中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (11): 605-608.doi: 10.3969/j.issn.1671-4091.2016.11.006

• 临床研究 • 上一篇    下一篇

应用MBIA法及NT-proBNP评估临床干体重达标的血液透析患者容量负荷的价值

孙颖,陈献广,赵班,刘昕,李湛, 富小红,毛永辉   

  1. 北京医院 国家老年医学中心肾脏内科
  • 收稿日期:2016-05-09 修回日期:2016-07-05 出版日期:2016-11-12 发布日期:2016-11-12
  • 通讯作者: 毛永辉 mmdn2009@163.com E-mail:mmdn2009@163.com
  • 基金资助:

    公益性行业科研专项(201502010)

Fluid status assessment by multi-frequency bioelectrical impedance analysis and serum NT-proBNP in maintenance hemodialysis patients

  • Received:2016-05-09 Revised:2016-07-05 Online:2016-11-12 Published:2016-11-12

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摘要： 目的通过多频生物电阻抗法(multifrequency bioelectrical impedance analysis, MBIA)评估临床干体质量达标的维持性血液透析(maintenance hemodialysis, MHD)患者理想干体质量达标情况，明确氨基末端前体脑钠肽(N-terminal pro brain natrinuretic peptide, NT-proBNP)对本组患者容量超负荷的诊断价值。方法选取血液净化中心临床干体质量达标的MHD 患者共105 例，采用MBIA 法完成人体体液成分测定，得到细胞外液量(extracellular Water, ECW)与身体总水量(total body water, TBW)的比值(ECW%)，确定理想干体质量是否达标，同时检测透前NT-proBNP，分析ECW%的相关影响因素，通过ROC 曲线确定NT-proBNP 定性诊断容量超负荷的最佳诊断临界值。结果应用MBIA法测定本组患者ECW%，平均值为0.39±0.01，以校正的ECW%应用公式确定本组患者理想干体质量，结果  显示在本组患者中仍有51.4% (54/105 例)的患者未达到理想干体质量。年龄与ECW%呈正相关关系 (r= 0.578，P= 0.000)；性别 (r=- 0.251，P =0.010)、脱水量 (r=- 0.226，P= 0.020)、各点舒张压(r 值分别为-0.336、-0.374、-0.281，P 值分别为0.000、0.000、0.004)与ECW%呈负相关关系；多元线性回归分析显示年龄是ECW%的独立影响因素(β=0.451，t=4.892，P=0.000)。血清NT-proBNP 水平与ECW%呈正相关关系(r=0.340，P =0.000)。理想干体质量达标组与未达标组的NT- proBNP 中位数分别为3321pg/ml 和5407pg/ml，差别有显著统计学意义(z=-3.802,P=0.000)，经ROC 曲线分析显示NT-proBNP 诊断理想干体质量不达标的曲线下面积为0.715(P =0.000)，NT-proBNP 浓度在3937pg/ml 时具有最高灵敏度(0.704)和特异度(0.627)，此截点值可作为理想干体质量定性评定的参考临界值。结论年龄及NT-proBNP水平与MHD 患者ECW%密切相关，NT-proBNP 可以作为定性评价MHD 患者容量状态的临床标志物，NT-proBNP截点浓度3937pg/ml 可作为临床定性判断是否干体质量达标的参考临界值。

关键词: 维持性血液透析, 多频生物电阻抗法, 理想干体重, 氨基末端前体脑钠肽

Abstract: Objective To assess the ideal dry body weight of maintenance hemodialysis (MHD) patients using multi-frequency bioelectrical impedance analysis (MBIA), and to evaluate the diagnostic value of serum N-terminal pro brain natrinuretic peptide (NT-proBNP) for the volume overload of MHD patients. Methods A total of 105 MHD patients with ideal dry body weight from our blood purification center were enrolled in this study. MBIA was used to obtain the body fluid composition, the ratio of extracellular water (ECW%), and the total body water (TBW), from which the fluid status of the patient was determined. Serum NT-proBNP before
dialysis was also measured. We then analyzed the influence factors for ECW% and the value of serum NT-proBNP for the diagnosis of fluid overload by ROC curve. Results The average ECW% was 0.39±0.01 by MBIA. Using the formula to correct the ECW%, fluid overload was found in 51.4% (54/105) of the patients.
ECW% was positively correlated with age (r= 0.578, P =0.000). ECW% was negatively correlated with gender (r=- 0.251, P=0.010), dehydration volume (r =- 0.226, P=0.020), and diastolic pressure at each time point (r=-0.336, -0.374, -0.281 respectively, and P=0.000, 0.000, 0.004 respectively). Multivariate linear regression showed that age was the independent risk factor for ECW% (β=0.451, t=4.892, P=0.000). Serum NT-proBNP was positively correlated with ECW% (r= 0.340, P =0.000). The median value of serum NT-proBNP was 3,321pg/ml in the patients with ideal dry body weight, and was 5,407pg/ml in the patients without ideal dry body weight (z=-3.802, P =0.000). The ROC curve showed that the area under the curve of serum NTproBNP for the diagnosis of fluid overload was 0.715 (P =0.000); when serum NT-proBNP was set at 3,937pg/ml as the cut-off value for the diagnosis of ideal dry body weight, the sensitivity was 0.704 and the specificity was 0.627. Conclusion Age and serum NT-proBNP level were closely correlated with ECW% in MHD patients. NT- proBNP was a useful marker for evaluating volume status in MHD patient, and NT- proBNP 3, 937pg/ml was the optimal cut-off value for the evaluation of ideal dry body weight.

Key words: Maintenance hemodialysis, Multi- frequency bioelectrical impedance analysis, Ideal dry weight, N-terminal pro brain natrinuretic peptide