BNP，NT-proBNP研究の最前線
Brain natriuretic peptide（BNP）とN terminal（NT）-proBNPは心不全の診断，予後を推定できる有用なバイオマーカーである．しかし，BNPは循環器内科医や一般内科医にとって有用なだけではなく，将来は健診医にとっても有用なバイオマーカーと成り得ると思われる．つまり，BNPやNT-proBNPは心不全と診断できる値より低値で，将来の死亡，心疾患や脳卒中の発症を予測できることが知られてきている．したがって，人間ドックにて高血圧，糖尿病（耐糖能障害も含む），脂質異常症，喫煙などがあり，すでに将来の動脈硬化性疾患の発症リスクのある人は，BNPやNT-proBNPを...
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| Published in | 人間ドック Vol. 31; no. 4; pp. 541 - 549 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
公益社団法人 日本人間ドック学会
2016
日本人間ドック学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1880-1021 2186-5027 |
| DOI | 10.11320/ningendock.31.541 |
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| Abstract | Brain natriuretic peptide（BNP）とN terminal（NT）-proBNPは心不全の診断，予後を推定できる有用なバイオマーカーである．しかし，BNPは循環器内科医や一般内科医にとって有用なだけではなく，将来は健診医にとっても有用なバイオマーカーと成り得ると思われる．つまり，BNPやNT-proBNPは心不全と診断できる値より低値で，将来の死亡，心疾患や脳卒中の発症を予測できることが知られてきている．したがって，人間ドックにて高血圧，糖尿病（耐糖能障害も含む），脂質異常症，喫煙などがあり，すでに将来の動脈硬化性疾患の発症リスクのある人は，BNPやNT-proBNPを測定し，もし，それが正常高値にあれば，将来の脳心疾患の発症を防ぐために，さらに厳密なリスク管理を施す必要があると思われる．さらに，BNPは糖代謝とも関連していることが最近知られてきており，将来，糖尿病医にとっても大切なバイオマーカーになる可能性もある． |
|---|---|
| AbstractList | Brain natriuretic peptide（BNP）とN terminal（NT）-proBNPは心不全の診断，予後を推定できる有用なバイオマーカーである．しかし，BNPは循環器内科医や一般内科医にとって有用なだけではなく，将来は健診医にとっても有用なバイオマーカーと成り得ると思われる．つまり，BNPやNT-proBNPは心不全と診断できる値より低値で，将来の死亡，心疾患や脳卒中の発症を予測できることが知られてきている．したがって，人間ドックにて高血圧，糖尿病（耐糖能障害も含む），脂質異常症，喫煙などがあり，すでに将来の動脈硬化性疾患の発症リスクのある人は，BNPやNT-proBNPを測定し，もし，それが正常高値にあれば，将来の脳心疾患の発症を防ぐために，さらに厳密なリスク管理を施す必要があると思われる．さらに，BNPは糖代謝とも関連していることが最近知られてきており，将来，糖尿病医にとっても大切なバイオマーカーになる可能性もある． 「要約」Brain natriuretic peptide(BNP)とN terminal(NT)-proBNPは心不全の診断, 予後を推定できる有用なバイオマーカーである. しかし, BNPは循環器内科医や一般内科医にとって有用なだけではなく, 将来は健診医にとっても有用なバイオマーカーと成り得ると思われる. つまり, BNPやNT-proBNPは心不全と診断できる値より低値で, 将来の死亡, 心疾患や脳卒中の発症を予測できることが知られてきている. したがって, 人間ドックにて高血圧, 糖尿病(耐糖能障害も含む), 脂質異常症, 喫煙などがあり, すでに将来の動脈硬化性疾患の発症リスクのある人は, BNPやNT-proBNPを測定し, もし, それが正常高値にあれば, 将来の脳心疾患の発症を防ぐために, さらに厳密なリスク管理を施す必要があると思われる. さらに, BNPは糖代謝とも関連していることが最近知られてきており, 将来, 糖尿病医にとっても大切なバイオマーカーになる可能性もある. |
| Author | 加藤, 公則 |
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| Copyright | 2016 公益社団法人 日本人間ドック学会 |
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| DOI | 10.11320/ningendock.31.541 |
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| References | 20）Schindler EI, Szymanski JJ, Hock KG, et al: Short- and Long-term Biologic Variability of Galectin-3 and Other Cardiac Biomarkers in Patients with Stable Heart Failure and Healthy Adults. Clin Chem 2016; 62: 360-366. 3）de Bold AJ, Borenstein HB, Veress AT, et al: A rapid and potent natriuretic response to intravenous injection of atrial myocardial extract in rats. Life Sci 1981; 28: 89-94. 23）Saenger AK, Dalenberg DA, Bryant SC, et al: Pediatric brain natriuretic peptide concentrations vary with age and sex and appear to be modulated by testosterone. Clin Chem 2009; 55: 1869-1875. 31）Doi Y, Ninomiya T, Hata J, et al: N-terminal pro-brain natriuretic peptide and risk of cardiovascular events in a Japanese community: the Hisayama study. Arterioscler Thromb Vasc Biol 2011; 31: 2997-3003. 