糖尿病患之心臟衰竭－談腦型利鈉肽胜(BNP)於糖尿病患之臨床運用

糖尿病為心臟衰竭之獨立危險因子，而糖尿病患的心臟衰竭，是以往大家所忽略的問題。由於thiazolidinedione類(TZD)藥物於糖尿病患之使用日益普遍，其所導致之水腫及心臟衰竭的問題，使糖尿病患與心臟衰竭之關係，再受到關注。心臟衰竭之診斷向以超音波為黃金標準，然而費用及技術性的難度，使它難以普及為第一線之篩檢工具。血中腦型利鈉肽勝(BNP)濃度與心臟功能密切關連，不止反應心室收縮功能的變化，也反應心室舒張功能的變化。相對於超音波，以BNP大規模篩檢糖尿病患之心臟功能有其潛在的優勢，唯目前無足夠証據支持對糖尿病患全面篩檢。但運用在特定高危險族群如糖尿病患因TZD類藥物造成水腫甚至心臟衰竭之疑慮時，BNP高陰性預測值(negative predictive value)之特點，可供臨床上排除心臟衰竭的重要依據。尤其有微量白蛋白尿之糖尿病患，若BNP值出現異常，在心臟超音波檢測時除收縮功能之外，更應詳細評估心室舒張功能。在使用TZD治療前有微量白蛋白尿且BNP值已高於正常值者，因TZD而產生心臟衰竭之風險較高，更應該詳細評估其水腫是否是心臟衰竭之兆。

關鍵字

心臟衰竭；糖尿病；腦型利鈉肽胜；微量白蛋白尿

並列摘要

As the use of thiazolidinedione (TZD) becomes more popular, there is a growing concern that fluid retention associated with TZD use may precipitate or induce heart failure in patients with diabetes mellitus. Diabetes mellitus is an independent risk factor of heart failure more attention must be given to this issue so that the outcome for this group of CAD equivalent patients can be improved. Traditionally echocardiography with dopplar ultrasound is the gold standard for the diagnosis of heart failure. However, the cost and technical cumbersome preclude it from being a full-scale screening tool. Plasma brain natriuretic peptide (BNP) level is closely correlated with both diastolic and systolic cardiac function, however the use of BNP for screening of cardiac dysfunction should be restricted to certain high-risk group. For diabetic patients with TZD associated edema the high negative predictive value of BNP may be useful for identifying patients who need further diagnostic evaluation. For diabetic patients with microalbuminuria and elevated BNP level prior to TZD administration, the risk of heart failure is higher than those without microalbuminuria. For this particular group of patients echocardiographic study should include a complete evaluation of diastolic dysfunction.

並列關鍵字

Heart failure ； Diabetes mellitus ； BNP ； Microalbuminuria ； Thiazolidinedione

國際替代計量

糖尿病患之心臟衰竭－談腦型利鈉肽胜(BNP)於糖尿病患之臨床運用

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