B型利钠肽对血液透析患者容量状况的评估价值

The Use of B-type Natriuretic Peptide to Assess Volume Status in Hemodialysis Patients

目的:探讨血液透析患者血浆B型利钠肽(BNP)水平与评估容量状况的临床参数之间的关系。方法:收集40例血液透析患者连续3次透析前后的BNP、体重、血压,以彩色多普勒超声心动图测定患者的左室射血分数(LVEF)。其中30例患者计算出血浆容量改变。结果:40例血液透析患者透析前后BNP、体重、平均动脉压(MAP)有统计学差异(P<0.01),验后的多重比较进行每周3次相互间比较无统计学差异(P>0.05)。采用Spearman相关分析示BNP与体重、MAP无相关性(P>0.05),BNP水平与LVEF值呈负相关(r=-0.586,P<0.01)。30例患者平均血浆容量改变只有265ml,透析前后血浆容量变化与BNP水平变化无相关性(r=0.197,P>0.05)。结论:透析前后BNP水平下降,但这些下降与传统评价容量状况的临床指标如体重、血压无关,这主要可能是因为透析前后血浆容量变化小。

Objective：To explore the relationship between plasma BNP and the measured clinical parameters to assess volume status in hemodialysis patients. Methods： Forty patients with hemodialysis were studied. Plasma BNP concentration was measured at the start and end of each of 3 consecutive HD sessions. Pre - and postsession weights and blood pressures were recorded. Left ventricular ejection fractions were obtained from echoeardiograms. Plasma volume changes were measured in a subset of 30 patients. Results： It showed significant difference among pre - and postdialysis BNP levels, body weighs and the values of MAP（ P〈 0.05）. Post hoc multiple comparisons among the 3 sessions showed no significant difference on BNP levels, My weighs and the values of MAP. Spearman analysis showed that BNP level did not correlate with body weighs and the values of MAP （P 〉 0.05）, and BNP level was significantly negatively correlated with LVEF（ r = - 0. 586, P 〈 0.01 ）. Plasma volume changed minimally during dialysis. Conclusion：The lack of correlation between changes in BNP and changes in measured clinical parameters is mainly explained by a lack of a significant change in plasma volume.