e1nh gi\u00e1 BNP v\u00e0 NT – proBNP \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n HF c\u1ea5p t\u00ednh<\/strong><\/h3>\n

    Th\u00f4ng th\u01b0\u1eddng, n\u1ed3ng \u0111\u1ed9 BNP v\u00e0 NT-proBNP l\u01b0u h\u00e0nh kh\u00e1 th\u1ea5p, nh\u01b0ng trong t\u00ecnh tr\u1ea1ng HF, n\u1ed3ng \u0111\u1ed9 c\u1ee7a ch\u00fang t\u0103ng l\u00ean \u0111\u00e1ng k\u1ec3. Nghi\u00ean c\u1ee9u the Breathing Not Properly Multinational \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng gi\u00e1 tr\u1ecb BNP >100 pg\/mL ch\u1ea9n \u0111o\u00e1n HF c\u1ea5p t\u00ednh v\u1edbi \u0111\u1ed9 ch\u00ednh x\u00e1c cao \u1edf m\u1ee9c 85% v\u00e0 d\u1ef1 \u0111o\u00e1n ch\u1eafc ch\u1eafn v\u1ec1 HF, v\u01b0\u1ee3t tr\u1ed9i so v\u1edbi c\u00e1c ti\u00eau ch\u00ed l\u00e2m s\u00e0ng. Nh\u1eefng ph\u00e1t hi\u1ec7n t\u01b0\u01a1ng t\u1ef1 c\u0169ng \u0111\u01b0\u1ee3c ghi nh\u1eadn \u0111\u1ed1i v\u1edbi NT-proBNP trong nghi\u00ean c\u1ee9u the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE), trong \u0111\u00f3 n\u1ed3ng \u0111\u1ed9 NT-proBNP t\u0103ng cao l\u00e0 y\u1ebfu t\u1ed1 d\u1ef1 \u0111o\u00e1n HF m\u1ea1nh nh\u1ea5t so v\u1edbi \u0111\u00e1nh gi\u00e1 truy\u1ec1n th\u1ed1ng. Ng\u01b0\u1ee1ng NT-proBNP \u0111\u01a1n l\u1ebb 900 pg\/mL cung c\u1ea5p hi\u1ec7u su\u1ea5t ch\u1ea9n \u0111o\u00e1n t\u01b0\u01a1ng t\u1ef1 nh\u01b0 BNP 100 pg\/mL, nh\u01b0ng ng\u01b0\u1ee1ng NT-proBNP \u0111\u01b0\u1ee3c ph\u00e2n t\u1ea7ng theo \u0111\u1ed9 tu\u1ed5i (\u2265450 cho \u0111\u1ed9 tu\u1ed5i <50 tu\u1ed5i, \u2265900 cho 50-75 tu\u1ed5i v\u00e0 \u22651800 pg\/mL trong >75 n\u0103m) cho k\u1ebft qu\u1ea3 t\u1ed1t nh\u1ea5t. \u00a0Ph\u01b0\u01a1ng ph\u00e1p ch\u1ea9n \u0111o\u00e1n t\u1ed1t nh\u1ea5t \u0111\u1ec3 s\u1eed d\u1ee5ng BNP ho\u1eb7c NT-proBNP l\u00e0 h\u1ed7 tr\u1ee3 \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng, thay v\u00ec thay th\u1ebf n\u00f3; th\u1ef1c s\u1ef1, c\u1ea3 hai d\u1ea5u \u1ea5n sinh h\u1ecdc \u0111\u1ec1u \u0111\u1eb7c bi\u1ec7t h\u1eefu \u00edch khi c\u00f2n nghi ng\u1edd trong ch\u1ea9n \u0111o\u00e1n. Ngo\u00e0i kh\u1ea3 n\u0103ng ch\u1ea9n \u0111o\u00e1n HF khi t\u0103ng r\u00f5 r\u1ec7t, c\u1ea3 BNP v\u00e0 NT-proBNP c\u0169ng h\u1eefu \u00edch \u0111\u1ec3 lo\u1ea1i tr\u1eeb ch\u1ea9n \u0111o\u00e1n khi r\u1ea5t th\u1ea5p.<\/p>\n

