中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2014年
7期
506-511
,共6页
陶志虎%肖琦%吕冬宁%黄仁发%史伟
陶誌虎%肖琦%呂鼕寧%黃仁髮%史偉
도지호%초기%려동저%황인발%사위
血液透析%心血管疾病%胱抑素C%氨基末端脑利钠肽前体
血液透析%心血管疾病%胱抑素C%氨基末耑腦利鈉肽前體
혈액투석%심혈관질병%광억소C%안기말단뇌리납태전체
Hemodialysis%Cardiovascular diseases%Cystatin C%Amino-terminal pro-brain natriuretic peptide
目的 探讨维持性血液透析(MHD)患者外周血胱抑素C(Cys-C)及氨基末端脑利钠肽前体(NT-proBNP)水平与心血管(CV)事件发生的相关关系,以期寻找一种有效的预测心血管疾病(CVD)的生物学标志物.方法 从3个血液净化中心的452例MHD患者中筛选出无冠心病、心力衰竭、心律失常病史,血甲状旁腺激素、血红蛋白、血脂等指标正常的患者126例,采用血液透析、血液透析加滤过及血液灌流等3种透析方式,治疗前及治疗期间每3个月检测透析前血C ys-C、NT-proBNP、血磷、血全段甲状旁腺素(iPTH)、血红蛋白、心电图;每6个月行超声心动检查,观察时间24个月,随访3年,记录患者的心血管事件发生情况及检查结果.应用多因素logistic回归分析上述各指标与CV事件发生的相关性.血Cys-C、NT-proBNP预测效能用受试者工作特征(ROC)曲线下面积(AUC)评价.结果 126例患者试验及随访期间发生CV事件18例次,其中心力衰竭8例次,心肌梗死4例次,心律失常6例次.发生CV事件患者血Cys-C中位数[M(1/4,3/4)]为8.59(9.74,7.10) mg/L,NT-proBNP中位数为7 739(9 887,6 736) ng/L.多因素非条件logistic回归分析结果显示,Cys-C、NT-proBNP、iPTH、透析低血压、透析期间体质量增长是CV事件发生的独立危险因素.血Cys-C和NT-proBNP水平在预测MHD患者CVD发生的AUC分别为0.64(95％CI 0.53～0.71,P＜0.05)和0.79 (95％CI 0.72～0.89,P＜ 0.01).以Cys-C中位数8.59 mg/L、NT-proBNP中位数7 739 ng/L作为临界值,其预测CV事件的灵敏度为84.3％,特异度为92.7％.结论 血清Cys-C、NT-proBNP是预测血液透析患者心血管事件发生的有效生物学标志物.
目的 探討維持性血液透析(MHD)患者外週血胱抑素C(Cys-C)及氨基末耑腦利鈉肽前體(NT-proBNP)水平與心血管(CV)事件髮生的相關關繫,以期尋找一種有效的預測心血管疾病(CVD)的生物學標誌物.方法 從3箇血液淨化中心的452例MHD患者中篩選齣無冠心病、心力衰竭、心律失常病史,血甲狀徬腺激素、血紅蛋白、血脂等指標正常的患者126例,採用血液透析、血液透析加濾過及血液灌流等3種透析方式,治療前及治療期間每3箇月檢測透析前血C ys-C、NT-proBNP、血燐、血全段甲狀徬腺素(iPTH)、血紅蛋白、心電圖;每6箇月行超聲心動檢查,觀察時間24箇月,隨訪3年,記錄患者的心血管事件髮生情況及檢查結果.應用多因素logistic迴歸分析上述各指標與CV事件髮生的相關性.血Cys-C、NT-proBNP預測效能用受試者工作特徵(ROC)麯線下麵積(AUC)評價.結果 126例患者試驗及隨訪期間髮生CV事件18例次,其中心力衰竭8例次,心肌梗死4例次,心律失常6例次.髮生CV事件患者血Cys-C中位數[M(1/4,3/4)]為8.59(9.74,7.10) mg/L,NT-proBNP中位數為7 739(9 887,6 736) ng/L.多因素非條件logistic迴歸分析結果顯示,Cys-C、NT-proBNP、iPTH、透析低血壓、透析期間體質量增長是CV事件髮生的獨立危險因素.血Cys-C和NT-proBNP水平在預測MHD患者CVD髮生的AUC分彆為0.64(95％CI 0.53～0.71,P＜0.05)和0.79 (95％CI 0.72～0.89,P＜ 0.01).以Cys-C中位數8.59 mg/L、NT-proBNP中位數7 739 ng/L作為臨界值,其預測CV事件的靈敏度為84.3％,特異度為92.7％.結論 血清Cys-C、NT-proBNP是預測血液透析患者心血管事件髮生的有效生物學標誌物.
