维持性血液透析对慢性肾衰合并心功能不全患者体内N端脑钠肽前体及心脏功能的影响

Influence of maintenance hemodialysis on left ventricular function and NT-proBNP level in patients with chronic renal failure and cardiac insufficiency

目的:研究慢性肾衰合并心功能不全患者体内N端脑钠肽前体的水平,分析维持性血液透析治疗前后心脏结构的变化。方法:选取我科治疗的60例慢性肾衰合并心功能不全患者为研究对象,均经规范的血液透析治疗3个月,比较治疗前后N端脑钠肽水平及左心室功能的变化。结果:随着心功能不全加重,NT-proBNP明显升高,eGFR降低。经维持性血液透析治疗3个月,患者NT-proBNP显著降低,同时左心室功能及左室射血分数等指标均有一定程度的改善。经Spearman相关性分析:(1)NT-proBNP水平与NYHA分级具有正相关性(r=0.852,P<0.001);(2)NT-proBNP水平与LVDd(r=0.343,P<0.01)、LVPWT(r=0.256,P<0.05)、LVDs(r=0.252,P<0.05)、LVMI(r=0.334,P<0.01)呈正相关,与LVEF(r=0.354,P<0.01)呈负相关;(3)血浆NT-proBNP水平与eGFR呈负相关(r=-0.671,P<0.01)。结论:慢性肾衰合并心功能不全患者NT-proBNP普遍升高,与左心室功能和容量负荷密切相关,规范的血液透析可降低NT-proBNP,延缓心衰进展。

Objective, To evaluate the influence of maintenance hemodialysis （MHD） on left ven- trieular function and NT-proBNP level in patients with chronic renal failure and cardiac insufficiency. Methods.A total of 60 patients with chronic renal failure and cardiac insufficiency were selected. All pa- tients underwent regular MHD for at least 3 months and left ventricular function and NT-proBNP level were compared before and after treatment. Result.With the increased severity of cardiac insufficiency, the NT-proBNP level significantly increased but eGFR decreased obviously. After undergoing regular MHD for 3 months, indexes including NT-proBNP level, left ventricular function and LVEF were improved ob- viously. @Positive correlation was found between NT-proBNP and NYHA level（r=0. 852,P^0. 001）@ There were also positive correlation between NT-proBNP and LVDd （r=0. 343,P^0.01）, LVPWT（r= 0. 256,P^0.05）, LVDs（r=0. 252,P^0.05）, LVMI（r=0. 334,P^0.01）. QNT-proBNP was negatively correlated with eGFR （r=--0. 671, P^0.01）. Conclusions. Higher serum BNP is common in MHD pa- tients, and this is closely related with the dilated left ventricle, poor cardiac function and volume overload. MHD could decrease the NT-proBNP level and improve the prognosis.