    2.2. C\u1ea9n th\u1eadn v\u1edbi BNP v\u00e0 NT – proBNP<\/strong><\/h3>\n

    Ngo\u00e0i “HF”, m\u1ed9t s\u1ed1 r\u1ed1i lo\u1ea1n tim ph\u1ed5i kh\u00e1c c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng gi\u00e1 tr\u1ecb BNP ho\u1eb7c NT-proBNP: h\u1ed9i ch\u1ee9ng m\u1ea1ch v\u00e0nh c\u1ea5p t\u00ednh, vi\u00eam c\u01a1 tim, b\u1ec7nh van tim, b\u1ec7nh c\u01a1 tim ph\u00ec \u0111\u1ea1i, thu\u1ed1c g\u00e2y \u0111\u1ed9c cho tim, rung t\u00e2m nh\u0129 ho\u1eb7c rung nh\u0129 v\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00e2m th\u1ea5t ph\u1ea3i trong b\u1ed1i c\u1ea3nh \u0111\u00e1ng k\u1ec3 b\u1ec7nh ph\u1ed5i (t\u0103ng huy\u1ebft \u00e1p ph\u1ed5i, thuy\u00ean t\u1eafc ph\u1ed5i).<\/p>\n

    C\u00e1c t\u00ecnh tr\u1ea1ng kh\u00e1c c\u00f3 li\u00ean quan \u0111\u1ebfn n\u1ed3ng \u0111\u1ed9 BNP ho\u1eb7c NT-proBNP cao h\u01a1n c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn c\u00e1c b\u1ec7nh \u0111i k\u00e8m (tu\u1ed5i cao, r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn, \u0111\u1ed9t qu\u1ef5 v\u00e0 b\u1ec7nh hi\u1ec3m ngh\u00e8o) v\u00e0 tr\u1ea1ng th\u00e1i k\u00edch th\u00edch. Cu\u1ed1i c\u00f9ng, nh\u01b0 \u0111\u00e3 l\u01b0u \u00fd \u1edf tr\u00ean, vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf neprilysin (ch\u1eb3ng h\u1ea1n nh\u01b0 ch\u1ea5t \u1ee9c ch\u1ebf trong LCZ696) d\u1eabn \u0111\u1ebfn vi\u1ec7c ‘t\u0103ng’ gi\u00e1 tr\u1ecb BNP; \u0111\u00e1ng ch\u00fa \u00fd l\u00e0 nh\u1eefng lo\u1ea1i thu\u1ed1c n\u00e0y kh\u00f4ng \u1ea3nh \u00a0h\u01b0\u1edfng \u0111\u1ebfn n\u1ed3ng \u0111\u1ed9 NT-proBNP. Khi s\u1ef1 \u1ee9c ch\u1ebf neprilysin \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn h\u01a1n, kh\u1ea3 n\u0103ng gi\u1ea3i th\u00edch BNP s\u1ebd b\u1ecb th\u00e1ch th\u1ee9c \u0111\u00e1ng k\u1ec3 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb nh\u01b0 v\u1eady.<\/p>\n

    \"\"
    Ngu\u1ed3n: Obesity and natriuretic peptides, BNP and NT-proBNP: mechanisms and diagnostic implications for heart failure<\/strong><\/figcaption><\/figure>\n

