南方医科大学学报

南方医科大学学报 ›› 2005, Vol. 25 ›› Issue (07): 892-894.

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脑钠肽对血液透析患者心功能不全的诊断价值

邵咏红1, 赖玉琼2, 林爱珍3, 孔耀中1   

  1. 1. 佛山市第一人民医院肾内科, 广东, 佛山, 528000;
    2. 佛山市第一人民医院心内科, 广东, 佛山, 528000;
    3. 佛山市第一人民医院检验科, 广东, 佛山, 528000
  • 出版日期:2005-07-20 发布日期:2005-07-20
  • 基金资助:
    收稿日期:2005-1-9。
    作者简介:邵咏红(1965- ),女,副主任医师,电话:0757-83833633-1423,E-mail:syhong@fsyyy.com

Value of plasma brain natriuretic peptide detection in cardiac function assessment in hemo-dialysis patients

SHAO Yong-hong1, LAI Yu-qiong2, LIN Ai-zhen3, KONG Yao-zhong1   

  1. 1. 佛山市第一人民医院肾内科, 广东, 佛山, 528000;
    2. 佛山市第一人民医院心内科, 广东, 佛山, 528000;
    3. 佛山市第一人民医院检验科, 广东, 佛山, 528000
  • Online:2005-07-20 Published:2005-07-20

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摘要： 目的 评价脑钠肽(BNP)在慢性肾衰竭血液透析患者透析前后血浆浓度的变化及其对心功能不全的诊断价值。方法 应用放射免疫分析法检测93例慢性肾衰血液透析患者透析前后血浆BNP水平,并与52例正常人对照。同时应用彩色多普勒超声心动图测定这93例透析患者透析前的左室舒张末内径(LVDd)及左室射血分数(LVEF),比较透析患者血浆BNP水平与其心脏功能的关系。结果 (1)52例正常对照组的血浆BNP中位数为3.35pg/ml(1.00~9.73pg/ml),93例透析患者透析前后血浆BNP中位数分别为146.5pg/ml(56.2~546.9pg/ml)和90.0pg/ml(18.3~310.5pg/ml),三者之间差异具有显著性(P<0.001)。(2)透析前合并心衰(LVEF<50%)患者透析前后血浆BNP分别为686.0pg/ml(334.5~1319.3pg/ml)和248.0pg/ml(80.3~814.5pg/ml),均显著高于心功能正常(LVEF≥50%)患者的62.8pg/ml(22.0~321.6pg/ml)和20.7pg/ml(1.0~200.9pg/ml)(P=0.002)。(3)透析前左室增大(LVDd男性≥55mm,女性≥50mm)组患者透析前后血浆BNP分别为609.0pg/ml(254.1~1152.0pg/ml)和310.0pg/ml(28.3~839.6pg/ml),显著大于左室正常组患者的62.8pg/ml(23.2~192.5pg/ml)和22.4pg/ml(1.0~80.7pg/ml)(P<0.001)。(4)对LVDd及LVEF与透析前血浆BNP水平的多元逐步回归分析显示,BNP升高与左心室增大、左心功能减低有显著相关性(P<0.01)。结论 (1)慢性肾衰血液透析患者血浆BNP水平显著高于正常对照组,血液透析可使血浆BNP显著减低,但仍显著高于正常对照组。(2)慢性肾衰血液透析患者合并左心室增大或左心功能不全者,其血浆BNP水平显著高于左室或左心功能正常者,血浆BNP升高与左心室增大、左心功能减低有显著相关性。

Abstract: Objective To detect plasma brain natriuretic peptide (BNP) changes in hemodialysis patients with chronic renal failure (CRF) and assess the diagnostic value of BNP for cardiac function. Methods Plasma BNP concentration was measured in 93 hemodialysis patients with CRF and 52 healthy control subjects.In the 93 patients,echocardiographic examinations were performed to determine the relationship between BNP and cardiac function. Results The median plasma BNP levels in 52 normal controls were 3.35 pg/ml (1.00-9.73 pg/ml),and 146.5 pg/ml (56.2-546.9 pg/ml) and 90.0 pg/ml (18.3-310.5 pg/ml) in 93 patients before and after hemodialysis,respectively,showing significant difference among those 3 groups (P<0.001).The plasma BNP levels in patients with CRF complicated by heart failure (LVEF<50%) before and after hemodialysis were 686.0 pg/ml (334.5-1319.3 pg/ml) and 248.0 pg/ml (80.3-814.5 pg/ml) respectively,significantly higher than 62.8 pg/ml (22.0-321.6 pg/ml) and 20.7 pg/ml (1.0-200.9 pg/ml) in patients with normal cardiac function (LVEF≥50%) (P=0.002).The plasma BNP levels in patients with dilated left ventricle before and after hemodialysis were 609.0 pg/ml (254-1152.0 pg/ml) and 310.0 pg/ml (28.3-839.6 pg/ml) respectively,significantly higher than 62.8 pg/ml (23.2-192.5 pg/ml) and 22.4 pg/ml (1.0-80.7 pg/ml) in patients with normal left ventricle.Multiple linear regression analysis for left ventricular diastolic dimension,LVEF and plasma BNP level before hemodialysis showed that high BNP level was significantly correlated with dilated left ventricle and poor cardiac function (P<0.01). Conclusions Plasma BNP levels in hemodialysis patients with CRF are significantly higher than those in healthy controls,and are significantly lowered after hemodialysis but still remain higher than the normal level.Plasma BNP levels in hemodialysis patients with dilated left ventricle or heart failure are significantly higher than those in patients with normal left ventricle or cardiac function,and high plasma BNP level is significantly correlated with dilated left ventricle and poor cardiac function.

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