1）JAMIESON JD, PALADE GE: SPECIFIC GRANULES IN ATRIAL MUSCLE CELLS. J Cell Biol 1964; 23: 151-172. 24）Dockery F, Bulpitt CJ, Agarwal S, et al: Anti-androgens increase N-terminal pro-BNP levels in men with prostate cancer. Clin Endocrinol (Oxf) 2008; 68: 59-65. 14）慢性心不全治療ガイドライン（2010年改訂版） 2013/9/13更新版，http://www.j-circ.or.jp/guideline/pdf/JCS2010_matsuzaki_h.pdf ［2016.11.9］ 6）Sudoh T, Kangawa K, Minamino N, et al: A new natriuretic peptide in porcine brain. Nature 1988; 332: 78-81. 26）加藤公則，中原寿子，小林隆司ほか：人間ドック受診者におけるN-terminal pro-brain natriuretic peptide測定の意義．人間ドック 2011；26：62-70. 13）Gruden G, Landi A, Bruno G: Natriuretic peptides, heart, and adipose tissue: new findings and future developments for diabetes research. Diabetes Care 2014; 37: 2899-2908. 34）Lazo M, Young JH, Brancati FL, et al: NH2-terminal pro-brain natriuretic peptide and risk of diabetes. Diabetes 2013; 62: 3189-3193. 25）Olivetti G, Melissari M, Capasso JM, et al: Cardiomyopathy of the aging human heart. Myocyte loss and reactive cellular hypertrophy. Circ Res 1991; 68: 1560-1568. 22）Tsutamoto T, Sakai H, Nishiyama K, et al: Direct comparison of transcardiac increase in brain natriuretic peptide (BNP) and N-terminal proBNP and prognosis in patients with chronic heart failure. Circ J 2007; 71: 1873-1878. 12）Dessì-Fulgheri P, Sarzani R, Tamburrini P, et al: Plasma atrial natriuretic peptide and natriuretic peptide receptor gene expression in adipose tissue of normotensive and hypertensive obese patients. J Hypertens 1997; 15: 1695-1699. 7）Sudoh T, Minamino N, Kangawa K, et al: C-type natriuretic peptide (CNP): a new member of natriuretic peptide family identified in porcine brain. Biochem Biophys Res Commun 1990; 168: 863-870. 19）Suzuki S, Yoshimura M, Nakayama M, et al: Plasma level of B-type natriuretic peptide as a prognostic marker after acute myocardial infarction: a long-term follow-up analysis. Circulation 2004; 110: 1387-1391. 29）Wang TJ, Larson MG, Levy D, et al: Plasma natriuretic peptide levels and the risk of cardiovascular events and death. N Engl J Med 2004; 350: 655-663. 5）Kangawa K, Matsuo H: Purification and complete amino acid sequence of alpha-human atrial natriuretic polypeptide (alpha-hANP). Biochem Biophys Res Commun 1984; 118: 131-139. 18）Nishii M, Inomata T, Takehana H, et al: Prognostic utility of B-type natriuretic peptide assessment in stable low-risk outpatients with nonischemic cardiomyopathy after decompensated heart failure. J Am Coll Cardiol 2008; 51: 2329-2335. 21）Ordonez-Llanos J, Collinson PO, Christenson RH: Amino-terminal pro-B-type natriuretic peptide: analytic considerations. Am J Cardiol 2008; 101: 9-15. 27）Kario K, Nishikimi T, Yoshihara F, et al: Plasma levels of natriuretic peptides and adrenomedullin in elderly hypertensive patients: relationships to 24 h blood pressure. J Hypertens 1998; 16: 1253-1259. 9）Maisel AS, Krishnaswamy P, Nowak RM, et al; Breathing Not Properly Multinational Study Investigators: Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002; 347: 161-167. 