中国血液净化

›› 2009, Vol. 8 ›› Issue (2): 80-83.

• 论著 • 上一篇    下一篇

脑钠素与老年血液透析患者左心室重塑的相关性研究

邬碧波 张黎明 唐 琦 俞 勇 贺云岚 郝晓萍   

  1. 上海市闸北区中心医院肾内科
  • 收稿日期:2008-09-16 修回日期:1900-01-01 出版日期:2009-02-12 发布日期:2009-02-12

The relationship between serum brain natriuretic peptide and left ventricular remodeling in elderly patients treated with maintenance hemodialysis

WU Bi-bo, ZHANG Li-ming, TANG Qi, YU Yong, HE Yun-lan, HAO Xiao-ping.   

  1. Division of Nephrology, Shanghai Zhabei District Central Hospital, Shanghai 200070, China
  • Received:2008-09-16 Revised:1900-01-01 Online:2009-02-12 Published:2009-02-12

RichHTML

0

PDF

218

摘要： 【摘要】目的 通过对脑钠素(BNP)、白介素-1β(IL-1β)、白介素-6（IL-6)、肿瘤坏死因子-α（TNF-α)及C反应蛋白（CRP)与老年维持性血液透析(MHD)患者左心室结构和功能指标的相关性分析，探讨BNP与老年MHD患者左心室重塑的关系。方法 选择在我院血液净化中心透析龄超过3个月的老年MHD患者64例，病情稳定，已排除急性感染及其他活动性疾病，分别检测患者的BNP、IL-1β、IL-6、TNF-α、CRP，并应用心脏超声心动图测定患者的左房内径(LAD)、左室舒张末内径(LVDd)、左室收缩末内径（LVDs)、室间隔厚度（IVST）、左室后壁厚度（LVPWT），左室射血分数(LVEF)等、计算左心室心肌重量指数（LVMI)，探讨BNP与老年MHD患者左心室重塑的关系。结果 老年MHD患者血清BNP、CRP、IL-1β、IL-6、TNF-α水平均显著高于正常对照组，二者差异有统计学意义（P＜0.05，P＜0.01）；老年MHD患者LAD、LVDd、IVST、LVPWT值均明显高于正常对照组，二者差异有统计学意义(P＜0.05，P＜0.01)，LVEF值较正常对照组明显降低(P＜0.05)，LVMI较正常对照组显著升高（P＜0.01），有统计学意义；BNP分别与LAD、LVDd、IVST、LVPWT、LVMI、E/A、左室异常呈正相关（P＜0.05，P＜0.01)，与LVEF呈负相关(P＜0.05)；BNP分别与CRP、IL-1β、IL-6、TNF-α、脂蛋白（a)〔Lp(a)〕呈正相关(P＜0.05，P＜0.01)，与血清白蛋白(SAlb)、血总胆固醇（Tch)、高密度脂蛋白胆固醇（HDL-C)呈负相关(P＜0.05，P＜0.01)；多因素逐步回归分析显示BNP水平升高是此类患者并发左心室重塑的独立危险因素之一。结论 老年MHD患者BNP水平普遍升高，并且与左心室重塑密切相关。

关键词: 脑钠素, 白细胞介素, 肿瘤坏死因子, 心室重塑, 血液透析

Abstract:

【Abstract】 Objective To investigate the correlation of serum levels of brain natriuretic peptide (BNP), interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and c-reactive protein (CRP) to left ventricular remodeling in elderly patients treated with maintenance hemodialysis (MHD). Methods We recruited 64 elderly MHD patients who had treated with hemodialysis for at least 3 months before the study and were in a stable clinic status without signs of infection or other active diseases. Serum BNP was assayed by chemiluminescence, and serum IL-1β, IL-6 and TNF-α were measured by enzyme-linked immunosorbent assay. Left atrial diameter (LAD), left ventricular end diastolic diameter (LVDd), left ventricular end systolic diameter (LVDs), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT) and left ventricular ejection fraction (LVEF) were evaluated by ultrasonic cardiography. Results In elderly MHD patients, the average serum BNP, IL-1β, IL-6, TNF-α and CRP were higher than those of normal control group (P<0.05 or <0.01), LAD, LVDd, IVST, LVPWT (P<0.05 or <0.01) and calculated left ventricular mass index (LVMI) (P＜0.01) increased, and LVEF decreased (P<0.05). In these patients, serum BNP level was positively correlated with the levels of LAD, LVDd, IVST, LVPWT and LVMI (P<0.05 or <0.01), and the serum levels of CRP, IL-1β, IL-6, TNF-α and lipoprotein (a) (P<0.05 or <0.01). Serum BNP level was negatively correlated with the level of LVEF (P<0.05) and also with serum levels of albumin, total cholesterol and high-density lipoprotein cholesterol (HDL-C) (P<0.05 or <0.01). Conclusion Higher serum BNP was frequently seen in elderly MHD patients, and this increase was closely related with left ventricle remodeling.

Key words: Interleukin, Tumor necrosis factor-α, Ventricular remodeling, Hemodialysis