脑利钠肽和C反应蛋白及左心室舒张功能与老年血液透析患者心脑血管事件的相关性研究

Relationship of B-type natriuretic peptide, C-reactive protein and left ventricular diastolic function with cardio-and cerebrovascular disease in the elderly patients with hemodialysis

目的 观察脑利钠肽（BNP）和C反应蛋白（CRP）水平及应用组织多普勒超声心动图测定患者静息状态心室舒张早期二尖瓣血流速度（E）与二尖瓣环运动速度（Em）的比值（E/Em）与老年血液透析患者的心脑血管事件（CVD）风险的相关性. 方法 2006年1月至2011年6月,对96例老年血液透析患者进行前瞻性队列研究,每月随访1次,随访时间24～30个月,根据是否发生CVD事件分为CVD组（35例）和对照组（61例）.记录观察开始时患者临床和实验室资料及超声心动图结果,记录患者因CVD事件住院和死亡的原因和时间. 结果 CVD组CRP、BNP水平[分别为（3.1±6.7）mg/L、（1345.2±1427.8）pmol/L]较对照组[分别为（1.8±1.2）mg/L、（719.8±1073.8）pmol/L]升高,差异有统计学意义（t值分别为2.14、-2.82,P＜0.05和P＜0.01）；E/Em升高（t=5.229,P＜0.01）.Kaplan-Meier生存曲线结果显示,BNP≥500 pmol/L、CRP≥1.5 mg/L、E/Em≥17时,老年血液透析患者的CVD发生率升高（P＜0.05或P＜0.01）.Cox回归模型提示,CRP≥1.5 mg/L,BNP≥500 pmol/L和E/Em≥17为老年血液透析患者CVD独立危险因素.Bivariate 相关分析结果显示,LogBNP水平与E/Em值呈线性相关（r=0.23,P＜0.05）. 结论 BNP、CRP 、及E/Em升高与老年血液透析患者CVD发生率相关.

Objective To investigate the relationship of B-type natriuretic peptide（BNP）,Creactive protein（CRP）and left ventricular diastolic function with cardio-and cerebrovascular disease （CVD）in the elderly patients with hemodialysis.Methods 96 elderly patients with hemodialysis were divided into CVD group（n =35）and non CVD control group（n =61）.The patients were followed up once a month for 24 to 30 months.The baseline anthropometric and laboratory parameters were measured.The ratio of mitral peak flow velocity（E）and peak velocities at mitral annuluses （Em）during early diastole of left ventricular was recorded by doppler echocardiography.The time and cause of hospitalization and mortality by CVD were documented.Results The levels of CRP and BNP were significantly higher in CVD group than in control group[（3.1 ± 6.7）mg/L vs.（1.8 ± 1.2）mg/L,（1345.2±1427.8）pmol/L vs.（719.8±1073.8）pmol/L]（t=2.14 and-2.82,P〈0.05 or P〈0.01）.The ratio of E/ Em was increased in CVD group as compared with control group（t=5.23,P〈0.01）.Kaplan-Meier survival curves showed that the morbidity of CVD events was enhanced（P〈0.05 or P〈0.01）at BNP≥500 pmol/L,CRP≥1.5 mg/L and E/Em≥17 which were the independent risk factors of CVD events for the elderly patients with hemodialysis by COX regression model.There was positive correlation between LogBNP and E /Em（r =0.23,P 〈 0.05）.Conclusions Higher levels of BNP,CRP and E/Em may predict the increasing risks of CVD in the elderly patients with hemodialysis.