脑钠肽对血液透析患者心功能不全及／或高血容量负荷的诊断价值  

The study on the diagnostic value of chronic heart failure and/or high blood-volume with plasma brain natriuretic peptide in maintenance hemodialysis patients

作　　者：李国刚[1] 刘惠兰[1] 薛菲[1] 

机构地区：[1]首都医科大学附属复兴医院肾内科,北京100038

出　　处：《中国医师进修杂志》2008年第1期8-10,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 观察脑钠肽（BNP）对血液透析患者透析前后血浆浓度的变化并评价其对心功能不全及，或高血容量负荷的诊断价值。方法 检测66例维持性血液透析患者（MHD组）透析前后血浆BNP水平，同时应用彩色多普勒超声心动图测定透析前及透析后的心脏结构，测量下腔静脉宽度，记录当次透析脱水量。与健康对照者32例（健康对照组）进行比较。结果 （1）MHD组透析后及透析前BNP均较健康对照组显著增高，与透析前及透析后左室舒张末期内径、左室收缩期内径呈正相关（P〈0．05）。MHD组透析前与透析后血浆BNP的减少之比与透析前及透析后平均下腔静脉宽度的减少之比呈正相关（P〈0．01），与体重减少之比呈正相关（P〈0．05）。透析前存在慢性心功能不全者及左心扩大者，BNP水平显著增高。结论 血液透析患者血浆BNP水平较对照组显著增高。左室内径的增大、心功能的减退、高血容量负荷可导致血浆BNP的增高，透析后BNP水平下降。血浆BNP水平在一定程度上反映了血液透析患者心功能和／或体内血容量的变化，是一个无创和敏感的指标。Objective To detect the changes of plasma brain natriuretic peptide （BNP） in maintenance hemodialysis （MHD） patients with chronic renal failure （CRF） and evaluate the diagnostic value of BNP for cardiac function and hquid overloard. Methods Plasma BNP concentrations were measured in 66 MHD patients with CRF and 32 healthy control subjects. Echocardiographic examinations about cardiac structure and the width of inferior vena cava were performed to determine the relationship between BNP and cardiac function. Results The median plasma BNP levels in 32 healthy controls were 10.3 ng/L （0.1-23.7 ng/L） ,378.6 ng/L （56.2-1243.0 ng/L） and 125.6 ng/L （28.3-805.5 ng/L） in 66 MHD patients before and after hemodialysis, respectively, showing significant difference among them （P 〈 0.01 ）. The plasma BNP levels in patients with heart failure before hemodialysis were 679.6 ng/L （226.2-1513.0 ng/L ）, significandy higher than the patients without heart failure （P 〈 0.01 ）. The plasma BNP levels in patients with left ventricle hypertrophy （ LVH ） before hemodialysis were 521.6 ng/L （ 351.4-1223.0 ng/L ）, showing significantly higher than the patients without LVH （P 〈 0.01 ）. Conclusions Plasma BNP levels in MHD patients with CRF are significantly higher than those in healthy controls. High plasma BNP level is significantly correlated with dilated left ventricle, poor cardiac function and high hquid volume. The BNP concentration may be used as a biochemical marker of hquid overload and/or chronic cardiac failure in MHD patients.

关 键 词：肾透析 脑钠肽 高血容量 

分 类 号：R459.5[医药卫生—治疗学]