摘要
目的:通过分析维持性血液透析(MHD)患者血浆N-末端前体脑钠肽(NT-proBNP)与血压、透析间期质量增长之间关系,探讨NT-proBNP评估MHD患者心脏负荷的临床应用价值。方法:2010年10月—2010年12月复旦大学附属中山医院血液净化中心透析龄超过3个月的MHD患者232例,所有患者心脏超声检查示左心室射血分数>50%,并且无明显心力衰竭临床表现,排除急性心血管事件,记录患者1周连续3次透析前血压、透析间期体质量增长量,分析血浆NT-proBNP水平与透析前血压、透析间期体质量增长量等反映心脏负荷指标之间的关系。结果:(1)MHD患者血浆NT-proBNP为2 598.0(1 404.0～4 736.3)pg/mL,所有患者均高于正常;(2)血浆NT-proBNP与收缩压(r=0.315,P<0.01)及舒张压(r=0.178,P<0.01)呈显著正相关,血压>160/100 mmHg患者的NT-proBNP显著高于血压140/90 mmHg～160/100 mmHg及≤140/90 mmHg患者(P<0.01);(3)透析间期体质量相对增长量≤4%患者血浆NT-proBNP水平显著低于>4%患者(P<0.01),且与透析间期体质量增长量呈显著正相关(r=0.395,P<0.01);(4)以血压≤140/90 mmHg,透析间期体质量相对增长量≤4%,且无明显心力衰竭视作为MHD患者心脏负荷状态良好,血浆NT-proBNP水平在判断MHD患者容量状态的受试者工作特征曲线(ROC)下面积为0.85(0.79～0.90,P<0.01),以NT-proBNP2 705.5 pg/mL作为界值的灵敏度为61.8%,特异度为98.2%。结论:MHD患者血浆NT-proBNP水平升高,且与患者血压及透析间期体质量增长显著相关。血浆NT-proB-NP水平可作为监测MHD患者心脏负荷状态的敏感指标。
Objective： To investigate the relationship between plasma levels of N-terminal pro brain natriuretic peptide （NT proBNP） with blood pressure and weight growth during dialysis in patients on maintainence hemodialysis and to evaluate the clinical value of NT-proBNP in the assessment of cardiac load. Methods： We recruited 232 patients who were treated with Maintainence hemodialysis（MHD） for at least 3 months before the study and were in a stable clinical status without any acute cardiovascular events and left ventricular ejection fractions（LVEF） obtained fom echocardiograms were〉50%. Plasma NT proB NP level was assayed by chemiluminescence. Body weight growth and blood pressure were recorded before dialysis for 3 consec utive hemodialysis sessions to determine the relationship between NT proBNP and cardiac load. Results： The average level of NTproBNP was 2598.0（3 404.0 - 4 736.3） pg/mL which was higher than normal. Plasma NT proBNP levels were signifi candy higher in patients with blood pressure〉 160/100mmHg or body weight growth〉4% than those of the control group （P〈0.01）, and plasma NT proBNP level significantly correlated with systolic blood pressure（r =0. 315, P〈0.0l）, diastolic blood pressure （r = 0.178, P〈0.01 ） and body weight growth during dialysis（r = 0. 395, P〈0.01 ） . The area under the receiv er operating characteristic curve for NT-proBNP to detect cardiac overload was 0.85（95% CI：0.79 - 0.90 P〈0.01 ） ,and cut- off NT proBNP value at 2705.5pg/mL had a sensitivity of 61.8 % and a specificity of 98.2% for detecting cardiac overload. Conclusions： In MHD patients, increased levels of NT-proBNP are associated with blood pressure and body weight growth dur ing dialysis. Plasma NT-proBNP can be a good marker for the detection and evaluation of cardiac overload in MHD patients.
出处
《中国临床医学》
2011年第5期578-581,共4页
Chinese Journal of Clinical Medicine
基金
上海市重大课题(编号:08DZ1900602)
教育部国家"211工程"重点学科建设项目(3期)(编号:211XK20)
