中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (12): 657-661.doi: 10.3969/j.issn.1671-4091.2013.12.00

• 临床研究 • 上一篇    下一篇

连续性肾脏替代治疗患者B型钠尿肽与超滤的相关性研究

崔永军1,万美燕1,夏平1,韩昆2,邹作君1   

  1. 1. 青岛市市立医院（本部）肾内科
    2. 青岛大学医学院附属医院神经外科
  • 收稿日期:2013-07-30 修回日期:2013-10-20 出版日期:2013-12-12 发布日期:2013-12-03
  • 通讯作者: 万美燕wanmeiyai07@163.com E-mail:wanmeiyan07@163.com
  • 基金资助:

    青岛市2011年度医药科研指导计划

The association between BNP and ultrafiltration in patients with CRRT

  • Received:2013-07-30 Revised:2013-10-20 Online:2013-12-12 Published:2013-12-03

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摘要： 目的 探讨B型钠尿肽（BNP）在行连续性肾脏替代治疗(CRRT)的急性肾损伤（AKI）患者中，与超滤速率和净超滤量的关系。方法 回顾性分析本院2010年8月至2012年4月住院期间行CRRT治疗的37例AKI患者的临床资料。记录患者进行1次CRRT治疗前的收缩压，舒张压，平均动脉压，心率，体重，血肌酐，尿素氮，白蛋白，血红蛋白，BNP，CRRT治疗过程中的血流量，置换速率，治疗时间，超滤速率和净超滤量。Pearson/Spearman相关法分析1次CRRT治疗中超滤速率和净超滤量的影响因素。用受试者工作特征曲线（ROC曲线）下面积（AUC）分析BNP预测1次CRRT治疗中超滤速率和总超滤量参数设定的效能。结果 37例患者进行CRRT治疗的前3位原因为,少尿/无尿15例（40.5%），水钠潴留9例（24.3%），高分解代谢8例（21.6%）； CRRT相关低血压发生4例（10.8%）；Pearson/Spearman相关分析显示，血肌酐与超滤速率呈负相关（r=-0.331，P=0.045），BNP与超滤速率呈正相关（r=0.380，P=0.02）；BNP（r=0.503，P=0.002）和治疗时间（r=0.759，P＜0.001）与净超滤量呈正相关。用肌酐与BNP预测超滤速率＞100ml/h的受试者工作特征曲线下面积（AUC）分别为0.327和0.750，用BNP与治疗时间预测CRRT治疗净超滤量＞1000ml的AUC分别为0.824和0.867。用BNP、超滤速率与净超滤量预测1次CRRT治疗中低血压发生的AUC分别为0.977，0.845和0.947。结论 CRRT治疗前AKI患者的BNP数值与CRRT治疗的超滤速率及净超滤量相关。可以作为患者在CRRT治疗前对于超滤速率及净超滤量设定的参考依据，并可能会减少或避免CRRT相关低血压的发生。

关键词: 连续性肾脏替代治疗, 肾损伤, 急性, B型钠尿肽

Abstract: Objective To examine the association of B-type natriuretic peptide with net ultrafiltration rate and net ultrafiltration in AKI patients with CRRT. Methods A total of 37 AKI patients with CRRT from August 2010 to April 2012 in Qingdao Municipal Hospital was enrolled in the retrospective study. Systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, heart rate, weight, Cr, BUN, albumin, hemoglobin, BNP, blood flow rate, replacement rate, duration of CRRT, net ultrafiltration rate and net ultrafiltration were recorded. Influencing factors of net ultrafiltration rate and net ultrafiltration were analyzed by Pearson/Spearman correlation. Predicting value of BNP in net ultrafiltration rate and net ultrafiltration was investigated by ROC curve. Results The top 3 reasons of our study patients for CRRT were oliguria/anuria (n=15, 40.5%), fluid retention (n=8,21.6%) and high urea/creatinine (n=8,21.6%). Hypotension related to CRRT occurred in 4 patients (10.8%). Serum creatinine was negatively correlated with net ultrafiltration rate (r=-0.331，P=0.045), and BNP positively correlated with net ultrafiltration rate (r=0.503，P=0.002). BNP (r=0.503，P=0.002) and duration of CRRT (r=0.759，P＜0.001) were positively correlated with net ultrafiltration respectively. In predicting net ultrafiltration rate ＞100ml/h, area under ROC curve of serum creatinine and BNP was 0.327 and 0.750 respectively. In predicting net ultrafiltration ＞1000ml, AUC of BNP and duration of CRRT was 0.824 and 0.867 respectively. In predicting hypotension related to CRRT, AUC of BNP, net ultrafiltration rate and net ultrafiltration was 0.977, 0.845 and 0.947 respectively. Conclusion The levels of BNP in AKI patients with CRRT were positively correlated with net ultrafiltration rate and net ultrafiltration. Net ultrafiltration rate and net ultrafiltration could be set according to the levels of BNP when CRRT initiates. It would maybe avoid or lessen hypotension related to CRRT in AKI patients.

Key words: Continuous renal replacement therapy, Acute kidney injury, B-type natriuretic peptide