WordNet

write by means of a keyboard with types; "type the acceptance letter, please" (同)typewrite
a small metal block bearing a raised character on one end; produces a printed character when inked and pressed on paper; "he dropped a case of type, so they made him pick them up"
(biology) the taxonomic group whose characteristics are used to define the next higher taxon
a subdivision of a particular kind of thing; "what type of sculpture do you prefer?"
all of the tokens of the same symbol; "the word `element contains five different types of character"
printed characters; "small type is hard to read"
identify as belonging to a certain type; "Such people can practically be typed" (同)typecast
put to bed; "The children were bedded at ten oclock"
a foundation of earth or rock supporting a road or railroad track; "the track bed had washed away"
a piece of furniture that provides a place to sleep; "he sat on the edge of the bed"; "the room had only a bed and chair"
a plot of ground in which plants are growing; "the gardener planted a bed of roses"
the flat surface of a printing press on which the type form is laid in the last stage of producing a newspaper or magazine or book etc.
a depression forming the ground under a body of water; "he searched for treasure on the ocean bed" (同)bottom
(geology) a stratum of rock (especially sedimentary rock); "they found a bed of sandstone"
furnish with a bed; "The inn keeper could bed all the new arrivals"
place (plants) in a prepared bed of soil
the 2nd letter of the Roman alphabet (同)b
the blood group whose red cells carry the B antigen (同)type_B, group B
amide combining the amino group of one amino acid with the carboxyl group of another; usually obtained by partial hydrolysis of protein
of or relating to natriuresis

PrepTutorEJDIC

〈C〉(…の)『型』,タイプ,類型,種類(kind)《+of+名》 / 〈C〉(その種類の特質を最もよく表している)『典型』,手本,模範《+of+名》 / 〈U〉《集合的に》活字;〈C〉(1個の)活字 / 〈U〉(印刷された)字体,活字 / 〈C〉(貨幣・メダルなどの)模様,図柄 / 〈C〉血液型(blood group) / …‘を'タイプに打つ / (…として)…‘を'分類する《+名+as+名(doing)》 / …‘の'型を決める / タイプライターを打つ
〈C〉〈U〉『ベット』,『寝台』 / 〈U〉睡眠,宿泊 / 〈C〉『花壇,苗床…』養殖場 / 〈C〉(海・川などの)『床』,水底 / 〈C〉地層;(一般に)土台 / …‘に'寝床を与える / 〈子供など〉'を'寝かしつける / 《古》寝る,床につく

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/08/10 17:42:06」(JST)

wiki en

Brain natriuretic peptide, uretic peptide or Ventricular Natriuretic Peptide (still BNP), is a 32-amino acid polypeptide secreted by the ventricles of the heart in response to excessive stretching of heart muscle cells (cardiomyocytes). The release of BNP is modulated by calcium ions.^[1] BNP is named as such because it was originally identified in extracts of porcine brain, although in humans it is produced mainly in the cardiac ventricles.

BNP is secreted along with a 76-amino acid N-terminal fragment (NT-proBNP) that is biologically inactive. BNP binds to and activates the atrial natriuretic factor receptors NPRA, and to a lesser extent NPRB, in a fashion similar to atrial natriuretic peptide (ANP) but with 10-fold lower affinity. The biological half-life of BNP, however, is twice as long as that of ANP, and that of NT-proBNP is even longer, making these peptides better targets than ANP for diagnostic blood testing.

The physiologic actions of BNP are similar to those of ANP and include decrease in systemic vascular resistance and central venous pressure as well as an increase in natriuresis. Thus, the net effect of BNP and ANP is a decrease in blood volume, which lowers systemic blood pressure and afterload, yielding an increase in cardiac output, partly due to a higher ejection fraction.

