摘要
目的探讨血浆N末端脑利钠肽（NT-BNP）对维持性血液透析（MHD）患者透析充分性的评估价值。方法选取行MHD的患者112例，根据心胸比值分为血液透析充分组（A组，63例，心胸比值〈0．5）及血液透析不充分组（B组，49例，心胸比值≥0．5），比较两组透析前、透析结束时、透析后4h、透析后24h血浆NT-BNP水平的变化，检查透析前后校正后下腔静脉宽度（VCD），并对透析后的血浆NT—BNP水平与心胸比值、校正后VCD进行相关性分析。结果A、B组透析前NT-BNP分别为（13808±7611）、（25573±8444）ng／L，差异有统计学意义（JP〈0．01），透析结束时两组NT-BNP均升高，但差异无统计学意义（P〉0．05），透析后4h两组NT-BNP均显著下降（P〈O．01），透析后4h两组NT-BNP分别为（8256±6611）、（21320±6828）ng／L，B组NT．BNP显著高于A组（P〈0．01）。透析后24h，A组NT-BNP仍处于较低水平，但B组NT-BNP再次呈上升趋势。透析前，两组校正后VCD比较差异无统计学意义（P〉0．05），透析后，两组校正后VCD均较透析前下降，但A组透析前后比较差异无统计学意义（P〉0．05），B组透析前后比较差异有统计学意义（P〈0．05）。血浆NT-BNP水平与心胸比值、校正后VCD均呈显著正相关（r=0．462，P〈0．01；r=0．513，P〈0．01）。结论血浆NT-BNP可在一定程度上反映MHD患者的容量负荷及尿素清除指数，可更为全面地评价透析的充分性。
Objective To investigate the value of plasma N terminal brain natriuretic peptide （NT-BNP） in dialysis adequacy assessment of maintenance hemodialysis （MHD）. Methods One hundred and twelve MHD patients were divided into hemodialysis adequacy group （group A,63 patients, cardiothoracic ration 〈0.5） and hemodialysis inadequate group （group B,49 patients, cardiothoracic ration ≥0.5 ）. The plasma NT-BNP levels of pre-dialysis, dialysis end, 4th and 24th hour after dialysis were compared. Before and after dialysis the inferior vena cava diameter （VCD） was checked. The correlation between NT-BNP level at the end of dialysis,cardiothoracic ration and post dialysis VCD were analyzed. Results The levels of NT-BNP in group A, B before dialysis were （ 13 808±7611 ） and （25 573± 8444） ug/L respectively, and there was significant difference （P 〈 0.01 ）. The levels of NT-BNP in two groups increased at the end of dialysis, but there was no significant difference （P 〉 0.05）. Then the levels of NT-BNP in two groups decreased significantly at 4th hour after dialysis （P 〈 0.01 ）. The levels of NT-BNP in two groups at 4th hour after dialysis were （8256±6611） and （21 320±6828） ng/L, and there was significant difference （P 〈 0.01 ）. At 24th hour after dialysis, the level of NT-BNP in group A was still at a low level, but in group B, the level of NT-BNP increased again. Before dialysis, the levels of VCD between two groups had no significant difference （P〉 0.05）. After dialysis, the level of VCD in group B decreased significantly（P 〈 0.05 ）. After dialysis, the ievel of VCD in group B was significantly higher than that in group A（P 〈 0.05 ）. The level of NT-BNP had positive relationship with cardiothoracic ration and VCD （r = 0.462, P 〈 0.01 ;r = 0.513 ,P 〈 0.01 ）. Conclusion The level of NT-BNP can reflect the volume overload and urea clearance index of MHD, which may be a more comprehensive evaluation index of the adequacy of dialysis.
出处
《中国医师进修杂志》
2012年第34期23-25,共3页
Chinese Journal of Postgraduates of Medicine
基金
浙江省温州市瓯海区科技计划（20100154）
关键词
利钠肽
脑
血液滤过
心胸比
Natriuretic peptide, brain
Hemofiltration
Cardiothoracic ration
