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Eur Heart J：利钠肽检测用于心力衰竭诊断的长期趋势

2021-11-30 MedSci原创 MedSci原创

心力衰竭利钠肽长期趋势
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初级保健中对利钠肽进行检测随着时间的推移有所增加，没有明显不平等的证据，但大多数HF患者在诊断前仍然没有利钠肽的检测记录。

心力衰竭(HF)是一种预后不良的恶性疾病，通常在急诊入院时即被诊断出来。全球受其影响的个体超过4000万人，且预后比大多数癌症患者更差。国际指南建议在HF患者初级保健过程中检测利钠肽的水平，以促进对HF患者的及时诊断。

近日，心血管领域权威杂志Eur Heart J上发表了一篇研究文章，研究人员旨在报告利尿肽检测和随后HF诊断率随时间推移的趋势。

该队列研究使用了2004-2018年英格兰成年（≥45岁）患者（n=7212013，48%为男性）的初级和二级保健数据来报告利钠肽检测水平的变化趋势（随着时间的推移，按年龄、性别、种族和社会经济状况）和HF诊断率。

利钠肽检测率从2004年的每1000人每年0.25人[95%置信区间(CI)为0.23-0.26]增加到2018年的每1000人每年16.88人(95%CI为16.73-17.03)，2010年在国家HF指南发布之后有显著上升的趋势。女性和不同种族群体的检测率相似，而且正如预期的那样，在年龄较大和社会贫困程度更高的群体中进行了利钠肽的检测人员更多。研究期间的HF患者检出率保持不变（约为10%），诊断前未进行利钠肽检测的患者比例仍然很高[2004年为99.6%(n=13484) vs. 2017年为76.7%(n=12978)]。

由此可见，初级保健中对利钠肽进行检测随着时间的推移有所增加，没有明显不平等的证据，但大多数HF患者在诊断前仍然没有利钠肽的检测记录。可能需要在初级保健中进行更多的利钠肽检测，以防止因HF住院，并在更早、更可治疗的阶段对HF进行诊断。

原始出处：

Andrea K Roalfe,et al.Long term trends in natriuretic peptide testing for heart failure in UK primary care: a cohort study.European Heart Journal.2021.https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehab781/6437771

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1357838, encodeId=0f07135e83824, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Thu Dec 02 07:52:04 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1366496, encodeId=337c136649621, content=<a href='/topic/show?id=76923233335' target=_blank style='color:#2F92EE;'>#利钠肽#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32333, encryptionId=76923233335, topicName=利钠肽)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ac1c235, createdName=tonychen21, createdTime=Thu Dec 02 07:52:04 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563555, encodeId=9d4a1563555aa, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Thu Dec 02 07:52:04 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1075784, encodeId=ffa810e578461, content=<a href='/topic/show?id=072c5088466' target=_blank style='color:#2F92EE;'>#心力衰竭#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50884, encryptionId=072c5088466, topicName=心力衰竭)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=病毒猎手, createdTime=Wed Dec 01 10:15:21 CST 2021, time=2021-12-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1075761, encodeId=097610e5761d4, content=，达到262,985,447例。累计死亡病例523.2万例，达到5,232,051例。新增死亡为, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Wed Dec 01 09:09:28 CST 2021, time=2021-12-01, status=1, ipAttribution=)]
    2021-12-02 zhaojie88

    #ART#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1357838, encodeId=0f07135e83824, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Thu Dec 02 07:52:04 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1366496, encodeId=337c136649621, content=<a href='/topic/show?id=76923233335' target=_blank style='color:#2F92EE;'>#利钠肽#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32333, encryptionId=76923233335, topicName=利钠肽)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ac1c235, createdName=tonychen21, createdTime=Thu Dec 02 07:52:04 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563555, encodeId=9d4a1563555aa, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Thu Dec 02 07:52:04 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1075784, encodeId=ffa810e578461, content=<a href='/topic/show?id=072c5088466' target=_blank style='color:#2F92EE;'>#心力衰竭#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50884, encryptionId=072c5088466, topicName=心力衰竭)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=病毒猎手, createdTime=Wed Dec 01 10:15:21 CST 2021, time=2021-12-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1075761, encodeId=097610e5761d4, content=，达到262,985,447例。累计死亡病例523.2万例，达到5,232,051例。新增死亡为, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Wed Dec 01 09:09:28 CST 2021, time=2021-12-01, status=1, ipAttribution=)]
    2021-12-02 tonychen21