Biosynthesis

BNP is synthesized as a 134-amino acid preprohormone (preproBNP), encoded by the human gene NPPB. Removal of the 25-residue N-terminal signal peptide generates the prohormone, proBNP, which is stored intracellularly as an O-linked glycoprotein; proBNP is subsequently cleaved between arginine-102 and serine-103 by a specific convertase (probably furin or corin) into NT-proBNP and the biologically active 32-amino acid polypeptide BNP-32, which are secreted into the blood in equimolar amounts.^[2] Cleavage at other sites produces shorter BNP peptides with unknown biological activity.^[3] Processing of proBNP may be regulated by O-glycosylation of residues near the cleavage sites.^[4]

Clinical significance

The main clinical utility of either BNP or NT-proBNP is that a normal level rules out acute heart failure in the emergency setting. An elevated BNP or NT-proBNP should never be used to "rule in" acute or heart failure in the emergency setting due to lack of specificity^{[dubious – discuss]}.^[5]
Either BNP or NT-proBNP can also be used for screening and prognosis of heart failure.^[6]

Both are also typically increased in patients with left ventricular dysfunction, with or without symptoms (BNP accurately reflects current ventricular status, as its half-life is 20 minutes, as opposed to 1–2 hours for NT-proBNP).^[7]

BNP can be elevated in renal failure.^{[citation needed]} BNP is cleared by binding to natriuretic peptide receptors (NPRs) and neutral endopeptidase (NEP). Less than 5% of BNP is cleared renally. NT-proBNP is the inactive molecule resulting from cleavage of the prohormone Pro-BNP and is reliant solely on the kidney for excretion. The achilles heel of the NT-proBNP molecule is the overlap in kidney disease in the heart failure patient population.^[8]^[9]

Low BNP was found to be a predictor of survival to age 90 in men. ^[10]

Measurement

BNP and NT-proBNP are measured by immunoassay.^[11]

BNP less than 100 pg per milliliter

sensitivity = 90%
specificity = 76%

BNP less than 50 pg per milliliter

sensitivity = 97%
specificity = 62%

Some laboratories report in units ng per Litre (ng/L), which is equivalent to pg/mL
For patients with heart failure, BNP values will, in general, be above 100 pg/mL.
A more conservative interpretation of the BNP is that normal values are less than 50 pg/ml, in order to achieve adequate sensitivity.
There is a diagnostic 'gray area', often defined as between 100 and 500 pg/mL, for which the test is considered inconclusive, but, in general, levels above 500 pg/ml are considered to be positive. This so-called gray zone has been addressed in several studies, and using clinical history or other available simple tools can help make the diagnosis.^[12]^[13]

BNP may be a reliable predictor of cardiovascular mortality in diabetics.^[14]
BNP was found to have an important role in prognostication of heart surgery patients^[15] and in the emergency department.^[16] Bhalla et al. showed that combining BNP with other tools like ICG can improve early diagnosis of heart failure and advance prevention strategies.^[17]^[18] Utility of BNP has also been explored in various settings like preeclampsia, ICU and shock and ESRD.^[19]^[20]^[21]

The effect or race and gender on value of BNP and its utility in that context has been studied extensively.^[22]^[23]

NT-proBNP levels (in pg/mL) by NYHA functional class ^[24]
	NYHA I	NYHA II	NYHA III	NYHA IV
5th Percentile	33	103	126	148
Mean	1015	1666	3029	3465
95th Percentile	3410	6567	10,449	12,188

The BNP test is used as an aid in the diagnosis and assessment of severity of heart failure. A recent meta-analysis concerning effects of BNP testing on clinical outcomes of patients presenting to the emergency department with acute dyspnea revealed that BNP testing led to a decrease in admission rates and decrease in mean length of stay, although neither was statistically significant. Effects on all cause hospital mortality was inconclusive.^[25] The BNP test is also used for the risk stratification of patients with acute coronary syndromes.^[26]^[27]

When interpreting an elevated BNP level, it is useful to remember that values may be elevated due to factors other than heart failure. Lower levels are often seen in obese patients.^[28] Higher levels are seen in those with renal disease, in the absence of heart failure.

Therapeutic application

Recombinant BNP, nesiritide, is used to treat decompensated heart failure. However, a recent clinical trial^[29] failed to show a benefit of nesiritide in patients with acute decompensated heart failure, and the authors could not recommend its use.