    2.3. Ti\u00ean l\u01b0\u1ee3ng v\u00e0 \u0111i\u1ec1u tr\u1ecb HF<\/strong><\/h3>\n

    BNP v\u00e0 NT-proBNP l\u00e0 nh\u1eefng y\u1ebfu t\u1ed1 ti\u00ean l\u01b0\u1ee3ng m\u1ea1nh m\u1ebd k\u1ebft qu\u1ea3 l\u00e2m s\u00e0ng trong t\u1ea5t c\u1ea3 c\u00e1c giai \u0111o\u1ea1n c\u1ee7a HF. Trong Acute Decompensated Heart Failure National Registry (ADHERE), \u00a0gi\u00e1 tr\u1ecb BNP khi nh\u1eadp vi\u1ec7n cho suy tim m\u1ea5t b\u00f9 c\u1ea5p \u1edf nh\u00f3m t\u1ee9 ph\u00e2n v\u1ecb cao nh\u1ea5t (BNP \u22651730 pg\/mL) c\u00f3 li\u00ean quan \u0111\u1ebfn t\u1ef7 l\u1ec7 t\u1eed vong trong b\u1ec7nh vi\u1ec7n t\u0103ng g\u1ea5p 2.23 l\u1ea7n so v\u1edbi BNP \u1edf nh\u00f3m ph\u1ea7n t\u01b0 th\u1ea5p nh\u1ea5t (<430 pg\/mL), ngay c\u1ea3 sau khi \u0111i\u1ec1u ch\u1ec9nh c\u00e1c y\u1ebfu t\u1ed1 g\u00e2y nhi\u1ec5u ti\u1ec1m \u1ea9n v\u00e0 b\u1ea5t k\u1ec3 EF. T\u01b0\u01a1ng t\u1ef1 nh\u01b0 v\u1eady, n\u1ed3ng \u0111\u1ed9 NT-proBNP c\u00f3 t\u00ednh d\u1ef1 \u0111o\u00e1n m\u1ea1nh m\u1ebd v\u1ec1 k\u1ebft qu\u1ea3 l\u00e2m s\u00e0ng ng\u1eafn h\u1ea1n v\u00e0 d\u00e0i h\u1ea1n; Nh\u1eadp vi\u1ec7n NT-proBNP >986 pg\/mL c\u00f3 li\u00ean quan \u0111\u1ebfn t\u1ef7 l\u1ec7 t\u1eed vong trong m\u1ed9t n\u0103m t\u0103ng g\u1ea7n g\u1ea5p ba l\u1ea7n (t\u1ef7 l\u1ec7 nguy c\u01a1 \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh [HR] 2,88). \u0110i\u1ec1u quan tr\u1ecdng l\u00e0, c\u1ea3 n\u1ed3ng \u0111\u1ed9 peptid natri l\u1ee3i ni\u1ec7u tuy\u1ec7t \u0111\u1ed1i khi xu\u1ea5t vi\u1ec7n c\u0169ng nh\u01b0 ph\u1ea7n tr\u0103m thay \u0111\u1ed5i t\u1eeb nh\u1eadp vi\u1ec7n \u0111\u1ec3 xu\u1ea5t vi\u1ec7n cung c\u1ea5p th\u00f4ng tin l\u1edbn h\u01a1n \u0111\u00e1ng k\u1ec3 v\u1ec1 nguy c\u01a1 t\u1eed vong v\u00e0\/ho\u1eb7c t\u00e1i nh\u1eadp vi\u1ec7n sau \u0111\u00f3 so v\u1edbi c\u00e1c gi\u00e1 tr\u1ecb nh\u1eadp vi\u1ec7n. Trong nghi\u00ean c\u1ee9u Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF), \u00a0BNP chuy\u1ec3n \u0111\u1ed5i \u00a0log khi xu\u1ea5t vi\u1ec7n (ch\u1ee9 kh\u00f4ng ph\u1ea3i nh\u1eadp vi\u1ec7n) l\u00e0 y\u1ebfu t\u1ed1 d\u1ef1 \u0111o\u00e1n quan tr\u1ecdng nh\u1ea5t v\u1ec1 t\u1ef7 l\u1ec7 t\u1eed vong trong m\u1ed9t n\u0103m (HR l\u00e0 1,34) v\u00e0 m\u1ed9t -n\u0103m t\u1eed vong ho\u1eb7c t\u00e1i nh\u1eadp vi\u1ec7n (HR 1.15). \u0110i\u1ec1u n\u00e0y cho th\u1ea5y chi\u1ebfn l\u01b0\u1ee3c l\u1ea5y m\u1eabu nh\u1eadp vi\u1ec7n\/xu\u1ea5t vi\u1ec7n l\u00e0 h\u1ee3p l\u00fd.<\/p>\n

