CAJ | 학술논문

目的通过对维持性血液透析患者血浆氨基末端前脑钠肽(N-terminal pro-brain natriuretic peptide,NT-proBNP)水平的横断面调查,分析透析人群中NT-proBNP的分布特点和影响因素,并探讨其临床意义.方法选取复旦大学附属中山医院血液透析中心病情稳定的维持性血液透析患者共207例,比较其临床指标、血浆NT-proBNP水平和超声心动图参数,对上述指标进行分析.结果伴有左心室肥厚(left ventricular hypertrophy,LVH)组血浆NT-proBNP显著高于非LVH组[M(1/4,3/4):3 104(1 626,7 843) ng/L比1 291(772,1 845) ng/L,P＜ 0.01].对偏态变量NT-proBNP进行对数转换后,log[NT-proBNP]与血红蛋白(r=-0.212,P=0.004)、左心室射血分数(left ventricular ejection fraction,LVEF)(r=-0.202,P=0.003)呈负相关,与左心室质量指数(left ventricular mass index,LVMI)(r=0.370,P=0.001)、检测当日透析前体质量增加(interdialysic weight gain,IDWG)比例(r=0.233,P=0.001)、透析前收缩压(r=0.345,P=0.001)、透析前舒张压(r=0.152,P=0.032)呈正相关.受试者工作特征曲线(ROC)分析结果显不,NT-proBNP诊断LVH及IDWG＞ 4％的ROC曲线下面积(AUC)分别为0.786(95％CI0.689～0.883,P＜0.01)和0.738(95％CI 0.667 ～ 0.810,P＜0.01).以NT-proBNP滴度1 917 ng/L为截点,诊断LVH的敏感度和特异度分别为0.676和0.824;以NT-proBNP滴度2 872 ng/L为截点,诊断IDWG＞4％的敏感度和特异度分别为0.704和0.758.结论 NT-proBNP水平在血液透析人群显著异常,主要与LVH、IDWG比例高以及透析前血压控制欠佳有关.合理的干体质量评估和严格控制透析间期体质量增加可能是干预NT-proRNP的有效办法.
목적 통과대유지성혈액투석환자혈장안기말단전뇌납태(N-terminal pro-brain natriuretic peptide,NT-proBNP)수평적횡단면조사,분석투석인군중NT-proBNP적분포특점화영향인소,병탐토기림상의의.방법 선취복단대학부속중산의원혈액투석중심병정은정적유지성혈액투석환자공207례,비교기림상지표、혈장NT-proBNP수평화초성심동도삼수,대상술지표진행분석.결과 반유좌심실비후(left ventricular hypertrophy,LVH)조혈장NT-proBNP현저고우비LVH조[M(1/4,3/4):3 104(1 626,7 843) ng/L비1 291(772,1 845) ng/L,P＜ 0.01].대편태변량NT-proBNP진행대수전환후,log[NT-proBNP]여혈홍단백(r=-0.212,P=0.004)、좌심실사혈분수(left ventricular ejection fraction,LVEF)(r=-0.202,P=0.003)정부상관,여좌심실질량지수(left ventricular mass index,LVMI)(r=0.370,P=0.001)、검측당일투석전체질량증가(interdialysic weight gain,IDWG)비례(r=0.233,P=0.001)、투석전수축압(r=0.345,P=0.001)、투석전서장압(r=0.152,P=0.032)정정상관.수시자공작특정곡선(ROC)분석결과현불,NT-proBNP진단LVH급IDWG＞ 4％적ROC곡선하면적(AUC)분별위0.786(95％CI0.689～0.883,P＜0.01)화0.738(95％CI 0.667 ～ 0.810,P＜0.01).이NT-proBNP적도1 917 ng/L위절점,진단LVH적민감도화특이도분별위0.676화0.824;이NT-proBNP적도2 872 ng/L위절점,진단IDWG＞4％적민감도화특이도분별위0.704화0.758.결론 NT-proBNP수평재혈액투석인군현저이상,주요여LVH、IDWG비례고이급투석전혈압공제흠가유관.합리적간체질량평고화엄격공제투석간기체질량증가가능시간예NT-proRNP적유효판법.
Objective To analysis the distribution and influence factors of N-terminal probrain natriuretic peptide (NT-pro BNP),and also its clinical significance though a cross-sectional survey of NT-pro BNP in maintenance hemodialysis patients in Zhongshan Hospital,Fudan University.Methods A total of 207 stable hemodialysis patients were enrolled.The clinical parameters,plasma NT-proBNP levels and echocardiographic parameters were analyzed.Results Level of plasma NTproBNP in patients with left ventricular hypertrophy (LVH) were significantly higher than those without LVH[M(1/4,3/4):3 104(1 626,7 843) ng/L vs 1 291(772,1 845) ng/L,P ＜ 0.01].After logarithmic transformation for skewed variables NT-proBNP,log[NT-proBNP] was negatively correlated with hemoglobin (r=-0.212,P=0.004) and left ventricular ejection fraction (LVEF)(r=-0.202,P=0.003),and was positively correlated with left ventricular mass index (LVMI)(r=0.370,P=0.001),interdialysic weight gain (IDWG) rate (r=0.233,P=0.001),predialysis systolic blood pressure (r=0.345,P=0.001),predialysis diastolic blood pressure (r=0.152,P=0.032).The areas under curve(AUC) of NT-proBNP for diagnosing LVH and IDWG ＞ 4％ were 0.786(95％CI 0.689-0.883,P ＜ 0.01) and 0.738(95％CI 0.667-0.810,P ＜ 0.01).When the threshold of NT-proBNP was set at 1 917 ng/L to diagnosis LVH,the sensitivity and specificity were 0.676 and 0.824.When the threshold of NT-proBNP was set at 2 872 ng/L to diagnosis IDWG ＞ 4％,the sensitivity and specificity were 0.704 and 0.758.Conclusions NT-proBNP levels are significantly abnormality in hemodialysis patients,mainly related with LVH,the high rate of IDWG,and the poorly controlled predialysis blood pressure.Proper dry weight assessment and strict control of IDWG may be effective way to intervene NT-proBNP.