References

^ Ziskoven D, Forssmann WG, Holthausen U, Menz G, Addicks K, Rippegater G (1989). "Calcium Calmodulin antagonists Influences the release of Cardiodilatin/ANP from Atrial Cardiocytes". In Kaufmann W, Wambach G. Handbook Endocrinology of the Heart. Berlin: Verlag: Springer. pp. 233–4. ISBN 978-3-540-51409-1.
^ Schellenberger U, O'Rear J, Guzzetta A, Jue RA, Protter AA, Pollitt NS (July 2006). "The precursor to B-type natriuretic peptide is an O-linked glycoprotein". Arch. Biochem. Biophys. 451 (2): 160–6. doi:10.1016/j.abb.2006.03.028. PMID 16750161.
^ Niederkofler EE, Kiernan UA, O'Rear J, Menon S, Saghir S, Protter AA, Nelson RW, Schellenberger U (November 2008). "Detection of endogenous B-type natriuretic peptide at very low concentrations in patients with heart failure". Circ Heart Fail 1 (4): 258–64. doi:10.1161/CIRCHEARTFAILURE.108.790774. PMID 19808300.
^ Semenov AG, Postnikov AB, Tamm NN, Seferian KR, Karpova NS, Bloshchitsyna MN, Koshkina EV, Krasnoselsky MI, Serebryanaya DV, Katrukha AG (March 2009). "Processing of pro-brain natriuretic peptide is suppressed by O-glycosylation in the region close to the cleavage site". Clin. Chem. 55 (3): 489–98. doi:10.1373/clinchem.2008.113373. PMID 19168558.
^ Maisel A, Krishnaswamy P, Nowak R, McCord J, Hollander J, Duc P, Omland T, Storrow A, Abraham W, Wu A, Clopton P, Steg P, Westheim A, Knudsen C, Perez A, Kazanegra R, Herrmann H, McCullough P (2002). "Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure". N Engl J Med 347 (3): 161–7. doi:10.1056/NEJMoa020233. PMID 12124404.
^ Bhalla V, Willis S, Maisel AS (2004). "B-type natriuretic peptide: the level and the drug--partners in the diagnosis of heart failure". Congest Heart Fail 10 (1 Suppl 1): 3–27. doi:10.1111/j.1527-5299.2004.03310.x. PMID 14872150.
^ Atisha D, Bhalla MA, Morrison LK, Felicio L, Clopton P, Gardetto N, Kazanegra R, Chiu A, Maisel AS (September 2004). "A prospective study in search of an optimal B-natriuretic peptide level to screen patients for cardiac dysfunction". Am. Heart J. 148 (3): 518–23. doi:10.1016/j.ahj.2004.03.014. PMID 15389242.
^ Austin WJ, Bhalla V, Hernandez-Arce I, Isakson SR, Beede J, Clopton P, Maisel AS, Fitzgerald RL (October 2006). "Correlation and prognostic utility of B-type natriuretic peptide and its amino-terminal fragment in patients with chronic kidney disease". Am. J. Clin. Pathol. 126 (4): 506–12. doi:10.1309/M7AAXA0J1THMNCDF. PMID 16938661.
^ Daniels LB, Clopton P, Bhalla V, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham WT, Wu AH, Steg PG, Westheim A, Knudsen CW, Perez A, Kazanegra R, Herrmann HC, McCullough PA, Maisel AS (May 2006). "How obesity affects the cut-points for B-type natriuretic peptide in the diagnosis of acute heart failure. Results from the Breathing Not Properly Multinational Study". Am. Heart J. 151 (5): 999–1005. doi:10.1016/j.ahj.2005.10.011. PMID 16644321.
^ Nilsson, G, Hedberg P, Ohrvik J (2014). "How to live until 90 – Factors predicting survival in 75-year-olds from the general population". Healthy Aging Research 3 (5): 1–10. doi:10.12715/har.2014.3.5.
