中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2015年
2期
166-171
,共6页
黎伟%潘玲%王照%伍巧源%廖蕴华
黎偉%潘玲%王照%伍巧源%廖蘊華
려위%반령%왕조%오교원%료온화
腹膜透析%脑钠肽前体%容量负荷%心功能
腹膜透析%腦鈉肽前體%容量負荷%心功能
복막투석%뇌납태전체%용량부하%심공능
Peritoneal dialysis%Brain natriuretic peptide%Load capacity%Cardiac function
目的:探讨持续性不卧床腹膜透析(CAPD)患者血清脑钠肽前体(NT - pro - BNP)水平与患者容量状态、心功能指标的关系,分析影响NT - pro - BNP水平的相关因素。方法选取2012年9月—2013年9月在广西医科大学第一附属医院腹膜透析中心随访的 CAPD 患者104例(CAPD 组),同时选取本院体检健康者30例作为对照组。测定 CAPD 组与对照组血清NT - pro - BNP水平;根据腹膜透析液尿素浓度/血尿素浓度(D/ P)值将 CAPD 患者分为高转运(0.82~1.03μmol/ L,n =16)组、高平均转运(0.66~0.81μmol/ L,n =33)组、低平均转运(0.50~0.65μmol/ L,n =48)组及低转运(0.34~0.49μmol/ L,n =7)组。比较4组患者血清NT - pro - BNP水平与容量状态及心功能指标的关系,探讨影响NT - pro - BNP水平的相关因素。结果4组患者清蛋白、血磷、高密度脂蛋白、低密度脂蛋白、总胆固醇比较,差异均有统计学意义(P <0.05);4组患者其余指标比较,差异均无统计学意义( P >0.05)。4组患者的总内生肌酐清除率(Ccr)值、D/ P、液体入量、水肿发生率比较,差异均有统计学意义(P <0.05);4组其余指标比较,差异均无统计学意义(P >0.05)。CAPD 组患者血清NT - pro - BNP水平为(4813±4360)ng/ L,高于对照组的(51±23)ng/ L,差异有统计学意义(t =9.301,P <0.001)。4组患者血清NT - pro - BNP水平、左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、室间隔厚度(LVST)、舒张末期左心室后壁厚度(LVPWT)、左房内径(LAD)比较,差异有统计学意义(P <0.05)。相关性分析显示,CAPD 患者血清NT - pro - BNP水平与转运类型呈正相关(r =0.617,P <0.001)。残肾 KT/ V、残肾 Ccr 值、尿量对NT - pro - BNP水平的影响有统计学意义(P <0.05),而肾小球滤过率估计值(eGFR)、腹膜透析透析充分性(KT/ V)、腹膜透析 Ccr 值、超滤量、血尿素氮、血肌酐(Scr)对NT - pro - BNP水平的影响无统计学意义( P >0.05)。NT - pro - BNP水平与水肿、收缩压、液体入量、Scr、高密度脂蛋白、心胸比、血钠、LVEDD、LVESD、LVST、LVPWT 及 LAD 呈正相关,与年龄、残肾 KT/ V、残肾Ccr 值、血红蛋白、清蛋白、血钙及 LVEF 呈负相关(P <0.05)。结论 CAPD 患者NT - pro - BNP水平普遍升高,且在不同腹膜转运类型间存在差异,并与血容量状态及心功能评估的有效指标密切相关,与残余肾功能、贫血及营养状态也存在一定相关性。
目的:探討持續性不臥床腹膜透析(CAPD)患者血清腦鈉肽前體(NT - pro - BNP)水平與患者容量狀態、心功能指標的關繫,分析影響NT - pro - BNP水平的相關因素。方法選取2012年9月—2013年9月在廣西醫科大學第一附屬醫院腹膜透析中心隨訪的 CAPD 患者104例(CAPD 組),同時選取本院體檢健康者30例作為對照組。測定 CAPD 組與對照組血清NT - pro - BNP水平;根據腹膜透析液尿素濃度/血尿素濃度(D/ P)值將 CAPD 患者分為高轉運(0.82~1.03μmol/ L,n =16)組、高平均轉運(0.66~0.81μmol/ L,n =33)組、低平均轉運(0.50~0.65μmol/ L,n =48)組及低轉運(0.34~0.49μmol/ L,n =7)組。比較4組患者血清NT - pro - BNP水平與容量狀態及心功能指標的關繫,探討影響NT - pro - BNP水平的相關因素。結果4組患者清蛋白、血燐、高密度脂蛋白、低密度脂蛋白、總膽固醇比較,差異均有統計學意義(P <0.05);4組患者其餘指標比較,差異均無統計學意義( P >0.05)。4組患者的總內生肌酐清除率(Ccr)值、D/ P、液體入量、水腫髮生率比較,差異均有統計學意義(P <0.05);4組其餘指標比較,差異均無統計學意義(P >0.05)。CAPD 組患者血清NT - pro - BNP水平為(4813±4360)ng/ L,高于對照組的(51±23)ng/ L,差異有統計學意義(t =9.301,P <0.001)。