心肾综合征患者心脏结构功能、BNP、Cys-C变化与CKD分期的相关性

Association of changes of heart structure and brain natriuretic peptide and cystatin C levels with chronic kidney disease staging in patients with cardiorenal syndrome

目的：探讨心肾综合征（cardiorenal syndrome,CRS）患者超声心动图变化及全血脑钠肽（brain natriuretic peptide,BNP）、胱抑素C（Cystatin C,Cys-C）水平等与慢性肾脏病（chronic kidney disease,CKD）分期的关系。方法：我院肾内科符合标准的84例CRS患者,检测入院时的全血BNP、Cys-C水平,并检测超声心动图及心电图,收集相关参数进行分析。结果：CKD3、4、5期CRS患者之间,全血BNP、Cys-C水平有显著差异,各组之间左室舒张末期内径（LVDd）、左室后壁厚度（LVPW）、E峰、E/A、心率差异有统计学意义（P〈0.05）,而BNP和LVDd与CKD分期的相关性更加密切。结论：CKD 3-5期CRS患者心脏结构改变主要表现在左室舒张末期内径、左室后壁厚度增加等,心功能障碍主要表现在舒张功能受累。联合全血BNP、Cys-C水平、超声心动图及心电图检查可以作为观察CRS病情的有效指标,有利于预防及早期治疗。

Objective： To explore the relationship between the staging of chronic kidney disease（ CKD） and changes of heart structure and brain natriuretic peptide（ BNP） and cystatin C（ Cys-C） in patients with cardiorenal syndrome（ CRS）. Methods： Total of 84 eligible patients with CKD were included between January 2011 and June 2012. All patients were undergone determination of whole blood BNP and cys-C levels as well as echocardiogram and electrocardiogram examination at admission. The data were gathered for analysis of the relationship among the indicators. Results： Of the patients in stage of CKD3,4 and 5,the BNP and cys-C levels,left ventricular end diastolic diameter（ LVDd）,left ventricular posterior wall thickness（ LVPW）,and flow velocity at peak E and E / A ratio were statistically different（ P 0. 01）. Conclusion： CRS patients in stage CKD 3 to 5 primarily demonstrated LVDd change and thickened posterior left ventricular wall and diastolic function impairment. Combined determination of whole blood BNP and cys-C with echocardiogram and electrocardiogram examination may be effective indicators for prevention and early treatment of this disease.