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CIHFC 2016:张宇辉:中国心衰诊疗的现状及NT-proBNP的临床应用(下)

2016-03-17 小M MedSci原创

当今世界上最好的心血管医生Eugene Braunwald教授曾评价:心力衰竭是心脏病最后的战场。心衰是一个与时俱增的疾病,随着年龄的增长,心衰的发病率也会逐渐增高,而当今世界处于一个全球老龄化的状态中,因此临床医生需要更深入地认识与诊治心衰。那么中国心衰诊疗的现状是怎样的呢? 3月12日,在中国国际心力衰竭大会新闻发布会上,来自中国医学科学院阜外医院心力衰竭中心的本届大会秘书长、张

当今世界上最好的心血管医生Eugene Braunwald教授曾评价:心力衰竭是心脏病最后的战场。心衰是一个与时俱增的疾病,随着年龄的增长,心衰的发病率也会逐渐增高,而当今世界处于一个全球老龄化的状态中,因此临床医生需要更深入地认识与诊治心衰。那么中国心衰诊疗的现状是怎样的呢?

3月12日,在中国国际心力衰竭大会新闻发布会上,来自中国医学科学院阜外医院心力衰竭中心的本届大会秘书长、张宇辉教授做了题为《中国心衰诊疗的现状及生物标志物NT-proBNP检测在临床诊疗中的应用》的演讲。以下是小编整理的主要内容:

“一、心力衰竭概述”和“二、NT-proBNP的生物学特征”的具体内容请参考“【CIHFC 2016】张宇辉:中国心衰诊疗的现状及NT-proBNP的临床应用(上)



三、NT-proBNP对急性心衰的诊断和预后评估

1.NT-proBNP用于急性心衰的诊断:

(1)首先,疑似急性心力衰竭的症状和体征

(2)其次,病史、体检、心电图、胸片以及NT-proBNP检测

根据NT-proBNP的数值,推测患者是否发生了AHF:

(1)若NT-proBNP<300ng/L,则心衰的可能性很小。建议评估非心源性的呼吸困难原因;预后较好

(2)若NT-proBNP在300-10000ng/L(灰区),则可能为心衰。需要结合临床症状适当诊断和治疗;可能早期出院

(3)若NT-proBNP在300-10000ng/L间,但>按年龄调整的阳性临界值,则很可能是心衰。应对其进行进一步检查,按需分类治疗

(4)若NT-proBNP>10000ng/L,则很可能为心衰,且是严重心衰。此时应对患者进行入院严密监测

2.急诊中如何解读NT-proBNP值

(1)肾功能不全患者,纳入截断值应为1200ng/L(2014年心衰指南,Ⅰ级推荐,A类证据)

(2)轻微肾功能不全是,影响不大;肾功能不全明显(eGFR<60)时,NT-proBNP水平与肾功能成反比,BNP/NT-proBNP对肾功能的依赖程度一致。

肾功能不全(eGFR<60)患者的诊断如下表所示:

3.NT-proBNP连续检测可更好判断急性心衰预后(Ⅰ级推荐,A类证据)

很多研究提示:住院期间NT-proBNP显著升高、居高不降,或降幅<30%,均预示再住院和死亡风险增加。

特别是当NT-proBNP>5000ng/L时,提示患者的近期再住院和死亡风险是很高的;当NT-proBNP>1000ng/L时,提示AHF患者的远期再住院和死亡风险是较高的。

4.急性心衰(AHF)小结:

(1)应用于急性心衰的诊断:NT-proBNP是诊断AHF的可靠因子(Ⅰ级推荐,A类证据)

排除AHF,推荐NT-proBNP<300ng/L;
按年龄分层提升了NT-proBNP的整体预测性能,推荐使用ICON试验中高效的三界值450/900/1800ng/L。

(2)更好判断急性心衰预后:NT-proBNP是评估AHF预后的有力指标(Ⅰ级推荐,A类证据)

