终末期肾脏病患者和肽素水平及临床价值探讨  

Exploration of Copeptin Levels and Clinical Value in Patients with End-stage Renal Disease

作　　者：苏明[1] 徐庆东[1] 姜松青[1] 胡国强[1] 陈思颖[1] 

机构地区：[1]江门市中心医院肾内科,广东江门529000

出　　处：《四川医学》2017年第8期961-964,共4页Sichuan Medical Journal

摘　　要：目的比较不同程度心力衰竭终末期肾脏病(end-stage renal disease,ESRD)患者和肽素水平的差异,为临床治疗提供参考义。方法纳入2015年6月至2016年6月于我院住院期间的214例ESRD患者,根据NYHA方案进行心功能分级分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级,另选10例肾功能、心功能均正常的健康体检者为对照组。所有研究对象均于早上空腹状态下抽取静脉血作血生化、血常规、和肽素和BNP检查,所有研究对象行心脏彩超检查测定左室射血分数。结果 (1)ESRDⅢ、Ⅳ级患者NT-proBNP均高于对照组,差异有统计学意义(q=8.27、14.25,P<0.01);Ⅰ级患者与Ⅱ、Ⅲ、Ⅳ级相比较差异有统计学意义(q=4.11、13.90、23.97,P<0.01);Ⅱ级与Ⅲ、Ⅳ级患者相比较差异有统计学意义(q=7.92、17.11,P<0.01);Ⅲ级与Ⅳ级患者相比较差异有统计学意义(q=12.18,P<0.01)。(2)各组患者间LVEF差异均有统计学意义(P<0.05)。(3)各组患者间和肽素水平差异均有统计学意义(P<0.05)。(4)将和肽素与其他指标进行相关性分析,结果发现和肽素与LVEF呈负相关(r=-0.81,P<0.01),与NYHA分级呈正相关(r=0.71,P<0.01),与NT-proBNP呈正相关(r=0.68,P<0.05)。结论和肽素可反应ESRD患者心力衰竭状态,其在心力衰竭早期即有可能变化明显。Objective To compare copeptin levels of patients with different degrees of end-stage renal disease（ ESRD）and provide a reference for clinical therapy.Methods 214 hospitalized patients with ESRD were selected from June 2015 to June2016.According to the NYHA Grade,the cardiac function classification was divided into Ⅰ、Ⅱ、Ⅲ and Ⅳ. And another 10 healthy persons with normal renal and cardiac function were selected as control group.All subjects were sampled for venous blood in fasting states in the morning to exam blood biochemistry,blood routine,copeptin and BNP.The left ventricular ejection fraction was measured by echocardiography in all the subjects.Results（1）Patients with ESRD Ⅲ and Ⅳ had higher NT-proBNP than control group（ q= 8. 27、14. 25,P〈0. 01）. Patients with ESRD Ⅰ had a statistical difference from those with ESRD Ⅱ,Ⅲ and Ⅳ（ q = 4. 11、13. 90、23. 97,P〈0. 01）.Patients with ESRDⅡ had a statistical difference from those with ESRD Ⅲ and Ⅳ（ q = 7. 92、17. 11,P〈0. 01）.Patients with ESRD Ⅲ had a statistical difference from those with ESRD Ⅳ（ q = 12. 18,P〈0. 01）.（2） The difference of LVEF between each two groups was statistically significant（ P〈0. 05）.（3）The difference of copeptin levels between each two groups was statistically significant（ P〈0. 05）.（4）Correlation of copeptin and other indexes were analyzed and the results showed copeptin was in negative correlation with LVEF（ r =-0. 81,P〈0. 01） and copeptin was in positive correlation with NYHA Grade（ r = 0. 71,P〈0. 01） and copeptin was in negative correlation with NT-proBNP（ r = 0. 68,P〈0. 05）. Conclusion Copeptin can reflect heart failure of patients with ESRD and it shows a significant change at an early stage of heart failure.

关 键 词：终末期肾脏病 心力衰竭 和肽素 

分 类 号：R692[医药卫生—泌尿科学]