中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (10): 717-721.doi: 10.3969/j.issn.1671-4091.2014.10.010

• 临床研究 • 上一篇    下一篇

腹膜透析患者血清N末端前体脑钠肽水平的变化及影响因素探讨

毛永辉,赵班,陈欢,贾莺梅,李天慧   

  1.  卫生部北京医院肾内科
  • 收稿日期:2014-04-09 修回日期:2014-06-10 出版日期:2014-10-12 发布日期:2014-10-21
  • 通讯作者: 赵班 zbyule@139.com E-mail:zbyule@139.com

Factors influencing the serum concentration of N-terminal pro brain natrinuretic peptide in peritoneal dialysis patients

  • Received:2014-04-09 Revised:2014-06-10 Online:2014-10-12 Published:2014-10-21
  • Contact: zhao ban E-mail:zbyule@139.com

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摘要： 目的探讨腹膜透析(PD)患者血清N 末端前体脑钠肽(NT-proBNP)水平的变化及相关的影响因素。方法横断面研究。选择2011 年4 月至2012 年5 月北京医院肾内科57 例腹膜透析患者，进行血清NT-proBNP 水平检测，同时评估患者的血压、透析充分性、营养、残余肾功能、心功能指标及相应的生化参数，对数据进行相关分析及分层分析。结果PD 患者血清lnNT-proBNP 水平与血磷(P=0.020)、MQSGA 评分(P＜0.001)、肌钙蛋白T(P=0.002)、收缩压(P=0.010)、平均血压(P=0.013)、收缩压指数(P＜0.001)、左心房内径(P=0.001)、左心室重量指数(P=0.001)呈明显正相关；与白蛋白(P=0.008)、24h 尿量(P=0.005)、残肾Kt/V(P=0.001)、残肾Ccr(P=0.010)、残余肾小球滤过率rGFR(P=0.001)、心脏射血分数(P＜0.001)、上臂围(P=0.031)、三头肌皮褶厚度(P=0.037)呈明显负相关。多元逐步回归法分析结果显示与lnNT-proBNP 相关的因素依次为：MQSGA 评分(β=0.470，P＜0.001)、残余肾小球滤过率rGFR(β=-0.389，P＜0.001)、收缩压指数(β=0.287，P＜0.001)、左心房内径LAD(β=0.236，P=0.006)，这些指标是PD 患者的血清NT-proBNP 水平的独立影响因素(R2=0.722，F=37.342，P＜0.001)。PD 患者血清NT-proBNP中位数为5240.00 pg/ml(699.90～35000pg/ml)，以中位数为截点将本组患者分为A 组(NT-proBNP 水平较低组)和B 组(NT-proBNP 水平较高组)。B 组在收缩压(P=0.010)、平均血压(P=0.009)、收缩压指数(P=0.001)、MQSGA 评分(P＜0.001)、血磷(P=0.022)、肌钙蛋白T(P=0.037)、左心房内径(P=0.002)、左心室重量指数(P=0.003)方面均显著高于A 组；在白蛋白(P=0.010)、三酰甘油(P=0.029)心脏射血分数(P＜0.001)方面明显低于A 组。分层分析显示：总Kt/V≥2.0 患者的lnNT-proBNP 水平明显低于Kt/V＜2.0 的患者(P=0.030)；总Ccr≥60L/周患者的lnNT- proBNP 水平明显低于总Ccr＜60L/周的患者(P=0.002)；MQSGA≥8.0 组患者的lnNT-proBNP 水平较MQSGA＜8.0 组明显升高(P＜0.001)；PEW 组患者的lnNT-proBNP水平较非PEW 组明显升高(P＜0.001)；有左心室肥厚的患者lnNT-proBNP 水平明显高于没有左心室肥厚的患者(P =0.02)；有心血管疾病史患者的lnNT-proBNP 水平明显高于没有心血管疾病史的患者(P＜0.001)。结论PD 患者血清NT-proBNP 水平与血压、营养状况、残余肾功能、透析充分性和心功能情况均有相关性；高MQSGA 评分、低残余肾小球滤过率、高收缩压指数、高左心房内径是血清NT-proBNP 升高的独立影响因素。

关键词: 腹膜透析, 氨基末端前体脑钠肽, 营养状态, 残余肾功能, 透析充分性

Abstract:  To study the factors influencing the serum concentration of N-terminal pro brain natrinuretic peptide (NT-proBNP ) in peritoneal dialysis (PD) patients. Methods Fifty-seven clinically stable PD patients were enrolled in this study. Serum NT-proBNP concentration was measured, the indices of blood pressure, dialysis adequacy, residual renal function and nutritional status were assessed, and echocardiography was performed in these patients. Results In this cross-sectional study, the median NT-proBNP was 5,240 (699.90～35,000) pg/mL. Correlation analysis showed that serum lnNT-proBNP level was positively correlated with MQSGA score, serum phosphorus, cardiac troponin T (cTnT), systolic blood pressure (SBP), mean blood pressure (MAP), SBP index, left atrial diameter (LAD), and left ventricle mass index (LVMI), and was negatively correlated with albumin (ALB), urine volume, residual renal Kt/V, residual renal Ccr, residual GFR (rGFR), ejection fraction (EF), upper arm circumference (MAC) and tricep skin fold thickness (TSF). The levels of MQSGA, cTnT, SBP, MAP, SBP index, LAD, LVMI, ALB, serum phosphorus, triglycerides (TG) and EF were statistically different between the higher NT-proBNP level group and the lower level group.
Multiple stepwise regression analysis demonstrated that lower rGFR (β =-0.389, P＜0.001), higher MQSGA (β=0.470, P＜0.001), increased SBP index (β= 0.287, P＜0.001), and larger LAD (β=0.236, P=0.006) were the independent influential factors for increase of serum lnNT-proBNP. Patients with Kt/V ＞2.0 or total Ccr ＞60L/week had lower serum lnNT-proBNP than those with Kt/V ＜2.0 or total Ccr ＜60L/week. Patients with MQSGA＞8.0 or PEW had higher serum lnNT-proBNP than those with MQSGA <8.0 or non-PEW. Patients with left ventricle hypertrophy (LVH) or cardiovascular disease (CVD) had higher serum lnNT-proBNP than those without LVH or CVD. Conclusions Serum NT-proBNP was markedly elevated in PD patients. Its level correlated with blood pressure, nutritional status, residual renal function, dialysis adequacy, and cardiac function. Higher MQSGA, lower rGFR, increased SBP index, and larger LAD were the independent factors for the elevation of serum NT-proBNP. 

Key words: peritoneal dialysis, N-terminal pro brain natrinuretic peptide, nutritional status, residual renal function, dialysis adequacy