血浆N-末端前体脑钠肽水平评估维持性血液透析患者心脏负荷状态的应用价值

摘要

目的:通过分析维持性血液透析(MHD)患者血浆N-末端前体脑钠肽(NT-proBNP)与血压、透析间期质量增长之间关系,探讨NT-proBNP评估MHD患者心脏负荷的临床应用价值.方法:2010年10月-2010年12月复旦大学附属中山医院血液净化中心透析龄超过3个月的MHD患者232例,所有患者心脏超声检查示左心室射血分数＞50％,并且无明显心力衰竭临床表现,排除急性心血管事件,记录患者1周连续3次透析前血压、透析间期体质量增长量,分析血浆NT-proBNP水平与透析前血压、透析间期体质量增长量等反映心脏负荷指标之间的关系.结果:(1)MHD患者血浆NT-proBNP为2 598.0(1 404.0～4 736.3)pg/mL,所有患者均高于正常；(2)血浆NT-proBNP与收缩压(r=0.315,P＜0.01)及舒张压(r=0.178,P＜0.01)呈显著正相关,血压＞160/100mmHg患者的NT-proBNP显著高于血压140/90mmHg～160/100mmHg及≤140/90 mmHg患者(P＜0.01)；(3)透析间期体质量相对增长量≤4％患者血浆NT-proBNP水平显著低于＞4％患者(P＜0.01),且与透析间期体质量增长量呈显著正相关(r=0.395,P＜0.01)；(4)以血压≤140/90 mmHg,透析间期体质量相对增长量≤4％,且无明显心力衰竭视作为MHD患者心脏负荷状态良好,血浆NT-proBNP水平在判断MHD患者容量状态的受试者工作特征曲线(ROC)下面积为0.85(0.79～0.90,P＜0.01),以NT-proBNP 2 705.5 pg/mL作为界值的灵敏度为61.8％,特异度为98.2％.结论:MHD患者血浆NT-proBNP水平升高,且与患者血压及透析间期体质量增长显著相关.血浆NT-proB-NP水平可作为监测MHD患者心脏负荷状态的敏感指标.%Objective:To investigate the relationship between plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) with blood pressure and weight growth during dialysis in patients on maintainence hemodialysis and to evaluate the clinical value of NT-proBNP in the assessment of cardiac load. Methods: We recruited 232 patients who were treated with Maintainence hemodialysis( MHD) for at least 3 months before the study and were in a stable clinical status without any acute cardiovascular events and left ventricular ejection fractions(LVEF) obtained fom echocardiograms were>50%. Plasma NT-proB-NP level was assayed by chemiluminescence. Body weight growth and blood pressure were recorded before dialysis for 3 consecutive hemodialysis sessions to determine the relationship between NT-proBNP and cardiac load. Results: The average level of NT-proBNP was 2598. 0(1 404. 0-4 736. 3) pg/mL which was higher than normal. Plasma NT-proBNP levels were significantly higher in patients with blood pressure>160/100mmHg or body weight growth>4% than those of the control group (P <0.01), and plasma NT-proBNP level significantly correlated with systolic blood pressure(r= 0. 315, P<0. 01), diastolic blood pressure (r=0. 178, P<0.01) and body weight growth during dialysis(r= 0. 395, P<0.01) . The area under the receiver operating characteristic curve for NT-proBNP to detect cardiac overload was 0. 85(95% CI:0. 79 - 0. 90 P<0. 01),and cutoff NT-proBNP value at 2705. 5pg/mL had a sensitivity of 61. 8 % and a specificity of 98. 2% for detecting cardiac overload. Conclusions; In MHD patients, increased levels of NT-proBNP are associated with blood pressure and body weight growth during dialysis. Plasma NT-proBNP can be a good marker for the detection and evaluation of cardiac overload in MHD patients.