维持性血透患者血清N端脑钠肽水平的影响因素及其与心脏重构和心功能的关系  

Cross-sectional study of NT-pro brain natriuretic peptide and its correlation with heart remodeling and function in maintenance hemodialysis patients

作　　者：郑寅[1] 匡鼎伟[1] 李海明[1] 陈靖[1] 顾勇[1] 林善锬[1] 丁峰[1] 

机构地区：[1]复旦大学附属华山医院肾脏科,上海200040

出　　处：《复旦学报（医学版）》2010年第3期298-303,共6页Fudan University Journal of Medical Sciences

摘　　要：目的研究维持性血透(maintenance heamodialysis,MHD)患者血清N端脑钠肽(NT-pro brain natriuretic peptide,NT-proBNP)水平及其可能的影响因素;分析MHD患者NT-proBNP与心脏重构和心功能的关系。方法测定117例MHD患者血清NT-proBNP,记录各患者临床、生化数据及心功能阶段分级(ACC/AHA),分析NT-proBNP的影响因素;行超声心动图检查,对MHD患者NT-proBNP水平与心超结果、心功能阶段分级进行相关分析。结果所有MHD患者血清NT-proBNP水平高于临床诊断值,中位数为4 242.00pg/mL。将NT-proBNP水平按四分位数分成4个亚组,在年龄、透析间期体重增加值、超滤量、收缩压、血红蛋白、红细胞压积、前白蛋白、左心房前后直径、左心室重量指数等指标组间差异有统计学意义(P<0.05或P<0.01)。单因素相关分析结果提示,MHD患者血清NT-proBNP水平与收缩压(r=0.348,P<0.01)、左心房前后径(r=0.312,P=0.014)、左心室重量指数(r=0.529,P<0.01)呈正相关;与血红蛋白(r=-0.210,P=0.006)、红细胞压积(r=-0.201,P=0.030)、前白蛋白(r=-0.377,P<0.01)呈负相关。多元线性回归分析显示,高收缩压(β=0.370,P=0.001)、低前白蛋白(β=-0.459,P<0.001)、左心室重量指数增加(β=0.251,P=0.025)是NT-proBNP水平升高的独立影响因素。将患者按照2005年ACC/AHA心衰指南提出的心功能阶段分级分组,发现血清NT-proBNP与心功能阶段分级呈正相关(r=0.553,P<0.01)。结论MHD患者血清NT-proBNP水平显著升高;高收缩压、低前白蛋白、左心室重量指数增加是NT-proBNP升高的独立影响因素;NT-proBNP水平高低能反映MHD患者心脏重塑和心功能状况的严重程度。Objective To study the level of NT-pro brain natriuretic peptide（NT-proBNP） and its correlation with heart remodeling and function in maintenance hemodialysis（MHD） patients. Methods NT-proBNP level was determined in 117 MHD patients before a regular 4-hour hemodialysis（HD）.Echocardiography was performed on a non-dialysis day.The clinical and biochemical characteristics of MHD patients were collected.The MHD patients were divided into four sub-groups according to their NT-proBNP levels. Results All of the patients had pre-dialysis concentration of NT-proBNP above the cut-off values for HF.There were differences in age,interdialysis bodyweight gain,ultrafiltration volume,systolic blood pressure（SBP）,hemoglobin,heamatocrit,left atrial diameters（LAD） and left ventricle mass index（LVMI） between the higher level NT-proBNP group and lower level group（P〈0.01 or P〈0.05）.The marker levels positively correlated with systolic blood pressure（SBP）（r=0.348,P〈0.01）,left atrial diameters（LAD）（r=0.312,P=0.01）and left ventricle mass index（LVMI）（r=0.529,P〈0.01）.Strong inverse correlation was found between NT-proBNP and hemoglobin（r=-0.210,P=0.006）,hematocrit（r=-0.201,P=0.030） and pre-albumin as well（r=-0.377,P〈0.01）.In the multiple regression model,higher SBP（β=0.370,P=0.001）,lower serum pre-albumin（β=-0.459,P〈0.001） and greater LVMI（β=0.251,P=0.025） were significant independent influential factors for increased NT-proBNP level.The elevated NT-proBNP level also positively correlated with ACC/AHA heart failure stages（r=0.553,P〈0.01）. Conclusions NT-proBNP level is markedly elevated in MHD patients.Higher SBP,lower serum pre-albumin and greater LVMI are significant independent influential factors for increased NT-proBNP level which may reflect heart remodeling and function in MHD patients.

关 键 词：血液透析 N端脑钠肽 心功能不全 左心室肥厚 

分 类 号：R459.5[医药卫生—治疗学]