脑钠肽对血液透析患者心功能不全的临床诊断意义

Clinical diagnosis of plasma brain natriuretic peptide detection in cardiac dysfunction in hemodialysis patients

目的:评价脑钠肽(BNP)在血液透析患者透析前后血浆浓度的变化及其对心功能不全的临床诊断意义。方法:检测45例血液透析患者透析前后血浆BNP水平,并与32例正常人对照。同时测定透析患者透析前的左室舒张末内径(LVDd)及左室射血分数(LVEF),比较透析患者血浆BNP水平与其心脏功能的关系。结果:(1)52例正常对照组的血浆BNP水平为(4.6±2.7)pg.m l-1,透析患者透析前后血浆BNP水平分别为(158.4±24.5)pg.m l-1和(97.5±16.8)pg.m l-1,三者之间差异具有显著性(P<0.01)。(2)心功能正常(LVEF≥50%)患者透析前后BNP水平分别为(72.7±13.3)pg.m l-1和(22.4±6.9)pg.m l-1(P<0.01),透析前合并心衰(LVEF<50%)患者透析前后血浆BNP分别为(669.2±120.7)pg.m l-1和(224.2±43.8)pg.m l-1,均显著高于心功能正常患者(P<0.01)。(3)左室正常组患者透析前后BNP水平分别为(69.8±12.2)pg.m l-1和(21.7±7.1)pg.m l-1,透析前左室增大组患者透析前后血浆BNP显著大于左室正常组患者(P<0.01)。(4)对LVDd及LVEF与透析前血浆BNP水平的多元逐步回归分析显示,BNP升高与左心室增大、左心功能降低有显著相关性(r=0.423、0.531,P<0.01)。结论:BNP在一定程度上可反映血液透析患者体内血容量的变化及左心功能状态,是诊断慢性心功能不全的敏感指标。

Objective： To detect plasma brain natriuretic peptide（BNP） changes in hemodialysis patients and assess the diagnostic value of BNP for cardiac dysfunction.Methods： Plasma BNP concentration was measured in 45 hemodialysis patients and 32 healthy control subjects.Left ventricular end diastolic diameter（LVDd） and left ventricular ejection fraction（LVEF） were determined before dialysis,and comparing the relationship between the levels of plasma BNP and cardiac function.Results：（1） The level of plasma BNP in control group was（4.6±2.7） pg·ml-1,the levels of plasma BNP in hemodialysis patients were（158.4±24.5） pg·ml-1 and（97.5±16.8） pg·ml-1 before and after hemodialysis,respectively.There was a significant difference among them（P〈0.01）.（2） The levels of plasma BNP in patients with normal cardiac function（LVEF≥50%） were（72.7±13.3） pg·ml-1 and（22.4±6.9） pg·ml-1 before and after hemodialysis,and the levels of plasma BNP in patients complicated by heart failure（LVEF50%） before and after hemodialysis were（669.2±120.7） pg·ml-1 and（224.2±43.8） pg·ml-1 respectively.There was a significant difference between the two groups（P〈0.01）.（3） The levels of plasma BNP in patients with normal left ventricle were（69.8±12.2） pg·ml-1 and（21.7±7.1） pg·ml-1 before and after hemodialysis,and the levels of plasma BNP in patients with dilated left ventricle before and after hemodialysis were（612.4±101.5） pg·ml-1 and（304.2±38.7） pg·ml-1 respectively.There was a significant difference between the two groups（P〈0.01）.（4） Multiple linear regression analysis for left ventricular diastolic dimension,LVEF and plasma BNP level before hemodialysis showed that high BNP level was significantly correlated with dilated left ventricle and poor cardiac function（r=0.423,r=0.531,P〈0.01）.Conclusion： BNP concentration may be used as a biochemical marker of liquid overload and chronic cardiac failure in hemodialysis patients.