血清脑钠肽及氨基末端脑钠肽前体在评价慢性肾衰竭患者心功能中的价值  

Clinical value of BNP and NT-proBNP for evaluating the cardiac function of patients with chronic renal failure

作　　者：唐利[1] 廖常彬[1] 钟春梅[1] 

机构地区：[1]四川省自贡市第三人民医院肾病科,643000

出　　处：《临床肾脏病杂志》2016年第4期215-218,共4页Journal Of Clinical Nephrology

基　　金：自贡市重点科技计划项目(NO.2013S10)

摘　　要：目的探讨血清脑钠肽(B-type natriuretic peptide,BNP)及氨基末端脑钠肽前体(Nterminal pro-B type natriuretic peptide,NT-pmBNP)在评价慢性肾衰竭患者心功能状态的临床应用价值。方法选择住院的慢性肾衰竭患者120例,测定患者血清肌酐、BNP、NT-proBNP浓度,按照我国改良的肾脏病膳食改善试验(modification of diet in renal disease,MDRD)公式计算肾小球滤过率,依据2003版肾脏病预后质量倡议(Kidney Disease Outcomes Quality Initiative,K/DOQI)指南标准将120例患者分为慢性肾脏病(chronic kidney disease,CKD)3、4、5(未透析)期三组进行比较;按照美国纽约心脏病学会(NYHA)制定的心功能分级将患者分为NYHAⅠ、Ⅱ、Ⅲ、Ⅳ四组进行比较。比较同一肾功能水平下不同心功能水平患者BNP及NT-proBNP的浓度差异,同一心功能水平下不同肾功能水平患者BNP及NT-proBNP的浓度差异。结果同一肾功能分期血BNP及NT-proBNP浓度随着NYHA分级升高逐渐升高,各级之间差异均有统计学意义(均P<0.01)。同一NYHA分级、不同CKD分期BNP浓度比较,差异无统计学意义(P>0.05)。同一NYHA分级,NYHAⅠ、Ⅱ、Ⅲ级时CKD 4期与CKD 3期的NT-proBNP浓度差异无统计学意义(P>0.05),CKD 5期与CKD 4期、CKD 3期比较NT-proBNP浓度显著升高(P<0.05)NYHAⅣ级时,NT-proBNP浓度在CKD 3期、4期、5期的浓度分别为(2 5540.00±4 537.30)μg/L、(25 820.00±3 636.18)μg/L、(26 208.00±3 920.68)μg/L,差异无统计学意义(P>0.05)。结论 BNP可作为CKD 3、CKD 4及CKD 5(未透析)期患者判断心功能不全的诊断指标。NT-proBNP受肾功能影响较大,对CKD 3及CKD 4期患者在考虑肾功能的前提下可评价心功能状态,但对于CKD 5期患者不建议使用。Objective To investigate the clinical value of B-type natriuretic peptide （BNP） and N-terminal pro-B type natriuretic peptide （NT-proBNP） for evaluating the cardiac function of patients with chronic renal failure （CRF）. Methods 120 inpatients with CRF were chosen. The serum creatinine, BNP, and NT-proBNP concentrations were determined. According to China＇s improved MDRD formula, the glomerular filtration rate was calculated. According to K/DOQI guide （2003 edition）, the patients were divided into CKD stage 3, 4, 5 （not given dialysis） groups. According to the classi- fication issued NYHA, the patients were classified into NYHA grade Ⅰ、Ⅱ、Ⅲ, and Ⅳ groups. The concentrations of BNP and NT-proBNP in patients with different cardiac functions under the same level of renal function, and those in patients with different renal functions under the same level of cardiac function were compared. Results The blood BNP and NT-proBNP concentrations under the same renal level gradually increased with the increases in NYHA grade [for BNP, （134. 00 ± 37. 27）, （300. 00± 22. 11）, （688. 00 ± 141.88）, and （1 003.5 ± 185.56） μg/L in NYHA grade Ⅰ,Ⅱ,Ⅲ, and IV respectively with the CKD stage 3 stage]; for NT-proBNP [（214. 00 ± 92. 63）, （896. 00 ± 200. 73）, （1 500. 00 ± 761.58）, and （25 540. 00 ± 4 537. 30） μg/L respectively]. There was statistically significant difference （P〈0. 05）. The blood BNP concentrations in different renal levels under the same NY- HA level had no obvious difference （P〉0. 05）. In NYHA grade Ⅰ, Ⅱ and Ⅲ, the blood NT-proB- NP concentrations in CKD stage 3 and 4 stage under the same NYHA level had no obvious difference. As compared with CKD stage 4 and 3, the blood NT-proBNP concentrations in CKD stage 5 increased significantly （P〈0. 05）. In NYHA grade Ⅳ, the concentrations of NT-proBNP in CKD stage 3, 4, and 5 were （25 540. 00 ± 4 537. 30）, （25 820. 00± 3 636. 18）, and （26 208. 00 ± 3 920. 68） μg

关 键 词：脑钠肽 氨基末端脑钠肽前体 慢性肾衰竭 心功能不全 

分 类 号：R692.5[医药卫生—泌尿科学] R541.6[医药卫生—外科学]