33）Ramos HR, Birkenfeld AL, de Bold AJ: INTERACTING DISCIPLINES: Cardiac natriuretic peptides and obesity: perspectives from an endocrinologist and a cardiologist. Endocr Connect 2015; 4: R25-36. 28）Seegers J, Zabel M, Grüter T, et al: Natriuretic peptides for the detection of paroxysmal atrial fibrillation. Open Heart 2015; 2: e000182. 30）Kistorp C, Raymond I, Pedersen F, et al: N-terminal pro-brain natriuretic peptide, C-reactive protein, and urinary albumin levels as predictors of mortality and cardiovascular events in older adults. JAMA 2005; 293: 1609-1616. 4）Currie MG, Geller DM, Cole BR, et al: Bioactive cardiac substances: potent vasorelaxant activity in mammalian atria. Science 1983; 221: 71-73. 15）Januzzi JL Jr, Sakhuja R, O'donoghue M, et al: Utility of amino-terminal pro-brain natriuretic peptide testing for prediction of 1-year mortality in patients with dyspnea treated in the emergency department. Arch Intern Med 2006; 166: 315-320. 17）Maeda K, Tsutamoto T, Wada A, et al: High levels of plasma brain natriuretic peptide and interleukin-6 after optimized treatment for heart failure are independent risk factors for morbidity and mortality in patients with congestive heart failure. J Am Coll Cardiol 2000; 36: 1587-1593. 11）Clerico A, Fontana M, Zyw L, et al: Comparison of the diagnostic accuracy of brain natriuretic peptide (BNP) and the N-terminal part of the propeptide of BNP immunoassays in chronic and acute heart failure: a systematic review. Clin Chem 2007; 53: 813-822. 2）KISCH B: Electron microscopy of the atrium of the heart. I. Guinea pig. Exp Med Surg 1956; 14: 99-112. 8）Weber M, Hamm C: Role of B-type natriuretic peptide (BNP) and NT-proBNP in clinical routine. Heart 2006; 92: 843-849. 32）Huelsmann M, Neuhold S, Resl M, et al: PONTIAC (NT-proBNP selected prevention of cardiac events in a population of diabetic patients without a history of cardiac disease): a prospective randomized controlled trial. J Am Coll Cardiol 2013; 62: 1365-1372. 35）Takahashi A, Ihara M, Yamazaki S, et al: Impact of Either GLP-1 Agonists or DPP-4 Inhibitors on Pathophysiology of Heart Failure. Int Heart J 2015; 56: 372-376. 10）大倉ひろ枝，伊藤寛子，吉岡秀樹ほか：心機能評価におけるN末端-proBNP測定の診断的意義と腎機能による影響-BNPとの比較検討-．臨病理 2010；58：139-147. 16）日本心不全学会：血中BNPやNT-proBNP値を用いた心不全診療の留意点について． http://www.asas.or.jp/jhfs/topics/bnp201300403.html ［2016.11.9］ |
| References_xml | – reference: 17）Maeda K, Tsutamoto T, Wada A, et al: High levels of plasma brain natriuretic peptide and interleukin-6 after optimized treatment for heart failure are independent risk factors for morbidity and mortality in patients with congestive heart failure. J Am Coll Cardiol 2000; 36: 1587-1593. – reference: 5）Kangawa K, Matsuo H: Purification and complete amino acid sequence of alpha-human atrial natriuretic polypeptide (alpha-hANP). Biochem Biophys Res Commun 1984; 118: 131-139. – reference: 19）Suzuki S, Yoshimura M, Nakayama M, et al: Plasma level of B-type natriuretic peptide as a prognostic marker after acute myocardial infarction: a long-term follow-up analysis. Circulation 2004; 110: 1387-1391. – reference: 20）Schindler EI, Szymanski JJ, Hock KG, et al: Short- and