B型利钠肽与心肾综合征相关性的临床研究

B-type natriuretic peptide in cardiorenal syndrome

目的探讨B型利钠肽（B-type natriuretic peptide,BNP）与心肾综合征发病的相关性,为指导临床治疗提供理论依据。方法以216例急慢性心力衰竭患者为研究对象,根据有无肾功能损害将其分为单纯心衰组（113例）和心肾综合征组（103例）。测量2组患者血液中BNP及氨基末端B型利钠肽前体（N-terminal prosoma of B-type natriuretic peptide,NT-ProBNP）的浓度。并通过随访,比较2组患者30 d病死率的差异。结果同单纯心衰组相比,心肾综合征组患者BNP与NT-ProBNP的浓度均明显升高,分别为334.00（180.50~628.00）pg/mL vs 794.00（509.00~1 620.00）pg/mL（P〈0.01）,22.51（13.09~35.26）ng/mL vs 32.62（21.10~61.24）ng/mL（P〈0.01）。同单纯心衰组相比,心肾综合征组30 d病死率明显升高,为7.1%vs 24.3%（P〈0.01）。结论 BNP的失代偿是导致心肾综合征发病的因素之一。合并肾功能损害的心功能不全患者预后更差,短期内病死率明显增高。

Objective To study the relationship between B-type natriuretic peptide（BNP） and cardiorenal syndrome,so as to provide additional theoretical basis for clinical treatment.Methods Totally 216 patients with acute or chronic heart failure were enrolled.Those without kidney dysfunction were enrolled into a group named simple heart failure group（113 cases） and those with kidney dysfunction were assigned into the group named cardiorenal syndrome group（103 cases）.The blood concentration of BNP and N-terminal prosoma of B-type natriuretic peptide（NT-ProBNP） were determined by using fluorescence immunoassay（FIA） in patients.The 30-day mortality was determined by following-up.Results Compared with patients of simple heart failure group,those with cardiorenal syndrome had a higher level of BNP and NT-ProBNP,334.00（180.50~628.00）pg/mL vs 794.00（509.00~1 620.00）pg/mL（P0.01）,22.51（13.09~35.26）ng/mL vs 32.62（21.10~61.24）ng/mL（P0.01） separately.Compared with patients of simple heart failure group,those with cardiorenal syndrome had a higher 30-days mortality,7.1% vs 24.3%（P0.01）.Conclusion The decompensation of BNP may lead to the progress of cardiorenal syndrome.Patients with heart failure combined with kidney dysfunction have poor prognosis,and have a significantly increased mortality in short term.