NT-proBNP与BMP-7水平在糖尿病肾病中的诊断价值

Diagnosis Value of the Levels of NT-proBNP and BMP-7 in Patients with Diabetic Nephropathy

目的探讨血浆氨基末端脑钠肽前体(NT-proBNP)及骨形态发生蛋白7(BMP-7)在糖尿病肾病(DN)中的应用价值及其与肾功能的关系。方法选取2013年6月至2014年6月湖北医药学院附属东风医院内分泌科收治的DN患者52例作为DN组,根据尿蛋白排泄率分为尿蛋白正常组(18例)、微量尿蛋白组(20例)和临床尿蛋白组(14例),另选取50例健康体检者为对照组。采用酶联免疫吸附测定试验法、电化学检测法测量52例DN患者及50例健康对照组血浆中BMP-7、NT-proBNP水平,并检查患者肌酐、血清尿素氮及估算的肾小球滤过率(e GFR)水平。结果 DN组患者血浆NT-proBNP水平显著高于对照组(P<0.05),而BMP-7水平低于对照组(P<0.05)。随着DN患者病情损害程度的增加,NT-proBNP水平显著上升,而BMP-7水平显著下降(P<0.05)。NT-proBNP与肌酐、血清尿素氮呈正相关(P<0.05),而与e GFR呈负相关(P<0.05)。BMP-7与肌酐、血清尿素氮呈负相关(P<0.05),而与e GFR呈正相关(P<0.05)。以病理活检为金标准,与单一指标检测相比,联合检测的敏感性、准确性、特异性较高。结论 DN患者存在明显的肾功能损害,NT-proBNP与BMP-7与肾功能具有密切的关系,通过测定NT-proBNP、BMP-7水平能有效预测DN患者肾功能损伤程度。两者联合检测可提高诊断的敏感性及特异性。

Objective To investigate the diagnosis value of the levels of N-terminal pro-brain natriuretic peptide（ NT-proBNP） and bone morphogenetic-7（ BMP-7） in patients with diabetic nephropathy（ DN） and their relationship with the renal function. Methods A total of 52 DN patients admitted in Dongfeng Hospital Affiliated to Hubei Medical College from Jun. 2013 to Jun. 2014 were selected as DN group,including 18 cases with normal level of urine protein,20 cases with microalbuminuria and 14 cases with clinical proteinuria according to the urinary protein excretion rates,while another 50 healthy subjects underwent physical examination in the hospital during the same period were served as control group. The levels of BMP-7 and NT-proBNP of 52 DN patients and 50 healthy people were detected by ELISA and electrochemical methods,while levels of creatinine,blood urea nitrogen and estimated glomerular filtration rate（ e GFR） of the two groups were compared. Results In DN group,plasma level of NT-proBNP was higher than the control group（ P〈0. 05）,while plasma level of BMP-7 was lower than the control group（ P〈0. 05）. With the severity of DN patients increased,the levels of NT-proBNP were significantly increased,while the levels of BMP-7 were significantly decreased（ P〈0. 05）. NT-proBNP level was positively correlated with levels of creatinine and blood urea nitrogen（ P〈0. 05）,while negatively correlated with e GFR（ P〈0. 05）. BMP-7 level was negatively correlated with levels of creatinine and blood urea nitrogen（ P〈0. 05）,while positively correlated with e GFR（ P〈0. 05）. The detection sensitivity,accuracy,specificity of combined detection were higher than single index detection taking pathologic biopsy results as the golden standard. Conclusion DN patients have significant renal impairment,their levels of NT-proBNP and BMP-7 have close relationship with renal function. Detection of NT-proBNP and BMP-7 levels can effectively predict the degree of renal dysfunction in DN patients. Combined detection of both indexes can improve the diagnostic sensitivity and specificity.