Long-term Biologic Variability of Galectin-3 and Other Cardiac Biomarkers in Patients with Stable Heart Failure and Healthy Adults. Clin Chem 2016; 62: 360-366. – reference: 31）Doi Y, Ninomiya T, Hata J, et al: N-terminal pro-brain natriuretic peptide and risk of cardiovascular events in a Japanese community: the Hisayama study. Arterioscler Thromb Vasc Biol 2011; 31: 2997-3003. – reference: 32）Huelsmann M, Neuhold S, Resl M, et al: PONTIAC (NT-proBNP selected prevention of cardiac events in a population of diabetic patients without a history of cardiac disease): a prospective randomized controlled trial. J Am Coll Cardiol 2013; 62: 1365-1372. – reference: 11）Clerico A, Fontana M, Zyw L, et al: Comparison of the diagnostic accuracy of brain natriuretic peptide (BNP) and the N-terminal part of the propeptide of BNP immunoassays in chronic and acute heart failure: a systematic review. Clin Chem 2007; 53: 813-822. – reference: 22）Tsutamoto T, Sakai H, Nishiyama K, et al: Direct comparison of transcardiac increase in brain natriuretic peptide (BNP) and N-terminal proBNP and prognosis in patients with chronic heart failure. Circ J 2007; 71: 1873-1878. – reference: 34）Lazo M, Young JH, Brancati FL, et al: NH2-terminal pro-brain natriuretic peptide and risk of diabetes. Diabetes 2013; 62: 3189-3193. – reference: 1）JAMIESON JD, PALADE GE: SPECIFIC GRANULES IN ATRIAL MUSCLE CELLS. J Cell Biol 1964; 23: 151-172. – reference: 8）Weber M, Hamm C: Role of B-type natriuretic peptide (BNP) and NT-proBNP in clinical routine. Heart 2006; 92: 843-849. – reference: 24）Dockery F, Bulpitt CJ, Agarwal S, et al: Anti-androgens increase N-terminal pro-BNP levels in men with prostate cancer. Clin Endocrinol (Oxf) 2008; 68: 59-65. – reference: 18）Nishii M, Inomata T, Takehana H, et al: Prognostic utility of B-type natriuretic peptide assessment in stable low-risk outpatients with nonischemic cardiomyopathy after decompensated heart failure. J Am Coll Cardiol 2008; 51: 2329-2335. – reference: 4）Currie MG, Geller DM, Cole BR, et al: Bioactive cardiac substances: potent vasorelaxant activity in mammalian atria. Science 1983; 221: 71-73. – reference: 14）慢性心不全治療ガイドライン（2010年改訂版） 2013/9/13更新版，http://www.j-circ.or.jp/guideline/pdf/JCS2010_matsuzaki_h.pdf ［2016.11.9］ – reference: 35）Takahashi A, Ihara M, Yamazaki S, et al: Impact of Either GLP-1 Agonists or DPP-4 Inhibitors on Pathophysiology of Heart Failure. Int Heart J 2015; 56: 372-376. – reference: 33）Ramos HR, Birkenfeld AL, de Bold AJ: INTERACTING DISCIPLINES: Cardiac natriuretic peptides and obesity: perspectives from an endocrinologist and a cardiologist. Endocr Connect 2015; 4: R25-36. – reference: 12）Dessì-Fulgheri P, Sarzani R, Tamburrini P, et al: Plasma atrial natriuretic peptide and natriuretic peptide receptor gene expression in adipose tissue of normotensive and hypertensive obese patients. J Hypertens 1997; 15: 1695-1699. – reference: 26）加藤公則，中原寿子，小林隆司ほか：人間ドック受診者におけるN-terminal pro-brain natriuretic peptide測定の意義．