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Circulation：NT-proBNP等生物标志物在成人先心病中提供可靠的临床预后价值

2016-11-05 xing.T MedSci原创

成人先天性心脏病生物标志物
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在ACHD患者中，NT-proBNP提供预后信息远超越了常规风险标志物，并且能够可靠地排除有死亡和心衰风险的患者。NT-proBNP、hs-TNT和GDF-15水平升高，可以识别具有最高心血管事件风险的患者。因此，这些生物标志物可以在ACHD患者的监测与管理中发挥的重要作用。

成人先天性心脏病（ACHD）患者的数量在迅速增加，为了优化病人的管理，需要准确地识别高风险的患者。然而，并没有明确的生物标志物来作为ACHD患者有用的判断临床预后的工具。近日，心血管领域权威杂志Circulation上发表了来自荷兰鹿特丹Erasmus医学中心心内科Vivan J. Baggen医生及其研究团队的研究文章，旨在明确ACHD患者氨基末端脑钠肽前体（NT-proBNP）、超敏肌钙蛋白T（hs-TnT）和生长分化因子15（GDF-15）与心血管事件的关系。

研究者在2011年4月至2013年4月期间，对临床症状稳定的经常在门诊就诊的ACHD患者进行临床评估、心电图、超声心动图和生物标志物（NT-proBNP、hs-TnT和GDF-15）检查。研究者前瞻性地随访了患者心血管事件（死亡、心力衰竭、住院治疗、心律失常、血栓栓塞事件和再次介入治疗）的发生情况。通过Kaplan Meier法得出生存曲线，利用Cox回归分析对临床和超声心动图等多个指标进行调整后，得出各个生物标志物和心血管事件之间的关系。

研究共纳入了595例患者（中位年龄为33岁，四分位数的间距为25-41岁，58%为男性，90%参与者心脏功能为I级），患者中位随访时间为42个月（四分位数的间距为37-46个月）。


在评估的三个生物标志物中，NT-proBNP水平在最高四分位数范围的患者（＞33.3pmol/L）与心血管事件（n=165，调整后的风险比为9.05，95%可信区间为3.24-25.3，P＜0.001）、死亡或心脏衰竭（n=50，调整后的风险比为16，95%可信区间为2.04-126，P＜0.001）密切相关。将NT-proBNP作为连续变量进行了分析，也可以得到类似的结果。NT-proBNP水平在最低两四分位数范围的患者发生亡和心脏衰竭的累计比例只有1%。在NT-proBNP（＞14pmol/L）、hs-TNT（＞14ng/L）和GDF-15（>1109ng/L）升高的患者中发生心血管事件的风险最高（p＜0.0001）。

由此可见，在ACHD患者中，NT-proBNP提供的临床预后信息远超越了常规风险标志物，并且能够可靠地排除有死亡和心衰风险的患者。NT-proBNP、hs-TNT和GDF-15水平升高，可以识别具有最高心血管事件风险的患者。因此，这些生物标志物可以在ACHD患者的监测与管理中发挥的重要作用。

原始出处：

Vivan J. Baggen, et al. Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide, Troponin-T, and Growth-Differentiation Factor 15 in Adult Congenital Heart Disease. Circulation. November 3,2016. http://dx.doi.org/10.1161/CIRCULATIONAHA.116.023255

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time=2016-11-07, status=1, ipAttribution=)]
    2017-10-18 hb2008ye

    #标志物#

    0

  2. 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    2016-11-07 huiwelcome

