高血压患者肾小球滤过率下降对脑钠肽前体判断心功能的影响  

Effect of low glomerular filtration rate on evaluating the cardiac function by N-terminal pro-brain natriuretic peptide in patients with hypertension

作　　者：王丽丽[1] 李培勇[1] 管樑[1] 

机构地区：[1]上海交通大学附属瑞金医院核医学科,200025

出　　处：《中华核医学与分子影像杂志》2013年第1期39-41,共3页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的通过观察原发性高血压患者在不同心功能状态下GFR下降对血浆氨基末端·脑钠肽前体（NT—proBNP）的影响，了解应用NT—proBNP判断原发性高血压患者心功能的准确性。方法回顾性分析89例原发性高血压患者，按UCG检查结果分成心功能正常组（43例）和异常组（46例）。患者均接受GFR、血浆NT—proBNP和其他心、肾相关指标测定。分析心功能正常时影响血浆NT—proBNP的因素及不同心功能情况下GFR正常（〉80ml／min）和GFR降低（≤80ml／min）对血浆NT—proBNP影响的差异。用两样本t检验、秩和检验和多元回归分析进行统计学处理。结果心功能正常时GFR（β=-0．361，P〈0．05）和左室舒张末期直径（LVEDD）（β=0．385，P〈0．05）较LVEF（β=0．189，P〉0．05）和室间隔厚度（β=0．003，P〉0．05）等其他指标对血浆NT—proBNP影响更具意义。心功能正常和异常组的血浆NT—proBNP质量浓度中位数分别为13．18及24．14μg／L，差异有统计学意义（z=-3．19，P〈0．01）；GFR降低时，心功能正常和异常患者（分别为6例和19例）血浆NT—proBNP质量浓度中位数分别为38．45和44．20μ∥L，差异无统计学意义（Z=-0．45，P〉0．05）。GFR正常的患者心功能正常和异常分别为37和27例，血浆NT—proBNP质量浓度中位数分别为12．51及20．31μg／L，均低于GFR降低时相应水平（Z=-2．76，均P〈0．05）。心功能正常而GFR下降患者，其血浆NT—proBNP与心功能异常而GFR正常患者差异无统计学意义（38．45与20．31μ/L，Z=-2．18，P〉0．05）。结论在原发性高血压患者应用NT—proBNP判断心功能异常的严重性时需注意GFR降低的影响。Objective To assess the diagnostic accuracy of NT-proBNP in hypertension patients by observing the effect of decreased GFR on N-terminal pro-brain natriuretic peptide （NT-proBNP） concentration in patients with different cardiac function. Methods Eighty-nine hypertension patients were divided into two groups based on the results of UCG. Forty-three patients had normal left ventrieular function and 46 patients had dysfunction. GFR, NT-proBNP and other biochemical markers of cardiac and renal function were measured. The factors affecting the NT-proBNP concentration under normal left ventricular function were analyzed, and the diagnostic value of NT-proBNP affected by normal or decreased GFR（ 〉 80 ml/min or 〈80 ml/min） under different left ventricular functions were further assessed. The two-sample t test, rank sum test and multiple regression analysis were used to analyze their statistical difference and relationship. Results In patients with normal left ventrieular function, GFR （fl = - 0. 361, P 〈 0.05 ） and left ventricular end-diastolic diameter （ LVEDD, fl = 0. 385, P 〈 0.05 ） were significant factors to NT-proBNP level. They were both meaningful compared with LVEF （/3 =0. 189, P 〉0.05） and septal thickness （/3 = 0. 003, P 〉 0.05）. The median concentration of NT-proBNP was 13.18 and 24.14 μg/L in patients with normal left ventricular function and dysfunction, respectively （ Z = - 3.19, P 〈 0. 01 ）. While in patients with decreased GFR, 6 cases with normal left ventricular function and 19 cases with dysfunction had a median concentration of NT-proBNP of 38.45 and 44. 20 μg/L, respectively （Z = -0. 45, P 〉0.05 ）. In patientswith normal GFR, 37 cases with normal left ventricular function and 27 cases with dysfunction had a median concentration of NT-proBNP of 12.51 and 20.31 μg/L, which was lower than that of patients with decreased GFR （Z = - 2.76, both P 〈 0.05 ）. The NT-proBNP concentration had no significant difference between patients of normal left ven

关 键 词：高血压 肾小球滤过率 利尿钠激素 心室功能 左 

分 类 号：R544.1[医药卫生—心血管疾病]