脑钠肽对慢性肾衰竭合并心力衰竭的诊断价值

Diagnostic value of serum brain natriuretic peptide in chronic renal failure patients with chronic heart failure

目的观察肾小球滤过率（eGFR）与脑钠肽（BNP）之间的关系，比较慢性肾衰竭合并心力衰竭（心衰）患者不同eGFR水平BNP的诊断界值（cut—off值），研究肾功能对BNP应用于心衰诊断的影响。方法对老年eCRF合并心衰未透析患者52例及无心衰29例和老年健康体检者30例（健康对照组）采用酶联免疫吸附法测定血清BNP浓度，根据eGFR分组进行对比。结果eGFR小于30ml、30～60ml心衰组BNP水平均高于eGFR小于30ml、30—60ml无心衰对照组和eGFR大于60ml健康对照组（P〈0．05），eGFR小于30ml、30—60ml无心衰对照组BNP水平较eGFR大于60柚健康对照组显著升高（P〈0．05）。eGFR小于30ml心衰组与eGFR30—60ml心衰组BNP相比较，差异无统计学意义（t=0．62，P〉0．05）。eGFR与BNP心衰组无相关，无心衰对照组呈负相关（心衰组γ=-0．081，P〉0．05，对照组γ=-0．581，P〈0．01）。eGFR30～60ml心衰组ROC曲线下面积（AUC）为0．951，1500ng／L作为临界值的敏感度为96．4％，特异度为86．7％；eGFR小于30ml心衰组AUC为0．860，1850ng/L作为临界值的敏感度为66．7％，特异度为92．9％。结论CRF合并心衰时心衰是导致BNP升高的主要原因，BNP可作为判断CRF患者是否合并心衰的诊断指标。

Objective To investigate the influence of renal function on serum BNP in the diagnosis of CRF with heart failure by observing the relationship between eGFR and BNP in serum and comparing cut-off values of BNP in different eGFR levels. Methods The elderly participants were enrolled in the study, including 52 patients with heart failure,and 29 patients without heart failure and 30 healthy controls. Serum BNP level was measured by ELISA. Results The level of serum BNP increased significantly in subjects with heart failure compared with those with renal dysfunction for no-heart failure patients （ P 〈 0. 05 ） and healthy controls. BNP level was signifieandy higher in CRF no-heart failure patients than in control subjects, eGFR showed negative correlation with BNP in ESRD no-heart failure patients （γ = -0. 581 ,P 〈0. 01 ）. There was no correlation between eGFR and ESRD with heart failure patients （γ = - 0. 081,P 〉 0. 05 ）. The AUC of BNP in patients （ eGFR 30 - 60 ml） was 0. 951, when cut-off value was 1 500 ng/ L,the sensitivity and specificity of BNP were 96.4% and 86.7% respectively. The AUC of BNP in patients（ eGFR 〈 30 ml） was 0. 860,when cut-off value was 1 850 ng/L, the sensitivity and specificity of BNP were 66.7 % and 92.9% respectively. Condusioas Heart failure was major factor result in higher levels of BNP in chronic renal failure with heart failure patients. BNP could be used as a diagnostic marker for CRF with heart failure patients.