Year: 2026
Type: article
Abstract: 心力衰竭(heart failure, HF)是多种心血管疾病的终末阶段，其高患病率与高再住院率使早期诊断与精准风险评估尤为关键。N末端B型利钠肽原(NT-proBNP)因具有较高灵敏度和良好稳定性，已成为心衰诊断与预后评估的核心生物标志物。然而，其循环水平受多种非心衰因素影响，易导致假阳性或假阴性，从而干扰临床决策。本文系统综述了NT-proBNP的生物学特性及其在不同病理生理状态下的变化机制，多角度讨论NT-proBNP的临床应用需突破单一固定阈值模式，结合患者个体特征及多维临床信息进行综合判断。未来应进一步完善特殊人群的分层诊断界值，并结合机器学习与多模态数据整合，推动心衰诊疗向精准医学方向发展。同时，本文进一步结合多重影响因素叠加的模拟临床场景，提出NT-proBNP判读应遵循“先评估验前概率、再识别干扰方向、继而结合动态变化和超声心动图/其他生物标志物验证”的综合决策路径。Heart failure (HF) represents the terminal stage of various cardiovascular diseases. Its high prevalence and readmission rates make early diagnosis and accurate risk assessment particularly crucial. N-terminal pro-B-type natriuretic peptide (NT-proBNP), characterized by high sensitivity and favorable stability, has emerged as a core biomarker for the diagnosis and prognostic assessment of heart failure. Nevertheless, its circulating levels are not specific to heart failure; instead, they are affected by a variety of non-cardiac factors, which tend to induce false-positive or false-negative results and thus impede clinical decision-making. This article systematically reviews the biological characteristics of NT-proBNP and its variation mechanisms under different pathophysiological conditions. From multiple perspectives, it addresses that the clinical application of NT-proBNP necessitates moving beyond the single fixed threshold paradigm, and comprehensive judgments should be made by integrating patients’ individual characteristics and multidimensional clinical information. Future studies are expected to further optimize stratified diagnostic cut-off values for special populations, and integrate machine learning with multimodal data to advance the precision medicine of heart failure diagnosis and treatment. In addition, simulated clinical scenarios with overlapping modifiers are used to propose a practical decision pathway in which pretest probability, direction of confounding, dynamic changes, echocardiography, and complementary biomarkers are integrated when interpreting NT-proBNP results.
Source: Advances in Clinical Medicine
Author: 皓珺 张
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7196983062