    #BNP#

    0

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    2016-11-07 mjldent

    #NT-proBNP#

    0

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encryptionId=a12628e0852, topicName=先心病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25c8396, createdName=ssnine, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1385182, encodeId=4d2413851822b, content=<a href='/topic/show?id=dc121001e22d' target=_blank style='color:#2F92EE;'>#预后价值#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100172, encryptionId=dc121001e22d, topicName=预后价值)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=70fe497, createdName=paperyu, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1534704, encodeId=4cea1534e04b1, content=<a href='/topic/show?id=6be9230842e' target=_blank style='color:#2F92EE;'>#临床预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23084, encryptionId=6be9230842e, topicName=临床预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a72412536387, createdName=budeshao, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1560576, encodeId=892f15605e6d8, content=<a href='/topic/show?id=3c746936567' target=_blank style='color:#2F92EE;'>#生物标志#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69365, encryptionId=3c746936567, topicName=生物标志)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=63db15173977, createdName=zhu_jun9842, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1566585, encodeId=fcdf156658595, content=<a href='/topic/show?id=3c746936567' target=_blank style='color:#2F92EE;'>#生物标志#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69365, encryptionId=3c746936567, topicName=生物标志)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=63db15173977, createdName=zhu_jun9842, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1601820, encodeId=46e21601820f9, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14697, encryptionId=2f801469e57, topicName=PRO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a60b18898917, createdName=sunylz, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=)]
    2016-11-07 ssnine

    #先心病#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1840934, encodeId=22ef18409347b, content=<a href='/topic/show?id=18bf61953d3' target=_blank style='color:#2F92EE;'>#标志物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=61953, encryptionId=18bf61953d3, topicName=标志物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Wed Oct 18 08:42:00 CST 2017, time=2017-10-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1289295, encodeId=ad1c128929506, content=<a href='/topic/show?id=ede136018b' target=_blank style='color:#2F92EE;'>#BNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3601, encryptionId=ede136018b, topicName=BNP)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd0d217, createdName=huiwelcome, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290334, encodeId=789412903347b, content=<a href='/topic/show?id=f6e513111bc' target=_blank style='color:#2F92EE;'>#NT-proBNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13111, encryptionId=f6e513111bc, topicName=NT-proBNP)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5662228, createdName=mjldent, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1311456, encodeId=be651311456c5, content=<a href='/topic/show?id=a12628e0852' target=_blank style='color:#2F92EE;'>#先心病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=155, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=28708, encryptionId=a12628e0852, topicName=先心病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25c8396, createdName=ssnine, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1385182, encodeId=4d2413851822b, content=<a href='/topic/show?id=dc121001e22d' target=_blank style='color:#2F92EE;'>#预后价值#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100172, encryptionId=dc121001e22d, topicName=预后价值)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=70fe497, createdName=paperyu, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1534704, encodeId=4cea1534e04b1, content=<a href='/topic/show?id=6be9230842e' target=_blank style='color:#2F92EE;'>#临床预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23084, encryptionId=6be9230842e, topicName=临床预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a72412536387, createdName=budeshao, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1560576, encodeId=892f15605e6d8, content=<a href='/topic/show?id=3c746936567' target=_blank style='color:#2F92EE;'>#生物标志#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69365, encryptionId=3c746936567, topicName=生物标志)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=63db15173977, createdName=zhu_jun9842, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1566585, encodeId=fcdf156658595, content=<a href='/topic/show?id=3c746936567' target=_blank style='color:#2F92EE;'>#生物标志#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69365, encryptionId=3c746936567, topicName=生物标志)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=63db15173977, createdName=zhu_jun9842, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1601820, encodeId=46e21601820f9, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14697, encryptionId=2f801469e57, topicName=PRO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a60b18898917, createdName=sunylz, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=)]
    2016-11-07 paperyu

