中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (05): 289-293.doi: 10.3969/j.issn.1671-4091.2016.05.009

• 临床研究 • 上一篇    下一篇

N端脑钠肽前体变化率评估血液透析患者容量负荷的临床价值

李杰1,张启蒙1,蒋小栋1,秦婷1,穆广琴2,付旭1,张震1 ,王丽云1 ,李梅1   

  1. 北京市中关村医院血液净化中心
  • 收稿日期:2015-12-07 修回日期:2016-03-17 出版日期:2016-05-12 发布日期:2016-05-19
  • 通讯作者: 张启蒙 zqmzgc@sina.com.cn E-mail:zqmzgc@sina.com.cn
  • 基金资助:

    北京市中关村医院科研培育专项资金项目编号：Y201401

Evaluation of volume load by using the change rate of N terminal brain natriuretic peptide in hemodialysis patients

  • Received:2015-12-07 Revised:2016-03-17 Online:2016-05-12 Published:2016-05-19

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摘要： 目的通过对维持性血液透析(maintenance hemodialysis，MHD)患者血清N 端脑钠肽前体(N- terminal pro- brain natriuretic peptide，NT- proBNP)的变化率与血压、体液水分含量和NTproBNP等指标的分析，探讨NT-proBNP 变化率对MHD 患者容量负荷及透析超滤量的诊断价值。方法检测103 位患者透析治疗前、后血清NT-proBNP 的水平，计算NT-proBNP 的变化率。根据NT-proBNP 变化率的中位数进行分组，对2 组患者各个时段血压、总体水含量(total body water，TBW)、细胞外液(extracellular water，ECW)和细胞内液(intracellular water，ICW)以及透析前NT-proBNP 水平比较。结果①MHD 患者透析后NT-proBNP 水平较透析前明显下降(Z=-3.968,P＜0.001)。②NT-proBNP 变化率小于等于0 的患者占总体数值的32.1%，大于0 的患者占67.9%。③NT-proBNP 变化率与透析第2h 血压呈明显的负相关(r=-0.198，P=0.045)，与透析前血压与透析第2h 血压差值呈明显的正相关。(r=0.265，P=0.007)。NT-proBNP 变化率较大组第2 小时(t=2.466，P0.015)和第3h(t=2.113，P=0.037)血压明显低于较小组。④NT-proBNP 变化率较大组TBW(t=2.579，P=0.012)、ECW(t=2.297，P=0.006)ICW(t=2.126，P=0.036)和NT-proBNP(z=1.829，P=0.002)明显低于较小组。结论血清NT-proBNP 变化率有助于判断MHD患者的容量负荷以及在一定的时间内是否能最大限度的清除体内潴留的水分。

关键词: 血液透析, N-末端脑钠肽, 变化率, 血压, 多频生物电阻抗

Abstract: Objective To explore the diagnostic value of N-terminal pro- brain natriuretic peptide (NTproBNP) change rate in the estimation of volume load and ultrafiltration volume in maintenance hemodialysis (MHD) patients through the analyses of the correlation among NT-proBNP change rate, serum NT-proBNP concentration, blood pressure and water content in the body. Method The change rate of serum NT-proBNP concentration before and after a dialysis session was calculated in 103 maintenance hemodialysis (MHD) patients. These patients were then divided into 2 groups based on the median value of the change rate. NT-proBNP
concentration before dialysis, blood pressure, total body water (TWB), extracellular water (ECW), intracellular water (ICW) and serum were compared between the 2 groups. Result ① Serum NT-proBNP concentration decreased significantly after dialysis as compared with the value before dialysis (P=0.001). ② The decrease rate of serum NT-proBNP was less than zero in 32.1% patients, and was more than zero in 67.9% patients. ③ The change rate of NT-proBNP was negatively correlated with the blood pressure at the 2nd hour of a dialysis session (r=-0.198, P=0.045), and was positively correlated with the blood pressure differences between pre- dialysis and at the 2nd hour of a dialysis session (r=0.265, P=0.007). Patients in the group with more NT-proBNP change rate had lower blood pressure at the 2nd (t=2.466, P=0.015) and 3rd hour (t=2.113, P=0.037) in a dialysis session than those in the group with less NT-proBNP change rate. ④ Patients in the group with more NT-proBNP change rate had lower TBW (t=2.579, P=0.012), ECW(t=2.297, P=0.006), ICW (t=2.126, P=0.036) and NT-proBNP (z=1.829, P=0.002) than those in the group with less NT-proBNP change rate. Conclusion Serum NT-proBNP change rate is a useful marker for the determination of volume load and the evaluation of water retention clearance in a defined period of time in MHD patients.

Key words: Hemodialysis, N-terminal pro brain natriuretic peptide, variation rate, Blood pressure, Multi-frequency bioimpedance analysis