4組患者血清NT - pro - BNP水平、左心室射血分數(LVEF)、左心室收縮末期內徑(LVESD)、室間隔厚度(LVST)、舒張末期左心室後壁厚度(LVPWT)、左房內徑(LAD)比較,差異有統計學意義(P <0.05)。相關性分析顯示,CAPD 患者血清NT - pro - BNP水平與轉運類型呈正相關(r =0.617,P <0.001)。殘腎 KT/ V、殘腎 Ccr 值、尿量對NT - pro - BNP水平的影響有統計學意義(P <0.05),而腎小毬濾過率估計值(eGFR)、腹膜透析透析充分性(KT/ V)、腹膜透析 Ccr 值、超濾量、血尿素氮、血肌酐(Scr)對NT - pro - BNP水平的影響無統計學意義( P >0.05)。NT - pro - BNP水平與水腫、收縮壓、液體入量、Scr、高密度脂蛋白、心胸比、血鈉、LVEDD、LVESD、LVST、LVPWT 及 LAD 呈正相關,與年齡、殘腎 KT/ V、殘腎Ccr 值、血紅蛋白、清蛋白、血鈣及 LVEF 呈負相關(P <0.05)。結論 CAPD 患者NT - pro - BNP水平普遍升高,且在不同腹膜轉運類型間存在差異,併與血容量狀態及心功能評估的有效指標密切相關,與殘餘腎功能、貧血及營養狀態也存在一定相關性。
목적:탐토지속성불와상복막투석(CAPD)환자혈청뇌납태전체(NT - pro - BNP)수평여환자용량상태、심공능지표적관계,분석영향NT - pro - BNP수평적상관인소。방법선취2012년9월—2013년9월재엄서의과대학제일부속의원복막투석중심수방적 CAPD 환자104례(CAPD 조),동시선취본원체검건강자30례작위대조조。측정 CAPD 조여대조조혈청NT - pro - BNP수평;근거복막투석액뇨소농도/혈뇨소농도(D/ P)치장 CAPD 환자분위고전운(0.82~1.03μmol/ L,n =16)조、고평균전운(0.66~0.81μmol/ L,n =33)조、저평균전운(0.50~0.65μmol/ L,n =48)조급저전운(0.34~0.49μmol/ L,n =7)조。비교4조환자혈청NT - pro - BNP수평여용량상태급심공능지표적관계,탐토영향NT - pro - BNP수평적상관인소。결과4조환자청단백、혈린、고밀도지단백、저밀도지단백、총담고순비교,차이균유통계학의의(P <0.05);4조환자기여지표비교,차이균무통계학의의( P >0.05)。4조환자적총내생기항청제솔(Ccr)치、D/ P、액체입량、수종발생솔비교,차이균유통계학의의(P <0.05);4조기여지표비교,차이균무통계학의의(P >0.05)。CAPD 조환자혈청NT - pro - BNP수평위(4813±4360)ng/ L,고우대조조적(51±23)ng/ L,차이유통계학의의(t =9.301,P <0.001)。4조환자혈청NT - pro - BNP수평、좌심실사혈분수(LVEF)、좌심실수축말기내경(LVESD)、실간격후도(LVST)、서장말기좌심실후벽후도(LVPWT)、좌방내경(LAD)비교,차이유통계학의의(P <0.05)。상관성분석현시,CAPD 환자혈청NT - pro - BNP수평여전운류형정정상관(r =0.617,P <0.001)。잔신 KT/ V、잔신 Ccr 치、뇨량대NT - pro - BNP수평적영향유통계학의의(P <0.05),이신소구려과솔고계치(eGFR)、복막투석투석충분성(KT/ V)、복막투석 Ccr 치、초려량、혈뇨소담、혈기항(Scr)대NT - pro - BNP수평적영향무통계학의의( P >0.05)。NT - pro - BNP수평여수종、수축압、액체입량、Scr、고밀도지단백、심흉비、혈납、LVEDD、LVESD、LVST、LVPWT 급 LAD 정정상관,여년령、잔신 KT/ V、잔신Ccr 치、혈홍단백、청단백、혈개급 LVEF 정부상관(P <0.05)。결론 CAPD 환자NT - pro - BNP수평보편승고,차재불동복막전운류형간존재차이,병여혈용량상태급심공능평고적유효지표밀절상관,여잔여신공능、빈혈급영양상태야존재일정상관성。
Objective To explore the relationship of N - terminal - probrain natriuretic peptide(NT - pro - BNP)to blood volume and cardiac function in continuous ambulatory peritoneal peptide( CAPD) patients. Methods A total of 104 CAPD in PD Center of the First Affiliated Hospital of Guangxi Medical University from September 2012 to September 2013 were enrolled as CAPD group,and 30 healthy subjects as control group. The levels of serum NT - pro - BNP were determined in 2 groups. The patients were divided,according to dialysate urea concentration/ plasma urea concentration( D/ P) values,into groups A〔high peritoneal transport(PT)group,0. 