    #预后价值#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1840934, encodeId=22ef18409347b, content=<a href='/topic/show?id=18bf61953d3' target=_blank style='color:#2F92EE;'>#标志物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=61953, encryptionId=18bf61953d3, topicName=标志物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Wed Oct 18 08:42:00 CST 2017, time=2017-10-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1289295, encodeId=ad1c128929506, content=<a href='/topic/show?id=ede136018b' target=_blank style='color:#2F92EE;'>#BNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3601, encryptionId=ede136018b, topicName=BNP)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd0d217, createdName=huiwelcome, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290334, encodeId=789412903347b, content=<a href='/topic/show?id=f6e513111bc' target=_blank style='color:#2F92EE;'>#NT-proBNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13111, encryptionId=f6e513111bc, topicName=NT-proBNP)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5662228, createdName=mjldent, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1311456, encodeId=be651311456c5, content=<a href='/topic/show?id=a12628e0852' target=_blank style='color:#2F92EE;'>#先心病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=155, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=28708, encryptionId=a12628e0852, topicName=先心病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25c8396, createdName=ssnine, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1385182, encodeId=4d2413851822b, content=<a href='/topic/show?id=dc121001e22d' target=_blank style='color:#2F92EE;'>#预后价值#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100172, encryptionId=dc121001e22d, topicName=预后价值)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=70fe497, createdName=paperyu, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1534704, encodeId=4cea1534e04b1, content=<a href='/topic/show?id=6be9230842e' target=_blank style='color:#2F92EE;'>#临床预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23084, encryptionId=6be9230842e, topicName=临床预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a72412536387, createdName=budeshao, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1560576, encodeId=892f15605e6d8, content=<a href='/topic/show?id=3c746936567' target=_blank style='color:#2F92EE;'>#生物标志#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69365, encryptionId=3c746936567, topicName=生物标志)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=63db15173977, createdName=zhu_jun9842, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1566585, encodeId=fcdf156658595, content=<a href='/topic/show?id=3c746936567' target=_blank style='color:#2F92EE;'>#生物标志#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69365, encryptionId=3c746936567, topicName=生物标志)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=63db15173977, createdName=zhu_jun9842, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1601820, encodeId=46e21601820f9, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14697, encryptionId=2f801469e57, topicName=PRO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a60b18898917, createdName=sunylz, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=)]
    2016-11-07 budeshao

    #临床预后#

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1840934, encodeId=22ef18409347b, content=<a href='/topic/show?id=18bf61953d3' target=_blank style='color:#2F92EE;'>#标志物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=61953, encryptionId=18bf61953d3, topicName=标志物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Wed Oct 18 08:42:00 CST 2017, time=2017-10-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1289295, encodeId=ad1c128929506, content=<a href='/topic/show?id=ede136018b' target=_blank style='color:#2F92EE;'>#BNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3601, encryptionId=ede136018b, topicName=BNP)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd0d217, createdName=huiwelcome, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290334, encodeId=789412903347b, content=<a href='/topic/show?id=f6e513111bc' target=_blank style='color:#2F92EE;'>#NT-proBNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13111, encryptionId=f6e513111bc, topicName=NT-proBNP)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5662228, createdName=mjldent, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1311456, encodeId=be651311456c5, content=<a href='/topic/show?id=a12628e0852' target=_blank style='color:#2F92EE;'>#先心病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=155, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=28708, encryptionId=a12628e0852, topicName=先心病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25c8396, createdName=ssnine, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1385182, encodeId=4d2413851822b, content=<a href='/topic/show?id=dc121001e22d' target=_blank style='color:#2F92EE;'>#预后价值#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100172, encryptionId=dc121001e22d, topicName=预后价值)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=70fe497, createdName=paperyu, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1534704, encodeId=4cea1534e04b1, content=<a href='/topic/show?id=6be9230842e' target=_blank style='color:#2F92EE;'>#临床预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23084, encryptionId=6be9230842e, topicName=临床预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a72412536387, createdName=budeshao, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1560576, encodeId=892f15605e6d8, content=<a href='/topic/show?id=3c746936567' target=_blank style='color:#2F92EE;'>#生物标志#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69365, encryptionId=3c746936567, topicName=生物标志)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=63db15173977, createdName=zhu_jun9842, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1566585, encodeId=fcdf156658595, content=<a href='/topic/show?id=3c746936567' target=_blank style='color:#2F92EE;'>#生物标志#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69365, encryptionId=3c746936567, topicName=生物标志)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=63db15173977, createdName=zhu_jun9842, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1601820, encodeId=46e21601820f9, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14697, encryptionId=2f801469e57, topicName=PRO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a60b18898917, createdName=sunylz, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=)]
    2016-11-07 zhu_jun9842

