血透患者血浆B型利钠肽水平与心功能关系的研究

目的观察B型利钠肽(BNP)在不同心功能状态的维持性血液透析患者血浆中的浓度,评价其对维持性血透患者心功能不全的诊断价值。方法检测45例维持性血液透析(MHD)患者透析前血浆BNP水平,另外检测45例不合并肾衰的心功能不全患者的血浆BNP水平。结果 15例心功能Ⅰ-Ⅱ级的血透患者透析前血浆BNP水平波动于1011～6440pg/ml,中位数为4213pg/ml;18例心功能Ⅰ-Ⅱ级的非血透患者血浆BNP水平波动于102～3653pg/ml,中位数为2894pg/ml。30例心功能Ⅲ-Ⅳ级的血透患者透析前血浆BNP水平波动于8927～35000pg/ml,中位数为20125pg/ml;27例心功能Ⅲ-Ⅳ级的非血透患者血浆BNP水平波动于6572～35000pg/ml,中位数为13584pg/ml。多元回归分析显示,BNP水平在相同心功能状态的透析患者中明显高于非透析患者,两者比较有显著性差异(P<0.01)。结论 BNP可以反映MHD患者的心功能状态,是诊断MHD患者慢性心功能不全的敏感指标,但是BNP在诊断MHD患者心功能状态时的诊断界值要高于非肾衰透析患者。

Objective To detect plasma B-type natriuretic peptide（BNP） level in maintenance hemodialysis（MHD） patients with heart failure and assess the diagnostic value of BNP for cardiac function of MHD patients. Methods The plasma BNP level was measured in 45 MHD patients before a regular hemodialysis（HD） and 45 heart failure patients without renal failure. Results The median plasma BNP levels were 4213 pg/ml （1011-6440 pg/ml） in 15 MHD patients before hemodialysis,and 2894 pg/ml （102-3653 pg/ml） in 18 non-MHD patients at cardiac functionI-IIgrade. The median plasma BNP levels were 20125 pg/ml （8927-35000 pg/ml） in 30 MHD patients before hemodialysis,and 13584 pg/ml （6572-35000 pg/ml） in 27 non-MHD patients at cardiac functionI-IIgrade. Multiple regression analysis showed that BNP level was significantly higher in MHD patients than non-MHD patients at same cardiac function grade（P〈0.01）. Conclusion BNP can reflect the cardiac function and could be used as a diagnostic marker for MHD patients with heart failure,but as diagnostic marker of heart failure the plasma BNP level should be higher in MHD patients than non MHD patients.