82 - 1. 03 μmol/ L,n = 16〕,B(high average PT group,0. 66 - 0. 81μmol/ L,n = 33),C(low average PT group,0. 50 - 0. 65 μmol/ L,n = 48),D(low PT group,0. 34 - 0. 49 μmol/ L,n =7). The relations of NT - pro - BNP level with blood volume and cardiac function were compared among groups A,B,C,D to explore the relevant factors influencing the levels of NT - pro - BNP. Results There was significant difference in albumin, phosphorus,high - density lipoprotein,low - density lipoprotein,total cholesterol among groups A,B,C,D(P < 0. 05), but there was not in the other indicators(P > 0. 05). There was difference in total endogenous creatinine clearance rate(Ccr), D/ P,fluid intake,edema incidence among 4 groups(P < 0. 05),there was no difference in the other indicators(P > 0. 05). NT - pro - BNP level was(4 813 ± 4 360)ng/ L in CAPD group,higher than in control group〔(51 ± 23)ng/ L〕(t = 9. 301, P < 0. 001). Groups A,B,C,D were different in NT - pro - BNP,left ventricular ejection fraction(LVEF),left ventricular end systolic diameter ( LVESD ), interventricular septal thickness ( LVST ), left ventricular posterior wall thickness (LVPWT),left atrial diameter(LAD)among 4 groups(P < 0. 05). By correlation analysis,NT - pro - BNP was positively correlated with PT types in CAPD(r = 0. 617,P < 0. 001). There was difference in the effects of residual renal KT/ V,Ccr values,urine volume on NT - pro - BNP(P < 0. 05),and there was no difference in the effects of estimated glomerular filtration rate(eGFR),PD adequacy( KT/ V),PD Ccr value,ultrafiltration volume,urea nitrogen,serum creatinine( Scr) on NT - pro - BNP(P > 0. 05). NT - pro - BNP was positively correlated with edema,SBP,fluid intake,Scr,HDL,cardio -thoracic proportion,serum sodium,LVEDD,LVESD,LVST,LPWT,LAD,and negatively with age,residual renal KT/ V, Ccr value,hemoglobin,albumin,calcium,LVEF( P < 0. 05). Conclusion In CAPD patients,NT - pro - BNP levels increase,are different between different PD transport types,and closely correlated with blood volume status,effective indicators of cardiac function assessment and with residual renal function,anemia,nutritional status to some extent.