高的NT-proBNP值预示不良的AHF预后;
短期预后界值推荐5000ng/L,长期预后界值推荐1000ng/L。

(3)指导AHF的住院治疗:NT-proBNP可用于指导AHF的住院治疗

判断治疗的效果,一方面是根据患者症状及体征的减轻或消失;另一个方面就是根据NT-proBNP的下降水平:急性不稳定心衰治疗后,NT-proBNP下降达30%是一个合理的目标,而且预后比NT-proBNP一直居高不下的患者的预后更好。

四、NT-proBNP用于慢性心衰管理

1.连续监测NT-proBNP可判断CHF预后情况

慢性心衰的管理,有利于患者接受长期规范化诊治,进而减少HF患者的再住院率和降低其死亡率,改善生活质量。

目前国外正在进行用NT-proBNP连续监测判断心衰预后情况的研究,如Val-HeFT研究。


定期的监测NT-proBNP有利于医生获取HF患者出院后的病情。比较CHF日常的NT-proBNP水平和住院时的NT-proBNP水平,还有利于医生对CHF患者住院时的治疗选择。

2.NT-proBNP指导CHF的治疗

NT-proBNP对CHF效果的评估、以及指导CHF的治疗的证据不是特别多,尚有争论,国外目前关于这方面的研究大致只有4个,但是这些研究的结果并不一致。

下图是PROTECT研究(4个研究之一)

3.NT-proBNP对慢性稳定性心衰治疗监测小结:

(1)2014心衰指南推荐血浆NT-proBNP为CHF的常规检查(Ⅰ级推荐,A类证据)

(2)NT-proBNP<125ng/L时,不支持慢性心衰诊断;NT-proBNP>125ng/L时,与CHF的严重程度相关(Ⅰ级推荐,A类证据)

(3)NT-proBNP指导的心衰治疗,降低<75岁患者的死亡率,降低中期(9-15个月)心衰住院风险(Ⅱa类,B级)

五、NT-proBNP的其他应用

NT-proBNP除了指导心衰病人的诊治,还指导冠心病、肺栓塞、感染等很多的疾病的诊治。因此,NT-proBNP被许多科室的医生使用,但是NT-proBNP的使用是把双刃剑:一方面,可以更方便医生对疾病的诊治;另一方面,却会给医生带来许多误导,需要医生更严谨仔细的分析判断。

例如对于冠心病患者来说:

(1)NT-proBNP水平升高与预后不佳相关(心梗、心梗合并心衰同样有意义),因为他们会导致心肌缺血,心脏张力增高,但是此时NT-proBNP的增加应该没有心衰造成的增加高。

(2)NT-proBNP与死亡率和未来HF发生强烈相关

(完)

想知道更多关于心衰标志物的新进展的内容吗?3月11日,在2016中国国际心力衰竭大会上,张宇辉教授还做了《标志物在心力衰竭中应用及进展》的演讲。敬请期待MedSci小编整理的“【CIHFC 2016】张宇辉:标志物在心力衰竭中应用及进展”。

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    2016-03-21 1de304d2m86(暂无匿称)

    值得学习

    0

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    2016-03-20 1ddc978cm67(暂无匿称)

