血浆BNP在维持性血液透析患者心功能评估中的应用价值

Clinical Value of Determination of Plasma BNP Levels for Assessment of Cardiac Function in Patients on Maintainence Hemodialysis

目的:探讨维持性血液透析患者血浆脑钠素(BNP)的变化及与心脏形态结构和功能改变的关系。方法:40例血液透析龄≥1年的稳定的MHD患者为MHD组;30名健康志愿者为正常对照组。放免法检测MHD患者血液透析前后血浆BNP浓度;分析血浆BNP浓度与心脏形态结构和功能的关系。结果:MHD患者血液透析前后血浆BNP浓度均明显高于正常对照组,差异有统计学意义(P<0.01);MHD患者血浆BNP浓度透析后较透析前明显下降,差异有统计学意义(P<0.01);MHD患者透析前血浆BNP浓度与左室舒张末期内径(LVEDD)和左室重量(LVM)呈正相关(r分别等于0.598、0.413,P均<0.01),与左室射血分数(LVEF)呈负相关(r=-0.429,P<0.01),而与左房内径(LAD)和左室后壁厚度(LVPWT)无相关性(P>0.05)。结论:血浆BNP能够反映左室功能,是一个反映心衰和左心室功能障碍的标志物,对早期诊断和评估MHD合并CVD患者的心功能具有重要的临床意义。

Objective To study the changes of plasma levels of BNP in patients on maintainence hemodialysis and the corresponding changes of cardiac morphology and function. Methods Plasma BNP levels were measured with RIA both before and after hemodialysis in 40 patients on maintainence hemodialysis over one year as well as once in 30 controls. Echocardiography was performed in all the patients. Results The plasma BNP levels in the patients both before and after hemodialysis were significantly higher than those in controls （both P〈0.01）. In the patients, after hemodialysis the plasma BNP levels dropped significantly （vs before hemodialysis, P〈0.01）. The plasma BNP levels before dialysis in the patients were positively correlated with left ventricular end diastolic diameter （LVEDD） and left ventricular mass （LVM） （r=0.598, r=0.413 respectively, P〈0.01）. The levels were negatively correlated with left ventricular ejection fraction （LVEF） （r=-0.429, P〈0.01）. However, the levels were not correlated with left atrial diameter （LAD） and left ventricular posterior wall thickness （LVPWT）. Conclusion Plasma BNP is a biomarker for ventricular remodeling and function and may play the role of diagnostic and therapeutic indicator.