    #生物标志#

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1840934, encodeId=22ef18409347b, content=<a href='/topic/show?id=18bf61953d3' target=_blank style='color:#2F92EE;'>#标志物#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=61953, encryptionId=18bf61953d3, topicName=标志物)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Wed Oct 18 08:42:00 CST 2017, time=2017-10-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1289295, encodeId=ad1c128929506, content=<a href='/topic/show?id=ede136018b' target=_blank style='color:#2F92EE;'>#BNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3601, encryptionId=ede136018b, topicName=BNP)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd0d217, createdName=huiwelcome, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290334, encodeId=789412903347b, content=<a href='/topic/show?id=f6e513111bc' target=_blank style='color:#2F92EE;'>#NT-proBNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13111, encryptionId=f6e513111bc, topicName=NT-proBNP)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5662228, createdName=mjldent, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1311456, encodeId=be651311456c5, content=<a href='/topic/show?id=a12628e0852' target=_blank style='color:#2F92EE;'>#先心病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=155, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=28708, encryptionId=a12628e0852, topicName=先心病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25c8396, createdName=ssnine, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1385182, encodeId=4d2413851822b, content=<a href='/topic/show?id=dc121001e22d' target=_blank style='color:#2F92EE;'>#预后价值#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100172, encryptionId=dc121001e22d, topicName=预后价值)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=70fe497, createdName=paperyu, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1534704, encodeId=4cea1534e04b1, content=<a href='/topic/show?id=6be9230842e' target=_blank style='color:#2F92EE;'>#临床预后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23084, encryptionId=6be9230842e, topicName=临床预后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a72412536387, createdName=budeshao, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1560576, encodeId=892f15605e6d8, content=<a href='/topic/show?id=3c746936567' target=_blank style='color:#2F92EE;'>#生物标志#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69365, encryptionId=3c746936567, topicName=生物标志)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=63db15173977, createdName=zhu_jun9842, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1566585, encodeId=fcdf156658595, content=<a href='/topic/show?id=3c746936567' target=_blank style='color:#2F92EE;'>#生物标志#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69365, encryptionId=3c746936567, topicName=生物标志)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=63db15173977, createdName=zhu_jun9842, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1601820, encodeId=46e21601820f9, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14697, encryptionId=2f801469e57, topicName=PRO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a60b18898917, createdName=sunylz, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=)]
    2016-11-07 zhu_jun9842

    #生物标志#

    0

  9. 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encryptionId=a12628e0852, topicName=先心病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=25c8396, createdName=ssnine, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1385182, encodeId=4d2413851822b, content=<a href='/topic/show?id=dc121001e22d' target=_blank style='color:#2F92EE;'>#预后价值#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100172, encryptionId=dc121001e22d, topicName=预后价值)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=70fe497, createdName=paperyu, createdTime=Mon Nov 07 03:42:00 CST 2016, time=2016-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1534704, encodeId=4cea1534e04b1, content=<a href='/topic/show?id=6be9230842e' target=_blank style='color:#2F92EE;'>#临床预后#</a>, beContent=null, objectType=article, channel=null, 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time=2016-11-07, status=1, ipAttribution=)]
    2016-11-07 sunylz

    #PRO#

    0

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　　美国学者的一项研究表明，美国大部分心脏儿科医生（PC）为心脏病 style=color:blue >成人先天性心脏病（ACHD）患者提供治疗；伴有成人共病为促成转诊的最常见原因。论文于2012年11月在线发表于《美国心脏病学会杂志》（J Am Coll Cardiol）。 　　相关临床指南推荐，中度/复杂性先天性心脏病成人患者的治疗应由ACHD受训医生指导

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