氨基末端脑钠肽前体在慢性肾功能衰竭合并心力衰竭的诊断价值  

Diagnostic value of serum amino-terminal proBNP in end-stage renal disease patients with heart failure

作　　者：赵爱国[1] 郭小云[1] 夏天[1] 苏如松[1] 

机构地区：[1]天津医科大学第二医院肾内科,300211

出　　处：《中华临床医师杂志（电子版）》2011年第3期64-67,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：天津市卫生局科技基金(06KZ30)

摘　　要：目的通过观察人血清估算肾小球滤过率(eGFR)与氨基末端脑钠肽(BNP)前体(NT-pro-BNP)之间的关系,比较慢性肾功能衰竭(CRF)合并心力衰竭患者不同eGFR水平NT-pro-BNP的诊断临床界值,研究肾功能对NT-pro-BNP应用于心力衰竭诊断的影响。方法对老年CRF合并心力衰竭未透析患者52例及无心力衰竭29例和老年健康体检者30例(正常对照组)采用酶联免疫吸附法测定血清NT-pro-BNP浓度,根据eGFR分组进行对比。结果 eGFR<30ml.min-1.(1.73m2)-1、30～60ml.min-1.(1.73m2)-1心力衰竭组NT-pro-BNP水平均高于eGFR<30ml.min-1.(1.73m2)-1、30～60ml.min-1.(1.73m2)-1无心力衰竭对照组和eGFR>60ml.min-1.(1.73m2)-1正常组(P<0.05),eGFR<30ml.min-1.(1.73m2)-1、30～60ml.min-1.(1.73m2)-1无心力衰竭对照组NT-pro-BNP水平较eGFR>60ml.min-1.(1.73m2)-1正常组显著升高(P<0.05)。eGFR<30ml.min-1.(1.73m2)-1心力衰竭组与无心力衰竭对照组NT-pro-BNP水平较eGFR30～60ml.min-1.(1.73m2)-1心力衰竭组与无心力衰竭对照组高(t=2.530,P<0.05;t=2.158,P<0.05)。心力衰竭组和无心力衰竭对照组eGFR与NT-pro-BNP水平呈负相关(心力衰竭组r=-0354,P<0.05,对照组r=-0.520,P<0.01)。eGFR30～60ml.min-1.(1.73m2)-1心力衰竭组ROC曲线下面积(AUC)为0.926,NT-pro-BNP410pmol/L作为临界值的敏感度为75.0%,特异度为92.9%;eGFR<30ml.min-1.(1.73m2)-1心力衰竭组AUC为0.950,NT-pro-BNP520pmol/L作为临界值的敏感度为82.1%,特异度为100.0%。结论 NT-pro-BNP水平与肾功能损害严重性微弱相关,在考虑肾功能的前提下可作为判断CRF患者是否合并心力衰竭的诊断指标。Objective To investigate the influence of renal function on serum NT-pro-BNP in the diagnosis of chronic renal failure（CRF）with heart failure by observing the relationship between eGFR and NT-pro-BNP in serum and comparing cut-off values of NT-pro-BNP in different eGFR levels.Methods 131 elderly participants were enrolled in the study,including 52 patients with heart failure and 29 patients without heart failure as well as 30 healthy controls.Serum NT-pro-BNP levels were measured using ELISA.Results The levels of serum NT-pro-BNP were increased significantly in subjects with heart failure compared with those with renal dysfunction for no-heart failure patients（P0.05）as well as healthy controls.NT-pro-BNP level was significantly higher in ESRD no-heart failure patients than in control subjects.eGFR showed negative correlation with NT-pro-BNP in ESRD heart failure and no-heart failure patients（r=-0354,P0.05;r=-0.520,P0.01）respectively.The AUC of NT-pro-BNP in patients [eGFR 30-60 ml·min-1·（1.73 m2）-1]was 0.926.when cut-off value was 410 pmol/L,The sensitivity and specificity of NT-pro-BNP were 75.0% and 92.9% respectively.The AUC of NT-pro-BNP in patients [eGFR30 ml·min-1·（1.73 m2）-1]was 0.950.when cut-off value was 520 pmol/L,The sensitivity and specificity of NT-pro-BNP were 82.1% and 100% respectively.Conclusions Renal function correlates weakly with NT-pro-BNP and influences the optimal cut-off value for NT-pro-BNP in heart failure.Diagnosis of heart failure with NT-pro-BNP should take renal function into consideration.NT-pro-BNP could be used as a diagnostic marker for chronic renal failure with heart failure patients.

关 键 词：利钠肽 脑 肾小球滤过率 心力衰竭 肾功能衰竭 老年人 

分 类 号：R541.6[医药卫生—心血管疾病] R692.5[医药卫生—内科学]