    #利钠肽#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1357838, encodeId=0f07135e83824, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Thu Dec 02 07:52:04 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1366496, encodeId=337c136649621, content=<a href='/topic/show?id=76923233335' target=_blank style='color:#2F92EE;'>#利钠肽#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32333, encryptionId=76923233335, topicName=利钠肽)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ac1c235, createdName=tonychen21, createdTime=Thu Dec 02 07:52:04 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563555, encodeId=9d4a1563555aa, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Thu Dec 02 07:52:04 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1075784, encodeId=ffa810e578461, content=<a href='/topic/show?id=072c5088466' target=_blank style='color:#2F92EE;'>#心力衰竭#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50884, encryptionId=072c5088466, topicName=心力衰竭)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=病毒猎手, createdTime=Wed Dec 01 10:15:21 CST 2021, time=2021-12-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1075761, encodeId=097610e5761d4, content=，达到262,985,447例。累计死亡病例523.2万例，达到5,232,051例。新增死亡为, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Wed Dec 01 09:09:28 CST 2021, time=2021-12-01, status=1, ipAttribution=)]
    2021-12-02 slcumt

    #HEART#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1357838, encodeId=0f07135e83824, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Thu Dec 02 07:52:04 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1366496, encodeId=337c136649621, content=<a href='/topic/show?id=76923233335' target=_blank style='color:#2F92EE;'>#利钠肽#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32333, encryptionId=76923233335, topicName=利钠肽)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ac1c235, createdName=tonychen21, createdTime=Thu Dec 02 07:52:04 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563555, encodeId=9d4a1563555aa, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Thu Dec 02 07:52:04 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1075784, encodeId=ffa810e578461, content=<a href='/topic/show?id=072c5088466' target=_blank style='color:#2F92EE;'>#心力衰竭#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50884, encryptionId=072c5088466, topicName=心力衰竭)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=病毒猎手, createdTime=Wed Dec 01 10:15:21 CST 2021, time=2021-12-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1075761, encodeId=097610e5761d4, content=，达到262,985,447例。累计死亡病例523.2万例，达到5,232,051例。新增死亡为, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Wed Dec 01 09:09:28 CST 2021, time=2021-12-01, status=1, ipAttribution=)]
    2021-12-01 病毒猎手

    #心力衰竭#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1357838, encodeId=0f07135e83824, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Thu Dec 02 07:52:04 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1366496, encodeId=337c136649621, content=<a href='/topic/show?id=76923233335' target=_blank style='color:#2F92EE;'>#利钠肽#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32333, encryptionId=76923233335, topicName=利钠肽)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ac1c235, createdName=tonychen21, createdTime=Thu Dec 02 07:52:04 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563555, encodeId=9d4a1563555aa, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Thu Dec 02 07:52:04 CST 2021, time=2021-12-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1075784, encodeId=ffa810e578461, content=<a href='/topic/show?id=072c5088466' target=_blank style='color:#2F92EE;'>#心力衰竭#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50884, encryptionId=072c5088466, topicName=心力衰竭)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=病毒猎手, createdTime=Wed Dec 01 10:15:21 CST 2021, time=2021-12-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1075761, encodeId=097610e5761d4, content=，达到262,985,447例。累计死亡病例523.2万例，达到5,232,051例。新增死亡为, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Wed Dec 01 09:09:28 CST 2021, time=2021-12-01, status=1, ipAttribution=)]
    2021-12-01 查查佳佳

    ，达到262,985,447例。累计死亡病例523.2万例，达到5,232,051例。新增死亡为

    0

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