B型钠尿肽联合生物电阻抗评估腹膜透析患者干体重的临床价值

The clinical significance of B-type natriuretic peptide combined with multi-frequency bioelectrical impedance analysis in assessing dry weight of patients with peritoneal dialysis

目的探讨应用B型钠尿肽(BNP)联合多频生物电阻抗在评估腹膜透析(PD)患者干体重方面的临床价值。方法选择透析龄大于3个月的持续性非卧床腹膜透析(CAPD)患者42例,依据下腔静脉直径/体表面积(VCD)分为达到干体重组和未达到干体重组各21例,选择健康志愿者21名作为正常对照组。使用多频生物电阻抗测定各组患者细胞外液百分比(ECW%)、总体液百分比(TBW%),同时检测血清BNP水平。结果未达到干体重组所测ECW%和TBW%水平较达到干体重组及对照组明显升高,差异有显著统计学意义(P<0.01)。达到干体重组测得ECW%和TBW%水平与对照组相比,差异无统计学意义(P>0.05)。未达到干体重组测得BNP数值较达到干体重组及对照组明显升高,差异有显著统计学意义(P<0.01)。达到干体重组测得BNP数值较对照组升高,差异有显著统计学意义(P<0.01)。结论 BNP可以用来评估PD患者的干体重,但在一定程度上受心功能的影响。生物电阻抗能准确评估PD患者干体重,受性别、体重等影响较大。BNP联合生物电阻抗能简便、准确、快速地评估PD患者的干体重。

Objective To evaluate the clinical significance of assessing the dry weight of patients undergoing peritoneal dial-ysis（PD） by the B-type natriuretic peptide（BNP） and multi-frequency bioelectrical impedance analysis. Methods A total of 42 patients treated with continuous ambulatory peritoneal dialysis（CAPD） for more than 3 months were enrolled in this study. The inferi-or vena cava diameter（IVCD） of all participants were measured,and then the values were adjusted by surface area（IVCD/surface area,or VCD）,which was deemed as a golden standard of assessing dry weight. All PD patients were divided into 2 groups by the val-ue of VCD：dry weight group and non-dry weight group. Twenty-one healthy volunteers were selected to the control group. Extracel-lular water percentage（ECW%） and total body water percentage（TBW%） of the 3 groups were measured by MBIA. Plasma BNPs of all participants were measured at the same time. Results Both ECW% and TBW% of non-dry weight group were significantly higher than those of the other two groups（P〈0.01）,and the differences in ECW% and TBW% between dry weight group and control group were not significant（P〉0.05）. The value of serum BNP in non-dry weight group was significantly higher than that of dry weight group and control group（P〈0.01）,meanwhile the value of serum BNP in dry weight group was significantly higher than that of control group（P〈0.01）. Conclusion BNP and MBIA can be used to assess dry weight in PD patients. But BNP is susceptible to cardiac function and MBIA is affected by sex and weight. A combination of BNP and MBIA will be a simple,correct and rapid method in assessing dry weight of PD patients.