^ Clerico A, Zaninotto M, Prontera C, Giovannini S, Ndreu R, Franzini M, Zucchelli GC, Plebani M (December 2012). "State of the art of BNP and NT-proBNP immunoassays: the CardioOrmoCheck study". Clin. Chim. Acta 414: 112–9. doi:10.1016/j.cca.2012.07.017. PMID 22910582.
^ Strunk A, Bhalla V, Clopton P, Nowak RM, McCord J, Hollander JE, Duc P, Storrow AB, Abraham WT, Wu AH, Steg G, Perez A, Kazanegra R, Herrmann HC, Aumont MC, McCullough PA, Maisel A (January 2006). "Impact of the history of congestive heart failure on the utility of B-type natriuretic peptide in the emergency diagnosis of heart failure: results from the Breathing Not Properly Multinational Study". Am. J. Med. 119 (1): 69.e1–11. doi:10.1016/j.amjmed.2005.04.029. PMID 16431187.
^ Brenden CK, Hollander JE, Guss D, McCullough PA, Nowak R, Green G, Saltzberg M, Ellison SR, Bhalla MA, Bhalla V, Clopton P, Jesse R, Maisel AS (May 2006). "Gray zone BNP levels in heart failure patients in the emergency department: results from the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT) multicenter study". Am. Heart J. 151 (5): 1006–11. doi:10.1016/j.ahj.2005.10.017. PMID 16644322.
^ Bhalla MA, Chiang A, Epshteyn VA, Kazanegra R, Bhalla V, Clopton P, Krishnaswamy P, Morrison LK, Chiu A, Gardetto N, Mudaliar S, Edelman SV, Henry RR, Maisel AS (September 2004). "Prognostic role of B-type natriuretic peptide levels in patients with type 2 diabetes mellitus". J. Am. Coll. Cardiol. 44 (5): 1047–52. doi:10.1016/j.jacc.2004.05.071. PMID 15337217.
^ Hutfless R, Kazanegra R, Madani M, Bhalla MA, Tulua-Tata A, Chen A, Clopton P, James C, Chiu A, Maisel AS (May 2004). "Utility of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients undergoing heart surgery". J. Am. Coll. Cardiol. 43 (10): 1873–9. doi:10.1016/j.jacc.2003.12.048. PMID 15145114.
^ Maisel A, Hollander JE, Guss D, McCullough P, Nowak R, Green G, Saltzberg M, Ellison SR, Bhalla MA, Bhalla V, Clopton P, Jesse R (September 2004). "Primary results of the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT). A multicenter study of B-type natriuretic peptide levels, emergency department decision making, and outcomes in patients presenting with shortness of breath". J. Am. Coll. Cardiol. 44 (6): 1328–33. doi:10.1016/j.jacc.2004.06.015. PMID 15364340.
^ Bhalla V, Isakson S, Bhalla MA, Lin JP, Clopton P, Gardetto N, Maisel AS (February 2005). "Diagnostic ability of B-type natriuretic peptide and impedance cardiography: testing to identify left ventricular dysfunction in hypertensive patients". Am. J. Hypertens. 18 (2 Pt 2): 73S–81S. doi:10.1016/j.amjhyper.2004.11.044. PMID 15752936.
^ Castellanos LR, Bhalla V, Isakson S, Daniels LB, Bhalla MA, Lin JP, Clopton P, Gardetto N, Hoshino M, Chiu A, Fitzgerald R, Maisel AS (February 2009). "B-type natriuretic peptide and impedance cardiography at the time of routine echocardiography predict subsequent heart failure events". J. Card. Fail. 15 (1): 41–7. doi:10.1016/j.cardfail.2008.09.003. PMID 19181293.
^ Resnik JL, Hong C, Resnik R, Kazanegra R, Beede J, Bhalla V, Maisel A (August 2005). "Evaluation of B-type natriuretic peptide (BNP) levels in normal and preeclamptic women". Am. J. Obstet. Gynecol. 193 (2): 450–4. doi:10.1016/j.ajog.2004.12.006. PMID 16098869.