    好,值得学习。

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1835614, encodeId=48eb18356143b, content=<a href='/topic/show?id=cfdc22e893f' target=_blank style='color:#2F92EE;'>#临床应用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22789, encryptionId=cfdc22e893f, topicName=临床应用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fc8528, createdName=clmlylxy, createdTime=Tue Jan 17 21:04:00 CST 2017, time=2017-01-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72116, encodeId=f437e2116d6, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44b91679772, createdName=1de304d2m86(暂无匿称), createdTime=Mon Mar 21 13:32:00 CST 2016, time=2016-03-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=71757, encodeId=3ed6e1757c0, content=好,值得学习。, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=73801651090, createdName=1ddc978cm67(暂无匿称), createdTime=Sun Mar 20 07:24:00 CST 2016, time=2016-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1289290, encodeId=bd2d128929077, content=<a href='/topic/show?id=ede136018b' target=_blank style='color:#2F92EE;'>#BNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3601, encryptionId=ede136018b, topicName=BNP)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd0d217, createdName=huiwelcome, createdTime=Sat Mar 19 08:04:00 CST 2016, time=2016-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290330, encodeId=c4e8129033061, content=<a href='/topic/show?id=f6e513111bc' target=_blank style='color:#2F92EE;'>#NT-proBNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, 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=Sat Mar 19 08:04:00 CST 2016, time=2016-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1601791, encodeId=047a1601e917d, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, 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=Sat Mar 19 08:04:00 CST 2016, time=2016-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=71037, encodeId=f850e1037bd, content=感谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=142, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=73801651090, createdName=1ddc978cm67(暂无匿称), createdTime=Fri Mar 18 06:34:00 CST 2016, time=2016-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=71020, encodeId=74f5e102032, content=指标, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTK29w9r0upRgxUXHNhe7bd3VxHnhBSpibMbKOjtX92zXr78SkuZfUNuADrjHiaw6uibZaEYjh9cJLzew/132, createdBy=261e1682638, createdName=1de3b290m83(暂无匿称), createdTime=Fri Mar 18 00:25:00 CST 2016, time=2016-03-18, status=1, ipAttribution=)]
    2016-03-19 huiwelcome
  5. [GetPortalCommentsPageByObjectIdResponse(id=1835614, encodeId=48eb18356143b, content=<a href='/topic/show?id=cfdc22e893f' target=_blank style='color:#2F92EE;'>#临床应用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22789, encryptionId=cfdc22e893f, topicName=临床应用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fc8528, createdName=clmlylxy, createdTime=Tue Jan 17 21:04:00 CST 2017, time=2017-01-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72116, encodeId=f437e2116d6, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44b91679772, createdName=1de304d2m86(暂无匿称), createdTime=Mon Mar 21 13:32:00 CST 2016, time=2016-03-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=71757, encodeId=3ed6e1757c0, content=好,值得学习。, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=73801651090, createdName=1ddc978cm67(暂无匿称), createdTime=Sun Mar 20 07:24:00 CST 2016, time=2016-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1289290, encodeId=bd2d128929077, content=<a href='/topic/show?id=ede136018b' target=_blank style='color:#2F92EE;'>#BNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3601, encryptionId=ede136018b, topicName=BNP)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd0d217, createdName=huiwelcome, createdTime=Sat Mar 19 08:04:00 CST 2016, time=2016-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290330, encodeId=c4e8129033061, content=<a href='/topic/show?id=f6e513111bc' target=_blank style='color:#2F92EE;'>#NT-proBNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, 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=Sat Mar 19 08:04:00 CST 2016, time=2016-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1601791, encodeId=047a1601e917d, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, 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=Sat Mar 19 08:04:00 CST 2016, time=2016-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=71037, encodeId=f850e1037bd, content=感谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=142, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=73801651090, createdName=1ddc978cm67(暂无匿称), createdTime=Fri Mar 18 06:34:00 CST 2016, time=2016-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=71020, encodeId=74f5e102032, content=指标, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTK29w9r0upRgxUXHNhe7bd3VxHnhBSpibMbKOjtX92zXr78SkuZfUNuADrjHiaw6uibZaEYjh9cJLzew/132, createdBy=261e1682638, createdName=1de3b290m83(暂无匿称), createdTime=Fri Mar 18 00:25:00 CST 2016, time=2016-03-18, status=1, ipAttribution=)]
    2016-03-19 mjldent
