心衰生物标记物研究新进展

Research Advancements for Biomarkers Used in Heart Failure

心力衰竭(心衰)是临床最常见的危重疾病之一,其致死率不低于某些癌症。随着现代医学进展,年龄依赖性死亡率明显下降,冠脉事件显著减少,患者生存时间延长,心衰患病率较前增加。针对心衰的研究不断更新,心衰的病理生理机制日益趋向完善,不仅仅涉及先前众所周知的心肌损伤或者心脏前后负荷增加,更多因素先后被发现参与心衰的发生、发展,包括神经内分泌机制、炎症反应,内分泌信号系统和生化因素等。伴随心衰病理生理过程产生了一系列的生物标记物,某些生物标记物在协助临床医生诊疗心衰患者方面发挥重要作用。具体包括神经激素类生物(例如:脑钠肽、氨基末端-pro BNP、心房钠尿肽前体中段、肾上腺髓质素前体中段和嗜铬素A),炎症因子类生物标记物(例如:CRP、IL-6和ST2),内分泌生物标志物(例如:脂联素、抵抗素、瘦素和醛固酮),其他生物标记物(包括:肌钙蛋白I/T、乳糖凝集素-3、胱氨酸蛋白酶抑制剂C、生长分化因子-15和基质金属蛋白酶)。生物标记物凭借其高度敏感性及特异性,在心衰的诊断、危险分层及评估预后等方面发挥重要作用。本文就心衰生物标记物最新研究进展做一综述。

Heart failure is potentially life threatening with a natural history that is as lethal as some forms of colon cancer. Whilst advances in modem treatment for HF are having significant impact on reducing age-adjusted mortality, there is a continuous increase in the prevalence of HF due to the ever-swelling aging population as well as medical success in reducing or preventing coronary events and thus prolongation of survival Heart failure appears to be not only the result of myocardial injury or hemodynamic overload as commonly perceived, but it is also the result of an interplay among genetic, neurohormonal, inflammatory, and biochemical factors. These are collectively referred to as biomarkers. Among those markers identified in patients with heart failure, a number appears to have direct clinical relevance in aiding diagnosis, risk stratification, monitoring therapy, and treating to targets in order to improve clinical outcomes. These include natriuretic peptides （e.g., Brain Natriuretic Peptide, N-terminal pro b-type natriuretic peptide, MR-pro-atrial natriuretic peptide, Midregion prohormone adrenomedullin, chromogranin A, et al.）, inflammatory markers （e.g., CRP, IL-6, ST2, et al.）, neurohormones （e.g., Adiponectin, Resistin, Leptin, aldosterone, et al.）, and other biomarkers （e.g., troponin I/T, Galeetin-3, Cystatin C, GDF-15, MMP, et al.）. Biomarkers, with their high specificity and sensitivity, play an important role in diagnosis, risk stratification and prognosis of patients with HF. Within this context, we will review current research advancements in this field.