^ Bhalla V, Bhalla MA, Maisel AS (August 2004). "Evolution of B-type natriuretic peptide in evaluation of intensive care unit shock". Crit. Care Med. 32 (8): 1787–9. doi:10.1097/01.CCM.0000135748.75590.54. PMID 15286561.
^ Sheen V, Bhalla V, Tulua-Tata A, Bhalla MA, Weiss D, Chiu A, Abdeen O, Mullaney S, Maisel A (February 2007). "The use of B-type natriuretic peptide to assess volume status in patients with end-stage renal disease". Am. Heart J. 153 (2): 244.e1–5. doi:10.1016/j.ahj.2006.10.041. PMID 17239684.
^ Maisel AS, Clopton P, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham WT, Wu AH, Steg G, Westheim A, Knudsen CW, Perez A, Kazanegra R, Bhalla V, Herrmann HC, Aumont MC, McCullough PA (June 2004). "Impact of age, race, and sex on the ability of B-type natriuretic peptide to aid in the emergency diagnosis of heart failure: results from the Breathing Not Properly (BNP) multinational study". Am. Heart J. 147 (6): 1078–84. doi:10.1016/j.ahj.2004.01.013. PMID 15199359.
^ Daniels LB, Bhalla V, Clopton P, Hollander JE, Guss D, McCullough PA, Nowak R, Green G, Saltzberg M, Ellison SR, Bhalla MA, Jesse R, Maisel A (May 2006). "B-type natriuretic peptide (BNP) levels and ethnic disparities in perceived severity of heart failure: results from the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT) multicenter study of BNP levels and emergency department decision making in patients presenting with shortness of breath". J. Card. Fail. 12 (4): 281–5. doi:10.1016/j.cardfail.2006.01.008. PMID 16679261.
^ "N-terminal pro-BNP".
^ Lam LL, Cameron PA, Schneider HG, Abramson MJ, Müller C, Krum H (December 2010). "Meta-analysis: effect of B-type natriuretic peptide testing on clinical outcomes in patients with acute dyspnea in the emergency setting". Ann. Intern. Med. 153 (11): 728–35. doi:10.7326/0003-4819-153-11-201012070-00006. PMID 21135296.
^ Bibbins-Domingo K, Gupta R, Na B, Wu AH, Schiller NB, Whooley MA (January 2007). "N-terminal fragment of the prohormone brain-type natriuretic peptide (NT-proBNP), cardiovascular events, and mortality in patients with stable coronary heart disease". JAMA 297 (2): 169–76. doi:10.1001/jama.297.2.169. PMC 2848442. PMID 17213400.
^ Fitzgerald RL, Cremo R, Gardetto N, Chiu A, Clopton P, Bhalla V, Maisel AS (September 2005). "Effect of nesiritide in combination with standard therapy on serum concentrations of natriuretic peptides in patients admitted for decompensated congestive heart failure". Am. Heart J. 150 (3): 471–7. doi:10.1016/j.ahj.2004.11.021. PMID 16169326.
^ Wang TJ, Larson MG, Levy D et al. (2004). "Impact of obesity on plasma natriuretic peptide levels". Circulation. 109 (5): 594–600. doi:10.1161/01.CIR.0000112582.16683.EA. PMID 14769680.
^ O'Connor CM, Starling RC, Hernandez AF, Armstrong PW, Dickstein K, Hasselblad V, Heizer GM, Komajda M, Massie BM, McMurray JJ et al. (July 2011). "Effect of nesiritide in patients with acute decompensated heart failure". N. Engl. J. Med. 365 (1): 32–43. doi:10.1056/NEJMoa1100171. PMID 21732835.