  6. [GetPortalCommentsPageByObjectIdResponse(id=1835614, encodeId=48eb18356143b, content=<a href='/topic/show?id=cfdc22e893f' target=_blank style='color:#2F92EE;'>#临床应用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22789, encryptionId=cfdc22e893f, topicName=临床应用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fc8528, createdName=clmlylxy, createdTime=Tue Jan 17 21:04:00 CST 2017, time=2017-01-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72116, encodeId=f437e2116d6, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44b91679772, createdName=1de304d2m86(暂无匿称), createdTime=Mon Mar 21 13:32:00 CST 2016, time=2016-03-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=71757, encodeId=3ed6e1757c0, content=好,值得学习。, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=73801651090, createdName=1ddc978cm67(暂无匿称), createdTime=Sun Mar 20 07:24:00 CST 2016, time=2016-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1289290, encodeId=bd2d128929077, content=<a href='/topic/show?id=ede136018b' target=_blank style='color:#2F92EE;'>#BNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3601, encryptionId=ede136018b, topicName=BNP)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd0d217, createdName=huiwelcome, createdTime=Sat Mar 19 08:04:00 CST 2016, time=2016-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290330, encodeId=c4e8129033061, content=<a href='/topic/show?id=f6e513111bc' target=_blank style='color:#2F92EE;'>#NT-proBNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, 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=Sat Mar 19 08:04:00 CST 2016, time=2016-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1601791, encodeId=047a1601e917d, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, 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=Sat Mar 19 08:04:00 CST 2016, time=2016-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=71037, encodeId=f850e1037bd, content=感谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=142, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=73801651090, createdName=1ddc978cm67(暂无匿称), createdTime=Fri Mar 18 06:34:00 CST 2016, time=2016-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=71020, encodeId=74f5e102032, content=指标, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTK29w9r0upRgxUXHNhe7bd3VxHnhBSpibMbKOjtX92zXr78SkuZfUNuADrjHiaw6uibZaEYjh9cJLzew/132, createdBy=261e1682638, createdName=1de3b290m83(暂无匿称), createdTime=Fri Mar 18 00:25:00 CST 2016, time=2016-03-18, status=1, ipAttribution=)]
    2016-03-19 sunylz
  7. [GetPortalCommentsPageByObjectIdResponse(id=1835614, encodeId=48eb18356143b, content=<a href='/topic/show?id=cfdc22e893f' target=_blank style='color:#2F92EE;'>#临床应用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22789, encryptionId=cfdc22e893f, topicName=临床应用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fc8528, createdName=clmlylxy, createdTime=Tue Jan 17 21:04:00 CST 2017, time=2017-01-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72116, encodeId=f437e2116d6, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44b91679772, createdName=1de304d2m86(暂无匿称), createdTime=Mon Mar 21 13:32:00 CST 2016, time=2016-03-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=71757, encodeId=3ed6e1757c0, content=好,值得学习。, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=73801651090, createdName=1ddc978cm67(暂无匿称), createdTime=Sun Mar 20 07:24:00 CST 2016, time=2016-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1289290, encodeId=bd2d128929077, content=<a href='/topic/show?id=ede136018b' target=_blank style='color:#2F92EE;'>#BNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3601, encryptionId=ede136018b, topicName=BNP)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd0d217, createdName=huiwelcome, createdTime=Sat Mar 19 08:04:00 CST 2016, time=2016-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290330, encodeId=c4e8129033061, content=<a href='/topic/show?id=f6e513111bc' target=_blank style='color:#2F92EE;'>#NT-proBNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, 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=Sat Mar 19 08:04:00 CST 2016, time=2016-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1601791, encodeId=047a1601e917d, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, 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=Sat Mar 19 08:04:00 CST 2016, time=2016-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=71037, encodeId=f850e1037bd, content=感谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=142, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=73801651090, createdName=1ddc978cm67(暂无匿称), createdTime=Fri Mar 18 06:34:00 CST 2016, time=2016-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=71020, encodeId=74f5e102032, content=指标, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTK29w9r0upRgxUXHNhe7bd3VxHnhBSpibMbKOjtX92zXr78SkuZfUNuADrjHiaw6uibZaEYjh9cJLzew/132, createdBy=261e1682638, createdName=1de3b290m83(暂无匿称), createdTime=Fri Mar 18 00:25:00 CST 2016, time=2016-03-18, status=1, ipAttribution=)]
    2016-03-18 1ddc978cm67(暂无匿称)

