维持性血液透析患者血清BNP水平变化及其临床意义分析  

The Level of Brain Natriuretic Peptide in MHD Patients and its Clinical Significance

作　　者：张清[1] 王昱[1] 鲍晓荣[1] 

机构地区：[1]复旦大学附属金山医院肾内科,上海201508

出　　处：《中国中西医结合肾病杂志》2015年第7期587-589,共3页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：上海市金山区科委基金资助项目(No.2011-3-13)()

摘　　要：目的:分析维持性血透(maintain hemodialysis,MHD)患者血透前后血清脑钠肽(brain natriuretic peptide,BNP)水平的变化及其意义。方法:以30例非CKD患者为健康对照组,并选择我院60例病情稳定且近期无急性心血管事件的MHD患者,分别检测同一次血透前后血清BNP水平,同时应用心脏超声心动图检测患者左心房内径(LAD)、左心室舒张末内径(LVDd)、左心室收缩末内径(LVDs)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室射血分数(LVEF)等,计算左心室心肌重量(LVM),探讨BNP与MHD患者左心室结构、功能和血容量的关系。结果:(1)MHD患者血透前、后血清BNP水平均显著高于对照组(P<0.01),且透析后BNP水平较血透前显著下降(P<0.01);(2)MHD患者LAD、LVDd、(LVDs、IVST、LVPWT、LVEF、LVM水平均显著高于对照组(P<0.01);(3)MHD患者血清BNP水平与LVDd、LVDs、LVPWT、LVM呈显著正相关,与LVEF呈显著负相关,与LAD、IVST无显著相关性;(4)MHD患者单次透析超滤量与血透前后BNP差值呈显著正相关(P<0.05)。结论:MHD患者BNP水平普遍升高,并且与左心室功能及血容量负荷密切相关,对评估MHD患者心功能状况、指导超滤量的设置有一定的临床指导价值。Objective：To explore the abnormal levels of brain natriuretic peptide （BNP）in maintain hemodialysis （MHD） patients and its significance by investigating the BNP levels before and after dialysis, and comparing them with the results of ultrasonic cardiography. Methods：We recruited 60 MHD patients that were in a stable clinic status without signs of cardiovascular disease. Blood samples were collected at the start and end of a dialysis session in order to detect the serum BNP level. Left ventricular diameter （LVD）, left atrial diameter （LAD）, left ventricular posterior wall thickness（ LVPWT）, interventricular septal thickness（IVST） and left ventricular ejection fraction （LVEF） were evaluated by ultrasonic cardiography. The relationship between serum BNP level and left heart failure in these patients was analyzed, Results： In MHD patients, the pre - and post - dialysis serum BNP levels were sig- nificantly higher than those of control group （ P 〈 0.01 ）, and the values declined after each dialysis session. The levels of LAD, LVDd, （LVDs, IVST, LVPWT, LVEF and LVM in MHD patients were significantly higher than that in control group （P 〈 0.01 ）. Serum BNP level has positive correlations with the levels of LVDd, LVDs, LVPWT and LVM, but has a negative correlation with the level of LVEF（P 〈 0.05）, and has no correlations with the levels of LAD, IVST. Ultrafihration notable correlated with variation of BNP level （r =0. 221 5, P 〈 0.05 ）. Conclusion： Higher serum BNP was frequently seen in MHD patient, and was closely related with the poor cardiac function and volume overload. And it may have an important clinical value to evaluate the heart function of MHD patient. The detection of plasma BNP may estimate the ultrafihration of MHD patients.

关 键 词：脑钠肽 维持性血透 超滤量 

分 类 号：R459.5[医药卫生—治疗学]