中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (10): 600-603.doi: 10.3969/j.issn.1671-4091.2015.10.00

• 临床研究 • 上一篇    下一篇

血清N端脑钠肽与维持性血液透析患者心血管功能的关系

郭学娜,任建伟,康志敏   

  1. 北京，航空总医院
  • 收稿日期:2015-01-23 修回日期:2015-08-07 出版日期:2015-10-12 发布日期:2015-10-12
  • 通讯作者: 郭学娜 guoxuena2008@163.com E-mail:guoxuena2008@163.com

The relationship between plasma N-terminal pro-B-type natriuretic peptide and cardiovascular function in maintenance hemodialysis patients

  • Received:2015-01-23 Revised:2015-08-07 Online:2015-10-12 Published:2015-10-12

RichHTML

0

PDF

400

摘要： 目的 探讨维持性血液透析(maintenance hemodialysis，MHD)患者心血管功能与N 末端B 型脑钠肽(N- terminal pro-brain natriuretic peptide，NT-proBNP)的关系。方法选取41 例维持性血液透析患者，根据透析前NT-proBNP 水平分成2 组，即低NT-proBNP 组和高NT-proBNP 组。分别检测两组患者临床及生物学指标、超声心动、透析过程中血压的平均值。结果NT-proBNP 水平与左室舒张末期内径、左室前后径、左室后壁厚度、左室间隔厚度及左室重量指数、收缩压平均值、心功能NYHA 分级成正相关(左室舒张末期内径r= 0.430，P=0.005；左室前后径r=0.400，P=0.001；左室后壁厚度r=0.508，P= 0.001；左室间隔厚度r = 0.412，P=0.007；左室重量指数r = 0.503，P = 0.001；收缩压平均值r = 0.462，P = 0.002；心功能NYHA 分级 r = 0.432，P = 0.005)，与射血分数成负相关(r = -0.386，P=0.013)。高NT-proBNP组患者中左室前后径，左室后壁厚度，左室间隔厚度，左室重量指数，脉压差，收缩压平均值，均明显高于低NT-proBNP 组[左室前后径，(t = -3.631，P = 0.001)；左室后壁厚度，(t = -3.665，P = 0.001)；左室间隔厚度，(t = -3.396，P=0.002)；左室重量指数，(t = -3.396，P = 0.002)；脉压差(t=-2.048，P=0.021)；收缩压平均值(t=-2.199，P=0.035)]。NT-proBNP 7000 pg/ml 作为界值诊断左室肥厚的灵敏度82.4%，特异度为91.7%，受试者工作特征曲线下面积(AUC)为0.878(P＜0.05)。结论NT-proBNP 水平是诊断MHD 患者合并左室肥厚、评估左室功能及左室重构的重要生物学指标。NT-proBNP＞7000pg/L 的患者中左室肥厚及左室重构均普遍存在。N T -proBNP 升高的幅度和高血压的严重程度密切相关。

关键词: 维持性血液透析, NT-proBNP, 心血管功能, 高血压

Abstract: Objective To investigate the relationship between N-terminal pro-B-type natriuretic peptide(NT- proBNP) and cardiovascular function in maintenance hemodialysis (MHD) patients. Methods Fortyone MHD patients were divided into 2 groups based on plasma NT-proBNP level before hemodialysis: low NT-proBNP group (NT-proBNP ＜7,000 pg/ml) and high NT-proBNP group (NT-proBNP >7,000 pg/ml). Clinical and biochemical indicators, echocardiography, and average blood pressure during hemodialysis were recorded. Results Plasma NT-proBNP level higher than normal was found in 93.8% MHD patients. NT-proBNP level correlated positively with left ventricular end diastolic diameter, left ventricular diameter, interventricular septal thickness, left ventricular posterior wall thickness, left ventricular mass index, and systolic blood pressure (P＜0.05), and negatively with left ventricular ejection fraction (P＜0.05). Left ventricular diameter (t=- 3.631), interventricular septal thickness (t=- 3.665), left ventricular posterior wall thickness (t=- 3.396), left ventricular mass index (t=- 3.396), pulse pressure (t=- 2.048), and systolic blood pressure (t=- 2.199) were significantly higher in the high NT-proBNP group than in the low NT-proBNP group (P＜0.05).
When the cut-off value of plasma NT-proBNP was set at 7,000 pg/ml, the sensitivity and specificity for detecting left ventricular hypertrophy were 82.4% and 91.7%, respectively, and the AUC was 0.878 (P＜0.05). Conclusions plasma NT-proBNP is an important biomarker for the diagnosis of left ventricular hypertrophy and for the evaluation of left ventricular function and reconstruction in MHD patients. Left ventricular hypertrophy and reconstruction are prevalent in patients with NT-proBNP ＞7,000 pg/ml. The increase of plasma NT-proBNP is correlated with the degree of hypertension.

Key words: Mintenance hemodialysis, NT-proBNP, Cardiovascular function, Hypertention