External links

Brain Natriuretic Peptide at the US National Library of Medicine Medical Subject Headings (MeSH)
BNP and NT-proBNP at Lab Tests Online

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 心不全におけるナトリウム利尿ペプチド測定 natriuretic peptide measurement in heart failure
2. 非心不全下におけるナトリウム利尿ペプチド測定 natriuretic peptide measurement in non heart failure settings
3. 成人における確定診断を得られていない低血圧やショックの評価および初期アプローチ evaluation of and initial approach to the adult patient with undifferentiated hypotension and shock
4. 脳卒中のための血液バイオマーカー blood biomarkers for stroke
5. 呼吸困難患者へのアプローチ approach to the patient with dyspnea

English Journal

Oral Levosimendan Increases Cerebral Blood Flow Velocities in Patients with a History of Stroke or Transient Ischemic Attack: A Pilot Safety Study.

Kivikko M1, Kuoppamäki M2, Soinne L3, Sundberg S4, Pohjanjousi P2, Ellmen J2, Roine RO5.
Current therapeutic research, clinical and experimental.Curr Ther Res Clin Exp.2015 Jan 29;77:46-51. doi: 10.1016/j.curtheres.2015.01.001. eCollection 2015.
BACKGROUND: Intravenous levosimendan is indicated for acute heart failure. The compound has shown promising beneficial effects in ischemic stroke models.OBJECTIVE: We evaluated the efficacy and safety of oral levosimendan in patients with a history of cerebral ischemia.METHODS: In a randomized, doub
PMID 26082815

Application of the United States acute heart failure risk prediction model in Japanese patients; analysis from a contemporary multicenter registry.

Makino J1, Kohsaka S2, Shiraishi Y1, Inohara T1, Goda A3, Izumi Y4, Yagawa M4, Mizuno A5, Fukuda K1, Yoshikawa T4.
International journal of cardiology.Int J Cardiol.2015 Sep 15;195:323-5. doi: 10.1016/j.ijcard.2015.05.164. Epub 2015 Jun 2.
PMID 26056965

Targeted delivery of interleukin-10 to chronic cardiac allograft rejection using a human antibody specific to the extra domain A of fibronectin.

Franz M1, Doll F2, Grün K3, Richter P4, Köse N4, Ziffels B3, Schubert H5, Figulla HR3, Jung C3, Gummert J6, Renner A6, Neri D2, Berndt A4.
International journal of cardiology.Int J Cardiol.2015 Sep 15;195:311-22. doi: 10.1016/j.ijcard.2015.05.144. Epub 2015 May 29.
BACKGROUND AND AIMS: Management of chronic rejection is challenging since there are not sufficient preventive or therapeutic strategies. The rejection process leads to overexpression of ED-A(+) fibronectin (ED-A(+) Fn). The human antibody F8, specific to ED-A(+) Fn, may serve as a vehicle for target
PMID 26056964

Japanese Journal

Changes in the Baseline Clinical Characteristics of Hospitalized Patients with Congestive Heart Failure

Morito Natsumi,Miura Shin-ichiro,Saku Keijiro
福岡大学医学紀要 38(4), 171-176, 2011-12
NAID 110008720007

Effect of Atorvastatin vs. Rosuvastatin on Cardiac Sympathetic Nerve Activity in Non-Diabetic Patients With Dilated Cardiomyopathy

TSUTAMOTO Takayoshi,SAKAI Hiroshi,IBE Kunihiro,YAMAJI Masayuki,KAWAHARA Chiho,NAKAE Ichiro,FUJII Masanori,YAMAMOTO Takashi,HORIE Minoru
Circulation journal : official journal of the Japanese Circulation Society 75(9), 2160-2166, 2011-08-25
… In the rosuvastatin group, there were no changes in MIBG parameters, left ventricular ejection fraction or plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) after 6 months of treatment. …
NAID 10029339567

「B」

Natriuretic peptide B
Available structures
PDB	Ortholog search: PDBe, RCSB
List of PDB id codes
	1YK1, 3N56
Identifiers
Symbols	NPPB ; BNP
External IDs	OMIM: 600295 HomoloGene: 81698 GeneCards: NPPB Gene
Gene ontology
Molecular function	• receptor binding; • hormone activity; • protein binding; • diuretic hormone activity;
Cellular component	• extracellular region; • extracellular space; • protein complex;
Biological process	• cGMP biosynthetic process; • cell surface receptor signaling pathway; • receptor guanylyl cyclase signaling pathway; • body fluid secretion; • regulation of blood pressure; • negative regulation of angiogenesis; • negative regulation of cell growth; • positive regulation of urine volume; • positive regulation of renal sodium excretion; • regulation of vasodilation; • regulation of vascular permeability; • regulation of blood vessel size;
	Sources: Amigo / QuickGO
RNA expression pattern
	More reference expression data
Orthologs
	v; t; e;