血清NT-pro-BNP水平与腹膜透析患者营养状况和残余肾功能及透析充分性的关系

Association of serum NT-pro-BNP levels with nutritional status,residual kidney function and dialysis adequacy in patients undergoing peritoneal dialysis

目的探讨血清氨基端脑钠肽前体(NT-pro-BNP)水平与腹膜透析患者营养状况、残余肾功能及透析充分性的关系。方法以横断面研究方式,检测58例病情稳定的持续非卧床腹膜透析(continuous ambulatoryperitoneal dialysis,CAPD)患者,以及心肾功能正常者(对照组A)和尿毒症非透析患者(对照组B)的血清NT-pro-BNP浓度,评估CAPD患者的透析充分性、残余肾功能以及营养状况,检测相应的生化参数,对数据进行相关分析。结果 CAPD患者血清NT-pro-BNP水平较对照组A明显升高(z=-7.653,P<0.001),差异有统计学意义;与对照组B比较,差异无统计学意义(z=-0.731,P=0.465)。患者血清NT-pro-BNP水平与BMI、ALB、TSF和MAMC呈负相关(r=-0.304,P=0.020;r=-0.385,P=0.003;r=-0.308,P=0.028;r=-0.333,P=0.017);与SGA(r=0.361,P=0.007)呈正相关。与尿量、rGFR、残肾Kt/V、总Kt/V、残肾Ccr、总Ccr呈负相关(-0.504,P<0.001;-0.616,P<0.001;-0.573,P<0.001;-0.331,P=0.020;-0.616,P<0.001;-0.598,P<0.001);总Kt/v≥2.0患者的血清NT-pro-BNP水平低于总Kt/v<2.0的患者,差异无统计学意义(z=-1.061,P=0.289);而总Ccr≥60 L/周的患者血清NT-pro-BNP水平明显低于总Ccr<60 L/周的患者(z=-3.248,P=0.001),差异有统计学意义。多元回归分析显示,定量SGA评分和残肾Ccr是影响腹透患者血清NT-pro-BNP水平两个独立因素(β=0.313,P=0.015;β=-0.418,P=0.002)。结论 CAPD患者的血清NT-pro-BNP水平与营养状况、残余肾功能和透析充分性密切相关;营养不良、残余肾功能下降是影响CAPD患者血清NT-pro-BNP水平的风险因素。

Objective To investigate the association of serum N-terminal pro-brain natriuretic peptide （NT-pro-BNP） levels with nutritional status, residual kidney function and dialysis adequacy in patients undergoing continuous ambulatory peritoneal dialysis （CAPD）. Methods Fifty eight clinically stable patients undergoing CAPD were enrolled in the study; subjects with no heart and renal diseases servedas control group A and uremic patients without dialysis as control group B. Serum NT-pro-BNP concentrations were measured in CAPD patients and control groups. The indices of dialysis adequacy, residual renal function and nutritional status were assessed in CAPD patients; and other biochemical parameters were also examined. Results Serum NT-pro-BNP levels in CAPD patients and in control group B were markedly higher than those in control group A（z = -7. 653, z = -6. 535 ; P 〈 0. 001 ）, there was no significant difference between CAPD patients and control group B （ z = - 0.731, P = 0.465 ）. Correlation analysis showed that BMI, MAMC, ALB and TSF were negatively correlated with serum NT- pro-BNP levels in all patients （ r = - 0.304, P = 0.020 ; r = - 0.385, P = 0.003 ; r = -0.308, P =0.028 ; r = -0.333, P =0.017）, and SGA was positively correlated with NT- pro-BNP （r =0. 361, P = 0. 007）. In CAPD patients urine volume, rGFR, residual renal Kt/V, total Kt/V, residual renal Ccr and total Ccr were negatively correlated with NT- pro-BNP levels （ r = - 0. 504, P 〈 0.001; r= -0.616, P〈 0.001; r= -0.573, P〈 0.001; r= -0.331, P =0.020; r= -0.616, P 〈0. 001 ; r = -0.598, P 〈 0. 001 ）. Patients with Kt/v≥2.0 tended to have lower serum NT- pro- BNP levels than those with Kt/v 〈 2.0, but the difference was not statistically significant （z = -1. 061, P =0. 289）. Patients with total Ccr≥60 L/week had lower serum NT- pro-BNP level than those with total Ccr 〈 60 1/week/1.73 mE patients（z = -3. 248, P =0.001 ）. Multivariate regression analysis revealed that quantitative SGA score and residual renal Ccr were independent risk factors for serum NT- pro-BNP levels（t=0.313, P=0.015;β= -0.418, P=0.002）. Conclusion Our data suggest that nutritional status, residual renal function and dialysis adequacy are closely associated with NT- pro-BNP in CAPD patients. Malnutrition and reduced residual renal function are independent risk factors for serum NT- pro-BNP levles.