    Ph\u00e9p \u0111o n\u1ed1i ti\u1ebfp \u1edf b\u1ec7nh nh\u00e2n HF m\u1ea1n t\u00ednh c\u0169ng d\u1ef1 \u0111o\u00e1n ti\u00ean l\u01b0\u1ee3ng r\u1ea5t t\u1ed1t. Trong nghi\u00ean c\u1ee9u Valsartan Heart Failure\u00a0 \u00a0(Val-HeFT), gi\u00e1 tr\u1ecb NT-proBNP li\u00ean t\u1ee5c \u0111\u01b0\u1ee3c chuy\u1ec3n \u0111\u1ed5i log trong 4 th\u00e1ng \u0111\u00e3 b\u1ed5 sung gi\u00e1 tr\u1ecb ti\u00ean l\u01b0\u1ee3ng gia t\u0103ng v\u00e0o ph\u00e9p \u0111o c\u01a1 b\u1ea3n trong m\u00f4 h\u00ecnh \u0111a bi\u1ebfn \u0111\u1ec3 d\u1ef1 \u0111o\u00e1n t\u1ef7 l\u1ec7 t\u1eed vong (HR = 1.99). H\u01b0\u1edbng thay \u0111\u1ed5i gi\u00e1 tr\u1ecb NT-proBNP theo th\u1eddi gian ph\u1ea3n \u00e1nh ch\u1eb7t ch\u1ebd nh\u1eefng thay \u0111\u1ed5i trong ti\u00ean l\u01b0\u1ee3ng. B\u1ec7nh nh\u00e2n c\u00f3 NT-proBNP ban \u0111\u1ea7u t\u0103ng trong b\u1ed1n th\u00e1ng t\u1eeb d\u01b0\u1edbi gi\u00e1 tr\u1ecb ng\u01b0\u1ee1ng 1.078 pg\/mL l\u00ean tr\u00ean gi\u00e1 tr\u1ecb ng\u01b0\u1ee1ng c\u00f3 li\u00ean quan \u0111\u1ebfn nguy c\u01a1 t\u1eed vong t\u0103ng 1.7 l\u1ea7n (HR = 1.70), so v\u1edbi NT-proBNP d\u01b0\u1edbi ng\u01b0\u1ee1ng gi\u00e1 tr\u1ecb ng\u01b0\u1ee1ng xuy\u00ean su\u1ed1t v\u00e0 c\u00f3 r\u1ee7i ro t\u01b0\u01a1ng t\u1ef1 nh\u01b0 nh\u1eefng ng\u01b0\u1eddi c\u00f3 gi\u00e1 tr\u1ecb NT-proBNP duy tr\u00ec \u1edf m\u1ee9c cao trong su\u1ed1t (HR 1.88).<\/p>\n

    C\u00e1c li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb suy tim gi\u00fap c\u1ea3i thi\u1ec7n t\u1ef7 l\u1ec7 t\u1eed vong v\u00e0 b\u1ec7nh su\u1ea5t \u1edf b\u1ec7nh nh\u00e2n suy tim l\u00e0m gi\u1ea3m c\u00e1c gi\u00e1 tr\u1ecb natriuretic peptide n\u00e0y. Quan s\u00e1t n\u00e0y \u0111\u00e3 d\u1eabn \u0111\u1ebfn kh\u00e1i ni\u1ec7m qu\u1ea3n l\u00fd HF h\u01b0\u1edbng d\u1eabn b\u1eb1ng d\u1ea5u \u1ea5n sinh h\u1ecdc s\u1eed d\u1ee5ng BNP ho\u1eb7c NT-proBNP \u0111\u1ec3 b\u1ed5 sung cho \u0111\u00e1nh gi\u00e1 l\u00e2m s\u00e0ng. C\u00e1c ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p cho th\u1ea5y gi\u1ea3m 20-30% t\u1ef7 l\u1ec7 t\u1eed vong khi ch\u0103m s\u00f3c HF theo h\u01b0\u1edbng d\u1eabn c\u1ee7a d\u1ea5u \u1ea5n sinh h\u1ecdc so v\u1edbi ch\u0103m s\u00f3c HF ti\u00eau chu\u1ea9n v\u00e0 c\u00e1c nghi\u00ean c\u1ee9u ti\u1ec1n c\u1ee9u \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng \u0111\u00e1nh gi\u00e1 ngo\u1ea1i tr\u00fa h\u00e0ng lo\u1ea1t c\u00e1c peptid l\u1ee3i ni\u1ec7u d\u1eabn \u0111\u1ebfn t\u0103ng li\u1ec1u thu\u1ed1c \u0111i\u1ec1u tr\u1ecb HF v\u00e0 gi\u1ea3m c\u00e1c peptide l\u1ee3i ni\u1ec7u. M\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng l\u1edbn, th\u1eed nghi\u1ec7m Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure (GUIDE-IT), s\u1ebd xem x\u00e9t gi\u00e1 tr\u1ecb c\u1ee7a vi\u1ec7c \u0111i\u1ec1u tr\u1ecb k\u00e8m theo d\u00f5i gi\u00e1 tr\u1ecb NT-proBNP \u1edf b\u1ec7nh nh\u00e2n HFrEF.<\/p>\n

