摘要
目的通过对维持性血液透析患者血浆氨基末端前脑钠肽（N—terminal pro—brain natriuretic peptide，NT-proBNP）水平的横断面调查，分析透析人群中NT—proBNP的分布特点和影响因素，并探讨其临床意义。方法选取复旦大学附属中山医院血液透析中心病情稳定的维持性血液透析患者共207例，比较其临床指标、血浆NT—proBNP水平和超声心动图参数，对上述指标进行分析。结果伴有左心室肥厚（1eft ventricular hypertrophy，LVH）组血浆NT-proBNP显著高于非LVH组彤（1／4，3／4）：3104（1626，7843）ng/L比1291（772，1845）ng/L，P＜0．01]。对偏态变量NT—proBNP进行对数转换后，log[NT-proBNP]与血红蛋白（r=-0．212，P=0．004）、左心室射血分数（1eft ventricula rejection fraction，LVEF）（r=-0．202，P=O．003）呈负相关，与左心室质量指数（1eft ventricular mass index，LVMI）（r=0．370，P=0．001）、检测当日透析前体质量增加（interdialysic weight gain，IDWG）比例（r=0．233，P=0．001）、透析前收缩压（r=O．345，P=0．001）、透析前舒张压（r=0．152，P=0．032）呈正相关。受试者工作特征曲线（ROC）分析结果显示，NT．proBNP诊断LVH及IDWG〉4％的ROC曲线下面积（AUC）分别为0．786（95％C10．689—0．883，P＜0．01）和0．738（95％CI 0．667～0．810，P＜0．01）。以NT．proBNP滴度1917ng／L为截点，诊断LVH的敏感度和特异度分别为0．676和0．824；以NT-proBNP滴度2872ng／L为截点，诊断IDWG＞4％的敏感度和特异度分别为0．704和0．758。结论NT-proBNP水平在血液透析人群显著异常，主要与LVH、IDWG比例高以及透析前血压控制欠佳有关。合理的干体质量评估和严格控制透析间期体质量增加可能是干预NT—proBNP的有效办法。
Objective To analysis the distribution and influence factors of N-terminal probrain natriuretic peptide （NT-pro BNP）, and also its clinical significance though a cross-sectional survey of NT-pro BNP in maintenance hemodialysis patients in Zhongshan Hospital, Fudan University. Methods A total of 207 stable hemodialysis patients were enrolled. The clinical parameters, plasma NT-proBNP levels and echocardiographic parameters were analyzed. Results Level of plasma NT- proBNP in patients with left ventricular hypertrophy （LVH） were significantly higher than those without LVH[M（1/4, 3/4）： 3 104（1 626, 7 843） ng/L vs 1 291（772, 1 845） ng/L, P〈0.01]. After logarithmic transformation for skewed variables NT-proBNP, log[NT-proBNP] was negatively correlated with hemoglobin （r=-0.212, P=0.004） and left ventricular ejection fraction （LVEF）（r=-0.202, P=0.003）, and was positively correlated with left ventricular mass index （LVMI）（r=0.370, P=0.001）, interdialysic weight gain （IDWG） rate （r=0.233, P=0.001）, predialysis systolic blood pressure （r=0.345, P=0.001）, predialysis diastolic blood pressure （r=0.152, P=0.032）. The areas under curve（AUC） of NT-proBNP for diagnosing LVH and IDWG〉4% were 0.786（95%CI 0.689-0.883, P〈0.01） and 0.738（95%CI 0.667- 0.810, P〈0.01）. When the threshold of NT-proBNP was set at 1917 ng/L to diagnosis LVH, the sensitivity and specificity were 0.676 and 0.824. When the threshold of NT-proBNP was set at 2 872 ng/L to diagnosis IDWG〉4%, the sensitivity and specificity were 0.704 and 0.758. Conclusions NT-proBNP levels are significantly abnormality in hemodialysis patients, mainly related with LVH, the high rate of IDWG, and the poorly controlled predialysis blood pressure. Proper dry weight assessment and strict control of IDWG may be effective way to intervene NT-proBNP.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2014年第8期586-591,共6页
Chinese Journal of Nephrology
基金
科技部国家科技支撑计划（2011BAJl8803）
国家十二五支撑计划课题（2011BAll0807）
关键词
肾透析
利钠肽
脑
肥大
左心室
透析间期体质量增加
Renal dialysis
Natriuretic peptide, brain
Hypertrophy, left ventricular
Interdialysic weight gain
