N-末端脑钠肽前体对预测血液透析患者透析中低血压发生的意义

Application of NT-Pro BNP in predicting intra-dialytic hypotension in hemodialysis

目的探讨血浆N-末端脑钠肽前体（NT-proBNP）在血液透析患者透析中低血压（IDH）发生的预测价值。方法将行血液透析的患者144例，根据透析过程中是否发生血压下降，分为IDH组和非IDH组。测定透析前后的血压、NT-proBNP，并记录心胸比、超滤量、超滤量占体质量百分比、低血容量发生次数，并分析NT-proBNP与IDH的相关性。结果透析期间，IDH的发生率为28．5％。与非IDH组比较，IDH组的年龄、NT-proBNP显著降低，超滤量、超滤量占体质量百分比、心胸比、低血容量发生次数明显升高（P〈0．05）。透析后，非IDH组SBP、DBP与透析前比较，无统计学差异（P〉0．05），而IDH组则较透析前显著下降（P〈0．05）。采用多因素Logistic回归分析结果显示，在控制年龄、超滤量、超滤量占体质量百分比、心胸比、低血容量发生次数后，NT-proBNP对透析中发生IDH仍有预测价值，OR=0．412（95％CI 0．212-0．801）。结论NT-proBNP与血液透析患者容量负荷密切相关，NT-proBNP水平检测有助于评估患者透析中血容量的变化，预测IDH的发生。

Objective To explore the predictive value of plasma NT-pro BNP concentration for intra-dialytic hypotension （IDH） in hemodialysis. Methods 144 patients who received hemodialysis in our hospital were assigned into IDH group or non-IDH group according to the blood pressure levels during the hemodialysis. NT-proBNP and blood pressure levels were detected before and after hemodi- alysis, and cardiothoracic ratio, ultrafiltration volume, ultrafiltration volume/body weight ratio, and number of occurrences of low blood volume were measured, and the correlation between NT-proBNP and blood pressure levels was analyzed. Results The incidence of IDH was 28. 5 % during the hemodi- alysis. As compared with non-IDH group, the age and NT-pro BNP were remarkably decreased, and ultrafiltration volume, ultrafiltration volume/body weight ratio, cardiothoracic ratio and number of oc- currences of low blood volume were significantly increased in IDH group （P^0. 05）. There was no significant difference in SBP and DBP in non-IDH group before and after hemodialysis （P〉0. 05）, but there was statistically significant difference in IDH group （ P 〈0. 05 ）. Logistic regression model showed that NT-pro BNP was a predictor for IDH （OR = 0. 412, 95% CI 0. 212 - 0. 801） after adjust- ment by age, ultrafiltration volume/body weight ratio, cardiothoracic ratio, and number of occur- rences of low blood volume. Conclusions NT-pro BNP is correlated with volume load in hemodialysis patients. Detection of NT-pro BNP level can contribute to evaluate change of blood volume, and pre-dict the incidence of IDH.