肾功能不全对心力衰竭患者NT-proBNP影响的初步研究

Impact of renal insufficiency on the level of NT-pro BNP in patients with heart failure: a pilot study

目的氨基末端脑钠肽前体(NT-pro BNP)是诊断心力衰竭的有力标记物。本文旨在研究肾功能不全(血肌酐(Cr)>133μmol/L)的情况下,慢性心力衰竭患者血浆NT-pro BNP水平的变化,并初步探讨Cr>133μmol/L时NT-pro BNP诊断心力衰竭的截断值。方法研究对象为43例慢性心力衰竭患者(其中20例合并肾功能不全未行血液透析治疗)和115例心功能正常患者(其中39例合并肾功能不全),测定其血浆NT-pro BNP和血肌酐浓度。结果无论正常组还是心衰组中,肾功能不全患者的NT-pro BNP浓度明显高于相应的肾功能正常患者水平,差异有统计学意义(P<0.05)。NT-pro BNP的截断值2 200 ng/L时诊断心力衰竭伴肾功能损害具有较好的敏感性(0.795)和特异性(0.797)。结论NT-pro BNP检测结果明显受到肾功能的影响,当心力衰竭患者合并肾功不全时NT-pro BNP相对升高,相应的提高其截断值可以有效提高心力衰竭诊断的特异性。

Objective N-terminal pro B-type natriuretic peptide （NT-proBNP） is one of thewell-established markers for heart failure. We attempt to assess the impact of renal insufficiency on the level of NT-proBNP in patients with heart failure and discuss the appropriate cut-off value when the serum creatinine （Cr）〉133 μmol/L. Methods 43 chronic heart failure patients （of which 20 are combined with renal insufficiency） and 119 controls with normal heart function （of which 39 are with renal insufficiency） were included in the study.The plasma NT-proBNP and serum Cr were measured. Results In both normal （Nor） and heart failure （HF） groups, NT-proBNP concentrations were higher in patients with renal insufficiency than those of patients without renal insufficiency. There was a statistically significant difference between the two sets（with or without renal insufficiency,P〈0.05）. The cut-off value of 2 200 ng/L NT-proBNP, for the diagnosis of heart failure combined renal insufficiency, has appropriate sensitivity （0.795） and specificity （0.797）. Conclusion The plasma level of NT-proBNP was obviously impacted by the kidney function. The NT-preBNP level was relatively elevated in patients with deeompensated renal insufficiency. A higher cut-off value is needed to gain better specificity during clinical diagnosis of heart failure with renal insufficiency.