목적 탐토유지성혈액투석(MHD)환자외주혈광억소C(Cys-C)급안기말단뇌리납태전체(NT-proBNP)수평여심혈관(CV)사건발생적상관관계,이기심조일충유효적예측심혈관질병(CVD)적생물학표지물.방법 종3개혈액정화중심적452례MHD환자중사선출무관심병、심력쇠갈、심률실상병사,혈갑상방선격소、혈홍단백、혈지등지표정상적환자126례,채용혈액투석、혈액투석가려과급혈액관류등3충투석방식,치료전급치료기간매3개월검측투석전혈C ys-C、NT-proBNP、혈린、혈전단갑상방선소(iPTH)、혈홍단백、심전도;매6개월행초성심동검사,관찰시간24개월,수방3년,기록환자적심혈관사건발생정황급검사결과.응용다인소logistic회귀분석상술각지표여CV사건발생적상관성.혈Cys-C、NT-proBNP예측효능용수시자공작특정(ROC)곡선하면적(AUC)평개.결과 126례환자시험급수방기간발생CV사건18례차,기중심력쇠갈8례차,심기경사4례차,심률실상6례차.발생CV사건환자혈Cys-C중위수[M(1/4,3/4)]위8.59(9.74,7.10) mg/L,NT-proBNP중위수위7 739(9 887,6 736) ng/L.다인소비조건logistic회귀분석결과현시,Cys-C、NT-proBNP、iPTH、투석저혈압、투석기간체질량증장시CV사건발생적독립위험인소.혈Cys-C화NT-proBNP수평재예측MHD환자CVD발생적AUC분별위0.64(95％CI 0.53～0.71,P＜0.05)화0.79 (95％CI 0.72～0.89,P＜ 0.01).이Cys-C중위수8.59 mg/L、NT-proBNP중위수7 739 ng/L작위림계치,기예측CV사건적령민도위84.3％,특이도위92.7％.결론 혈청Cys-C、NT-proBNP시예측혈액투석환자심혈관사건발생적유효생물학표지물.
Objective To research the relationship between the serum level of cystatin C (CysC),N-terminal pro brain natriuretic peptide (NT-proBNP) and the cardiovascular (CV) events in maintenance hemodialysis (MHD) patients,looking for a new and effective biological prediction method for cardiovascular disease (CVD).Methods According to the excluded criteria and included criteria,a total of 126 patients [male 67(53.2％),female 59 (46.8％)] were included in this study,screening out of 452 MHD patients from 3 blood purification centre,no secondary hyperparathyroidism,blood pressure controlled,hemoglobin standard,no lipid abnormalities,and without history of coronary heart disease,heart failure and arrhythmia.Participants adopted 3 dialysis treatment,including hemodialysis,hemoperfusion and hemodiafiltration.Every 3 months before the dialysis,the Cys-C,NT-proBNP,serum phosphorus,serum intact parathyroid hormone (iPTH),hemoglobin and electrocardiogram were detected.The heartbeat ultrasound was examined every 6 months,observed for 24 months and followed up for 3 years,recording the incidence and the inspection results.The correlation and the occurrence of CVD were analyzed by conducting a multiple factor logistic regression analysis.The forecast performance of Cys-C,NT-proBNP was evaluated by using receiver operating characteristic (ROC) curves and area under curves (AUC).Results Eighteen episodes of CV events occurred in 126 patients during the experiment and follow-up,including 8 episodes of heart failure,4 episodes of myocardial infarction,6 episodes of arrhythmia.Detection indexes had no statistically significant correlation (P ＞ 0.05),and the results of ECG and ultrasound heartbeat graph showed that no significant difference in cardiac structure and function before treatment (P ＞ 0.05).After 24 months duration,the research showed that the level of serum calcemia was lower,and the levels of phosphorus and iPTH were higher in hemodialysis group compared with that in the other 2 groups,and the differences had statistical significance (P ＜ 0.05).The median levels of Cys-C and NT-proBNP were 8.59 (9.74,7.10) mg/L and 7 739 (9 887,6 736) ng/L in the patients CV events occurred.Non conditional multivariate logistic regression analysis demonstrated that the increasing interdialytic weight,Cys-C,NT-proBNP,iPTH,dialysis hypotension were the independent risk factors of CV occurrence.AUCs to predict CVD occurrence in MHD patients was 0.64 (95％CI 0.53-0.71,P ＜ 0.05) and 0.79 (95％CI 0.72-0.89,P＜ 0.01) using Cys-C and NT-proBNP respectively.The cut-off values of serum Cys-C and NT-proBNP for CVD occurrence were 8.59 mg/L and 7 739 ng/L,with a sensitivity of 84.3％ and a specificity of 92.7％.Conclusions Cys-C,NT-proBNP can be used to predict the risk of CV events in dialysis patients.