人間ドック 2011；26：62-70. – reference: 6）Sudoh T, Kangawa K, Minamino N, et al: A new natriuretic peptide in porcine brain. Nature 1988; 332: 78-81. – reference: 9）Maisel AS, Krishnaswamy P, Nowak RM, et al; Breathing Not Properly Multinational Study Investigators: Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002; 347: 161-167. – reference: 23）Saenger AK, Dalenberg DA, Bryant SC, et al: Pediatric brain natriuretic peptide concentrations vary with age and sex and appear to be modulated by testosterone. Clin Chem 2009; 55: 1869-1875. – reference: 15）Januzzi JL Jr, Sakhuja R, O'donoghue M, et al: Utility of amino-terminal pro-brain natriuretic peptide testing for prediction of 1-year mortality in patients with dyspnea treated in the emergency department. Arch Intern Med 2006; 166: 315-320. – reference: 3）de Bold AJ, Borenstein HB, Veress AT, et al: A rapid and potent natriuretic response to intravenous injection of atrial myocardial extract in rats. Life Sci 1981; 28: 89-94. – reference: 13）Gruden G, Landi A, Bruno G: Natriuretic peptides, heart, and adipose tissue: new findings and future developments for diabetes research. Diabetes Care 2014; 37: 2899-2908. – reference: 21）Ordonez-Llanos J, Collinson PO, Christenson RH: Amino-terminal pro-B-type natriuretic peptide: analytic considerations. Am J Cardiol 2008; 101: 9-15. – reference: 27）Kario K, Nishikimi T, Yoshihara F, et al: Plasma levels of natriuretic peptides and adrenomedullin in elderly hypertensive patients: relationships to 24 h blood pressure. J Hypertens 1998; 16: 1253-1259. – reference: 30）Kistorp C, Raymond I, Pedersen F, et al: N-terminal pro-brain natriuretic peptide, C-reactive protein, and urinary albumin levels as predictors of mortality and cardiovascular events in older adults. JAMA 2005; 293: 1609-1616. – reference: 25）Olivetti G, Melissari M, Capasso JM, et al: Cardiomyopathy of the aging human heart. Myocyte loss and reactive cellular hypertrophy. Circ Res 1991; 68: 1560-1568. – reference: 7）Sudoh T, Minamino N, Kangawa K, et al: C-type natriuretic peptide (CNP): a new member of natriuretic peptide family identified in porcine brain. Biochem Biophys Res Commun 1990; 168: 863-870. – reference: 29）Wang TJ, Larson MG, Levy D, et al: Plasma natriuretic peptide levels and the risk of cardiovascular events and death. N Engl J Med 2004; 350: 655-663. – reference: 10）大倉ひろ枝，伊藤寛子，吉岡秀樹ほか：心機能評価におけるN末端-proBNP測定の診断的意義と腎機能による影響-BNPとの比較検討-．臨病理 2010；58：139-147. – reference: 28）Seegers J, Zabel M, Grüter T, et al: Natriuretic peptides for the detection of paroxysmal atrial fibrillation. Open Heart 2015; 2: e000182. – reference: 2）KISCH B: Electron microscopy of the atrium of the heart. I. Guinea pig. Exp Med Surg 1956; 14: 99-112. – reference: 16）日本心不全学会：血中BNPやNT-proBNP値を用いた心不全診療の留意点について． http://www.asas.or.jp/jhfs/topics/bnp201300403.html ［2016.11.9］ |
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| Snippet | Brain natriuretic peptide（BNP）とN terminal（NT）-proBNPは心不全の診断，予後を推定できる有用なバイオマーカーである．しかし，BNPは循環器内科医や一般内科... 「要約」Brain natriuretic peptide(BNP)とN terminal(NT)-proBNPは心不全の診断, 予後を推定できる有用なバイオマーカーである. しかし, BNPは循環器内科医や一般内科... |
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