脑钠肽对维持性血液透析患者心功能不全诊断价值的临床研究  

The study on the diagnostic value of plasma brain natriuretic peptide in hemodialysis patients with chronic heart failure

作　　者：刘惠兰[1] 李国刚[1] 薛菲[1] 谭延国[2] 

机构地区：[1]首都医科大学附属复兴医院肾内科,北京100038 [2]首都医科大学附属复兴医院检验科,北京100038

出　　处：《北京医学》2008年第4期227-229,共3页Beijing Medical Journal

摘　　要：目的观察B型脑钠肽(BNP)在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的诊断价值。方法检测66例维持性血液透析(MHD)患者透析前后血浆BNP水平,同时应用彩色多普勒超声心动图测定透析前后的心脏结构及功能变化,测量下腔静脉宽度,记录当次透析脱水量。结果□66例MHD患者透析前后血浆BNP中位数分别为378.6pg/ml及125.6pg/ml,健康对照组为10.3pg/ml;透析前后均较健康对照组显著增高(P﹤0.01),透析后较透析前显著下降(P﹤0.01)。多元回归分析显示,MHD患者透析前后血BNP水平与LVDd、LVDs呈正相关(P﹤0.05),与LVEF呈负相关(P﹤0.05),与LV、RV、RVD、IVS无相关性。MHD患者透析前后下腔静脉宽度(IVCD)分别为(15.2±3.2)mm、(12.1±2.4)mm,当次透析脱水量占自身干体重的(5.1±2.1)%。透析前后血BNP的减少之比与平均下腔静脉宽度的减少之比呈正相关(P﹤0.01),与透析前后体重的减少之比呈正相关(P﹤0.05)。LVEF﹤50%者8例,LVEF﹥50%者58例,血浆BNP水平分别为679.6pg/ml及112.5pg/ml,两者比较有显著性差异(P﹤0.01)。12例左心扩大者血浆BNP水平(521.6pg/ml)显著低于54例左心室正常者(105.1pg/ml)(P﹤0.01)。结论BNP在一定程度上可反映MHD患者体内血容量的变化及左心功能状态,是诊断慢性心功能不全的敏感指标。Objective To detect plasma brain natriuretic peptide（BNP） changes in hemodialysis patients with chronic renal failure （CRF） before and after hemodialysis and assess the diagnostic value of BNP for cardiac function. Methods Plasma BNP concentration was measured in 66 maintained hemodialysis patients with CRF and 32 healthy control subjects. Echocardiographic examination was performed to determine the structure and function of heart. The width of postcava before and after hemodialysis was measured. Results The median plasma BNP level in 66 patients before and after hemodialysis was 378.6pg/ml （56.2～1243.0pg/ml） and 125.6 pg/ml （28.3～805.5pg/ml）, and 10.3pg/ml（0.01～23.7pg/ml）in 32 healthy controls. It showed significant difference among those 3 groups （P﹤0.01）. The plasma BNP level in patients with heart failure （LVEF﹤50%） before hemodialysis was 679.6pg/ml （226.2～1513.0pg/ml）, significantly higher than that in the patients without heart failure （P﹤0.01）. The plasma BNP level in patients with left ventricle hypertrophy （LVH） before hemodialysis was 521.6 pg/ml （351.4～1223.0pg/ml）, significantly higher than that in patients without LVH （P﹤0.01）. Conclusions BNP concentration may be used as a biochemical marker of liquid overload and chronic cardiac failure in hemodialysis patients.

关 键 词：血液透析 脑钠肽 慢性心功能不全 

分 类 号：R541.6[医药卫生—心血管疾病] R459.5[医药卫生—内科学]