    M\u1ed9t s\u1ed1 t\u00ecnh tr\u1ea1ng c\u00f3 li\u00ean quan \u0111\u1ebfn n\u1ed3ng \u0111\u1ed9 natriuretic peptide th\u1ea5p h\u01a1n d\u1ef1 ki\u1ebfn: HF v\u1edbi ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u b\u1ea3o t\u1ed3n (HFpEF) so v\u1edbi HF v\u1edbi ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m (HFrEF) v\u00e0 b\u00e9o ph\u00ec. B\u00e9o ph\u00ec c\u00f3 li\u00ean quan \u0111\u1ebfn gi\u00e1 tr\u1ecb BNP ho\u1eb7c NT-proBNP th\u1ea5p h\u01a1n d\u1ef1 ki\u1ebfn, c\u00f3 th\u1ec3 l\u00e0 do \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p ho\u1eb7c gi\u1ea3i ph\u00f3ng peptit natriuretic. Tuy nhi\u00ean, BNP v\u00e0 NT-proBNP t\u0103ng cao v\u1eabn c\u00f3 th\u1ec3 ch\u1ea9n \u0111o\u00e1n HF c\u1ea5p t\u00ednh b\u1ea5t k\u1ec3 ch\u1ec9 s\u1ed1 kh\u1ed1i c\u01a1 th\u1ec3 m\u1ed9t c\u00e1ch ch\u00ednh x\u00e1c, nh\u01b0ng v\u1edbi \u0111\u1ed9 nh\u1ea1y th\u1ea5p h\u01a1n.7 Tr\u00ean th\u1ef1c t\u1ebf, c\u00e1c \u0111i\u1ec3m c\u1eaft ph\u00e2n t\u1ea7ng theo \u0111\u1ed9 tu\u1ed5i c\u1ee7a NT-proBNP c\u00f3 \u0111\u1ed9 nh\u1ea1y 86%, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u l\u00e0 90% v\u1edbi gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n d\u01b0\u01a1ng t\u00ednh l\u00e0 85% v\u00e0 gi\u00e1 tr\u1ecb ti\u00ean \u0111o\u00e1n \u00e2m t\u00ednh l\u00e0 95% \u1edf b\u1ec7nh nh\u00e2n b\u00e9o ph\u00ec. \u0110\u1ed1i v\u1edbi HFpEF, c\u00e1c ng\u01b0\u1ee1ng t\u01b0\u01a1ng t\u1ef1 \u0111\u1ed1i v\u1edbi BNP ho\u1eb7c NT-proBNP c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n HF v\u1edbi hi\u1ec3u bi\u1ebft r\u1eb1ng \u0111\u1ed9 nh\u1ea1y gi\u1ea3m \u0111i ph\u1ea7n n\u00e0o.<\/p>\n

    Ngu\u1ed3n tham kh\u1ea3o<\/strong>:<\/p>\n

      \n
    • Hanna Kim Gaggin, MD, MPH, FACC; James L. Januzzi, Jr., MD, FACC, \u201cCardiac Biomarkers and Heart Failure\u201d,<\/strong> American College of Cardiology<\/em>, May 05, 2023.<\/li>\n<\/ul>\n
      usechatgpt init success<\/div>\n","protected":false},"excerpt":{"rendered":"

      Nh\u1eefng ti\u1ebfn b\u1ed9 g\u1ea7n \u0111\u00e2y trong c\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 d\u1ea5u \u1ea5n sinh h\u1ecdc trong suy tim (HF) cho th\u1ea5y tri\u1ec3n v\u1ecdng t\u1eeb c\u00e1c d\u1ea5u \u1ea5n truy\u1ec1n th\u1ed1ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 b\u1ec7nh nh\u00e2n b\u1ecb \u1ea3nh h\u01b0\u1edfng. Peptide l\u1ee3i ni\u1ec7u lo\u1ea1i B (BNP) v\u00e0 \u0111\u1ed1i t\u00e1c pro-peptide \u0111\u1ea7u cu\u1ed1i amino (NT-proBNP) \u0111\u00e3 nhanh ch\u00f3ng tr\u1edf th\u00e0nh […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[],"yoast_head":"\nC\u1eadp nh\u1eadt d\u1ea5u \u1ea5n BNP v\u00e0 NT - proBNP trong suy tim - Vinmec<\/title>\n<meta name=\"description\" content=\"Nh\u1eefng ti\u1ebfn b\u1ed9 g\u1ea7n \u0111\u00e2y trong c\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 d\u1ea5u \u1ea5n sinh h\u1ecdc trong suy tim (HF) cho th\u1ea5y tri\u1ec3n v\u1ecdng t\u1eeb c\u00e1c d\u1ea5u \u1ea5n BNP v\u00e0 NT - proBNP \u0111\u1ec3 \u0111\u00e1nh\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"C\u1eadp nh\u1eadt d\u1ea5u \u1ea5n BNP v\u00e0 NT - 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