血浆脑型钠利尿肽在维持性血液透析患者左室舒张功能障碍诊断中的价值  

Clinical value of B-natriuretic peptide in the diagnosis of left ventricular diastolic dysfunction in maintenance hemodialysis patients with normal ejection fraction

作　　者：张英姿[1,2] 刘宏[1] 高民[1] 刘必成[1] 

机构地区：[1]东南大学临床医学院,江苏南京210009 [2]东南大学附属江阴医院肾脏科,江苏江阴214400

出　　处：《现代医学》2010年第1期36-39,共4页Modern Medical Journal

摘　　要：目的：探讨血浆脑型钠利尿肽（BNP）在维持性血透（MHD）患者左心室舒张功能障碍（LVDD）中的诊断价值。方法：MHD患者59例，透析前行心脏多普勒组织成像检测，按不同舒张早期峰值速度（Ve）与舒张晚期峰值速度（Va）的比值分为LVDD组（Ve／Va〈1）和左心室舒张功能正常组（Ve／Va≥1）两组。同时检测透析前血浆BNP、血常规及生化指标、超敏c反应蛋白（hs—CRP）、甲状旁腺激素（PTH）等。结果：LVDD组与左心室舒张功能正常组相比，BNP、hs—CRP、收缩压显著性升高，血红蛋白（Hb）显著性降低（P〈0．05）。MHD患者的BNP水平与hs-CRP、收缩压、舒张压等显著正相关，与Hb显著负相关。BNP诊断MHD患者LVDD的曲线下面积（AUC）为0．86（95％CI：0．76—0．96），353．6Pg·ml-1作为界值的灵敏度为80％，特异度为85％。结论：BNP水平升高对MHD患者合并LVDD可能具有重要的诊断价值。Objective： To evaluate the diagnostic value of B-natriuretic peptide（BNP） in the diagnosis of left ven- tricular diastolic dysfunction（LVDD） in maintenance hemodialysis （MHD） patients with normal ejection fraction. Methods： The study population comprised 59 MHD patients with normal ejection fraction. The ratio of early to late annular velocity（Ve/Va） was determined as a parameter of diastolic function. Plasma BNP levels and serum high sensitivity C-reactive protein（ hs-CRP）, parathyroid hormone（trFH） levels were assayed with a commercially avail- able kit. Results： Plasma BNP levels were significantly higher in patients with LVDD than that in persons without LVDD（P 〈 0. O1 ）. Plasma BNP levels significantly correlated with hs-CRP（ r = O. 280, P = 0.031 ）, systolie blood pressure （r = 0. 285, P = 0. 029 ）, diastolic blood pressure （ r = 0. 259, P = 0. 048 ） and hemoglobin （Hb） （ r = -0. 338 ,P =0.009）. The area under the receiver-operating characteristic curve for BNP to detect LVI）D was 0.86 （ 95% CI： 0. 76 to 0.96 ; P 〈 0.001 ）. A BNP value of 353.6 pg· ml -1 had a sensitivity of 80% and a specificity of 85% for detecting diastolic dysfunction. Conclusion： Increased levels of BNP were associated with microinflammation state, anemia and hypertension. BNP may be a discerning marker for the detection and evaluation of LVDD in hemodialysis patients with normal ejection fraction.

关 键 词：脑型钠利尿肽 多普勒组织成像 左心室舒张功能障碍 血液透析 

分 类 号：R541.9[医药卫生—心血管疾病] R692.5[医药卫生—内科学]