    感谢分享。

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1835614, encodeId=48eb18356143b, content=<a href='/topic/show?id=cfdc22e893f' target=_blank style='color:#2F92EE;'>#临床应用#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22789, encryptionId=cfdc22e893f, topicName=临床应用)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fc8528, createdName=clmlylxy, createdTime=Tue Jan 17 21:04:00 CST 2017, time=2017-01-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=72116, encodeId=f437e2116d6, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44b91679772, createdName=1de304d2m86(暂无匿称), createdTime=Mon Mar 21 13:32:00 CST 2016, time=2016-03-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=71757, encodeId=3ed6e1757c0, content=好,值得学习。, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=73801651090, createdName=1ddc978cm67(暂无匿称), createdTime=Sun Mar 20 07:24:00 CST 2016, time=2016-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1289290, encodeId=bd2d128929077, content=<a href='/topic/show?id=ede136018b' target=_blank style='color:#2F92EE;'>#BNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3601, encryptionId=ede136018b, topicName=BNP)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd0d217, createdName=huiwelcome, createdTime=Sat Mar 19 08:04:00 CST 2016, time=2016-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1290330, encodeId=c4e8129033061, content=<a href='/topic/show?id=f6e513111bc' target=_blank style='color:#2F92EE;'>#NT-proBNP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, 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=Sat Mar 19 08:04:00 CST 2016, time=2016-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1601791, encodeId=047a1601e917d, content=<a href='/topic/show?id=2f801469e57' target=_blank style='color:#2F92EE;'>#PRO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, 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=Sat Mar 19 08:04:00 CST 2016, time=2016-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=71037, encodeId=f850e1037bd, content=感谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=142, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=73801651090, createdName=1ddc978cm67(暂无匿称), createdTime=Fri Mar 18 06:34:00 CST 2016, time=2016-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=71020, encodeId=74f5e102032, content=指标, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTK29w9r0upRgxUXHNhe7bd3VxHnhBSpibMbKOjtX92zXr78SkuZfUNuADrjHiaw6uibZaEYjh9cJLzew/132, createdBy=261e1682638, createdName=1de3b290m83(暂无匿称), createdTime=Fri Mar 18 00:25:00 CST 2016, time=2016-03-18, status=1, ipAttribution=)]
    2016-03-18 1de3b290m83(暂无匿称)

    指标

    0

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2016年3月12日,中国国际心力衰竭大会暨中国医师协会心力衰竭专业委员会第一届学术年会2016在中国北京国家会议中心隆重开幕。 近来,随着科学技术的进步,心力衰竭在诊断、治疗等方面都取得了巨大的进展,但由于心力衰竭发病率、致死率和致残率高,心衰仍然是威胁人类健康的公共和社会重大问题,也是当前心血管领域的热点问题和亟待解决的难题。 此次大会由中国医师协会、中国医师协会心力衰竭专业委员会

2016中国国际心力衰竭大会暨中国医师协会心力衰竭专业委员会第一届学术年会在京盛大召开

(2016年3月12日 北京)由中国医师协会、中国医师协会心力衰竭专业委员会主办,国家心血管病中心、中国医学科学院阜外医院协办的“2016 中国国际心力衰竭大会暨中国医师协会心力衰竭专业委员会第一届学术年会”在北京国际会议中心隆重召开。 “近三十年,人们对心力衰竭的认识有了很大的提高,对心力衰竭的诊断和治疗取得了很大的进步。然而研究表明,心力衰竭在发达国家仍然是发病率快速增长的唯一的心血管病

Am J Epidemiol:1998-2011年美国急性失代偿性心力衰竭患者住院趋势

估计因急性失代偿性心力衰竭住院的患者例数高于以ICD-9-CM-428为主要诊断的主要患者的2倍。这一趋势增加值到2005年达到高峰,在2005年以后相对持平。

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(2016年3月13日 北京)心力衰竭是多种心血管疾病的严重和终末阶段,其发病率上升最快、致残致死率最高,具有重大的疾病负担和社会负担,如何有效防治心力衰竭一直是慢病领域的热点问题。 由中国医师协会、中国医师协会心力衰竭专业委员会主办,国家心血管病中心、中国医学科学院阜外医院协办的“2016中国国际心力衰竭大会暨中国医师协会心力衰竭专业委员会第一届学术年会”在北京国际

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