血清氨基末端脑钠肽前体水平初筛腹膜透析患者容量超负荷的价值  

Value of serum N-terminal pro-brain natriuretic peptide levels in primary screening peritoneal dialysis patients with volume overload

作　　者：李花[1,2] 黄晓敏 张春燕[1] 杜路[1,3] 任红 徐天[1] LI Hua;HUANG Xiaomin;ZHANG Chunyan;DU Lu;REN Hong;XU Tian(Department of Nephrology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Nephrology,Huangpu Branch,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Department of Nephrology,The First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,China)

机构地区：[1]上海交通大学医学院附属瑞金医院肾脏内科,上海200025 [2]上海交通大学医学院附属第九人民医院黄浦分院肾内科,上海200011 [3]新乡医学院第一附属医院肾内科,河南卫辉453100

出　　处：《内科理论与实践》2023年第3期157-164,共8页Journal of Internal Medicine Concepts & Practice

基　　金：中国医院协会血液净化中心分会研究项目(项目编号:CHABP2021-03);上海交通大学医学院转化医学协同创新中心合作研究项目(项目编号:TM201905)。

摘　　要：目的:探讨腹膜透析(peritoneal dialysis,PD)患者血清氨基末端脑钠肽前体(N-terminal pro-B natriuretic peptide,NT-proBNP)水平与患者水合状态、心功能指标的关系,并进一步分析影响PD患者NT-proBNP水平的因素。方法:回顾性收集2019年5月—2022年1月在上海交通大学医学院附属瑞金医院PD中心随访的PD患者111例,根据多频生物电阻抗人体成分分析仪(body composition monitor,BCM)测定结果,按相对水合状态(relative hydration status,DHS),即超负荷水量(overhydration,OH)和细胞外水(extracellular water,ECW)比值,将其分为容量正常组(OH/ECW≤15%)与容量超负荷组(OH/ECW>15%)。比较2组患者血清NT-proBNP水平与水合状态关系,并进一步分析探讨影响NT-proBNP水平的相关因素。以BCM结果作为“金标准”,受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)确定容量超负荷时NT-proBNP最佳阈值。并根据NT-proBNP进行分组,比较2组的临床资料。结果:容量超负荷组和容量正常组在收缩压、尿量、总尿素清除指数(urea clearance index,Kt/V)、总肌酐清除率(creatinine clearance rate,CCr)、4 h透析液肌酐/血肌酐比值(dialysate to plasma ratio for urea at 4 hours,4hD/PCr)、降压药种类、利尿剂种类、血红蛋白、血清白蛋白、log2(NT-proBNP)、室间隔厚度(interventricular septal thickness,IVST)、左室后壁厚度(left ventricular posterior wall thickness,LVPWT)、左房内径(left atrial diameter,LAD)、OH、TBW、ECW、OH/TBW、ECW/TBW、ECW/ICW方面差异有统计学意义(均P<0.05)。log2(NT-proBNP)水平与收缩压、透析龄、超滤量、透析剂量、降压药分组、IVST、LVPWT、LAD、左心室收缩末期内径(left ventricular end-systolic dimension,LVESD)、左室舒张末期内径(left ventricular end-diastolic dimension,LVEDD)、OH、OH/ECW呈正相关(均P<0.05),与尿量、总Kt/V、总CCr、标准蛋白分解率(normalized protein catabolic rate,nPCR)、血红蛋白、血清白�Objective To explore the relationship between serum N-terminal pro-brain natriuretic peptide(NT-proBNP)level and hydration status and cardiac function indexes in the patients receiving peritoneal dialysis(PD)treatment,and to further analyze the factors affecting the level of NT-proBNP.Methods A total of 111 patients with PD who were followed up in the PD Center of Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from May 2019 to January 2022 were enrolled and the data was analyzed retrospectively.According to the results of multi-frequency bioelectrical impedance body composition monitor(BCM),relative hydration status(DHS),the ratio obtained through dividing extracellular water(ECW)by overhydration(OH),the patients were divided into normal volume group(OH/ECW≤15%)and overhydration group(OH/ECW>15%).The relationship between serum NT-proBNP level and hydration status in two groups was compared,and the related factors affecting the level of NT-proBNP were further analyzed and discussed.Using BCM result as the“gold standard”,the receiver operator characteristic curve(ROC curve)determined the optimal threshold of NT-proBNP as the capacity was overloaded.The patients were divided into two groups according to NT-proBNP and their clinical data were compared.Results The indexes including systolic blood pressure,urine volume,urea clearance index(Kt/V),creatinine clearance rate(CCr),dialysate to plasma ratio for urea at 4 hours(4hD/PCr),types of antihypertensive drugs,type of diuretic,hemoglobin,serum albumin,log2(NT-proBNP),interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),left atrial diameter(LAD),OH,TBW,ECW,OH/TBW,ECW/TBW and ECW/ICW were detected in volume overload group and normal volume group,and showed statistically significant(all P<0.05).log2(NT-proBNP)level was correlated with systolic blood pressure,dialysis duration,ultrafiltration volume,dialysis dose,antihypertensive drug group,IVST,LVPWT,LAD,left ventricular end-systolic dimension(LVESD),left ventri

关 键 词：腹膜透析 氨基末端脑钠肽前体 容量超负荷 多频生物电阻抗法 超声心动图 

分 类 号：R459.5[医药卫生—治疗学]