终末期肾脏病患者急性心力衰竭显性发作的危险因素及其与血浆B型钠尿肽的相关性分析  

Risk factors of acute heart failure attack in patients with ESRD and the correlation with serum BNP

作　　者：邱杰山[1] 李青华[1] 朱晓玲[2] 沈水娟[1] 胡作祥[1] 

机构地区：[1]绍兴市人民医院(浙江大学绍兴医院)肾脏内科,浙江绍兴312000 [2]浙江中医药大学附属广兴医院肾脏病实验室,浙江杭州317000

出　　处：《中国急救医学》2013年第9期832-836,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的 探讨终末期肾脏病（ESRD）患者急性心力衰竭（AHF）显性发作的危险因素及其与血浆B型钠尿肽（BNP）的相关性,确定BNP对ESRD患者AHF发作的预测价值及诊断界值,以期做到早期预防及治疗.方法 收集慢性肾脏病5期（CKD5期）患者83例,其中伴AHF发作ESRD＋AHF组40例作为试验组,不伴AHF发作ESRD-AHF组43例作为对照组.收集患者一般临床资料、血红蛋白（Hb）、收缩压（SBP）、舒张压（DBP）、脉压差（PP）、血肌酐（SCr）、尿素氮（BUN）、BNP、左心室舒张末期内径（LVEDD）、左心房内径（LAD）、左心室壁厚度（LVWT）及左室射血分数（LVEF）等参数.对两组患者各项参数进行对比分析,并分别与BNP做相关性分析.以ESRD-AHF组患者BNP作为参照,对ESRD＋AHF组患者BNP绘制ROC曲线,确定BNP对预测ESRD患者AHF发作的诊断界值.结果 年龄、Hb、SBP、DBP、PP、SCr、BUN、BNP、LVEDD、LAD及LVWT值增大,估算的肾小球滤过率（eGFR）及LVEF值减小是ESRD患者AHF显性发作的相关危险因素（P〈0.001）.相关分析显示,ESRD＋AHF组患者SBP、DBP及LAD与BNP呈正相关（r分别为：0.297、0.238和0.385）,EF与BNP呈负相关（r=-0.362）.其余参数与BNP均无明显相关.ROC曲线结果显示,BNP预测ESRD患者AHF显性发作的诊断界值为1192.8 pg/mL,敏感性为92.6%,特异性为85.3%.结论 ESRD患者是发生AHF的高危人群,需重视ESRD患者AHF的预防及早期诊治,BNP对预测ESRD患者AHF显性发作具有重要的临床诊断价值.Objective To investigate the risk factors of acute heart failure （ARF） attack in patients with end stage kidney disease （ESRD） and the correlation with B - type natriuretic peptide （ BNP）, and to determine the predictive value and diagnostic cutoff of BNP in patients with ESRD with AHF. Methods Eighty three patients with CKD5 period were collected, in which 40 cases with AHF （ESRD ＋ AHF） as the test group and the other 43 cases without AHF （ESRD- AHF） as the control group. The data including general clinical conditions, hemoglobin （Hb）, systolic blood pressure （SBP）, diastolic blood pressure （ DBP）, pulse pressure （ PP）, serum creatinine （ SCr）, blood urea nitrogen （BUN）, BNP, left ventricular end - diastolic diameter （LVEDD）, left atrial diameter （LAD）, left ventricular wall thickness （LVWD） and left ventricular ejection fraction （LVEF） were collected and analyzed between the two groups. BNP value in （ ESRD - AHF） group was set as a reference to determine the cutoff of BNP in predicting the occurrence of （ ESRD ＋ AHF） group by the ROC- curve. Results The increased values of age, Hb, SBP, DBP, PP, SCr, BUN, BNP, LVEDD, LAD and LVWT as well as the decreased values of eGFR and LVEF were the risk factors associated with （ESRD ＋ AHF） group. Correlation analysis showed that SBP, DBP and LAD were positively correlated with BNP （r = 0. 297, 0. 238 and 0. 385, respectively）, and LVEF was negative correlated with BNP （r = - 0. 362）. The remaiping parameters had no association with BNP. ROC curve showed that the cutoff value of BNP in predicting AHF attack in patients with ESRD was 1192.8 pg/mL, with a high sensitivity and specificity of 92.6% and 85.3%, respectively. Conclusion Patients with ESRD are at high risks of AHF attack. Early diagnosis and treatment of AHF are in great need. BNP has a great clinical value in predicting the AHF attack in patients with ESRD.

关 键 词：终末期肾脏病 急性心力衰竭 B型钠尿肽 危险因素 

分 类 号：R544.2[医药卫生—心血管疾病]