BNP及NT-proBNP在鉴别同种异体肾移植术后患者急性排斥反应中的早期辅助诊断价值

Application of BNP and NT-pro BNP in the early auxiliary diagnosis of acute rejection reaction after allograft renal transplantation

目的探讨同种异体肾移植术后患者发生急性排斥反应时血浆B型钠尿肽(BNP)、B型钠尿肽氨基末端前体(NT-proBNP)的浓度变化及早期的辅助诊断价值。方法选择在我院行首次同种异体肾移植术患者术后发生急性排斥反应12例为实验组(A组),并随机选择同期未发生急性排斥反应17例为对照组(B组)。回顾性分析两组患者血浆B型钠尿肽及其氨基末端前体浓度、血肌酐(SCr)水平、尿量及左心室舒张末期内径(LVDD)、舒张早期与心房收缩期二尖瓣血流峰速比值(E/A)、射血分数(LVEF)的变化,进行统计学比较。结果急性排斥反应组比较非急性排斥反应组同期BNP、NT-proBNP增高发生率高于尿量减少的发生率、SCr增高及左室结构及功能指标改变的发生率(P<0.01),且急性排斥反应时BNP、NT-proBNP增高早于SCr,NT-proBNP与BNP比较增高幅度更大、发生更早。结论肾移植术后发生急性排斥反应时血BNP、NT-proBNP浓度早期显著增高,血BNP、NT-proBNP浓度变化可作为早期辅助诊断移植肾急性排斥反应发生的敏感指标,其中NT-proBNP更敏感。

Objective To investigate the plasma concentration change and early auxiliary diagnosis value of brain natri‐uretic peptid （BNP） and amino terminal procursor of natriuretic peptid （NT‐proBNP） in acute rejection reaction after allograft renal transplantation .Methods A total of 12 cases with postoperative acute rejection were enrolled in the experimental group （group A） among patients who received allograft renal transplantation the first time ,meanwhile 17 cases without acute rejec‐tion were randomly selected as the control group （group B） .The plasma concentration of BNP and NT‐proBNP ,level of serum creatinine （SCr） ,urine volume and parameters of left ventricular structure and function were retrospectively analyzed and compared .Results Compared to group B ,group A had higher incidence of BNP and NT‐proBNP than change of urine vol‐ume ,SCr ,parameters of left ventricular structure and function .The occurrence of BNP and NT‐proBNP was earlier that of SCr .Moreover ,BNP had more increase than NT‐proBNP .Conclusions The plasma concentration of BNP and NT‐proBNP increased significantly and early when acute rejection after renal transplantation occurred ,and this change can serve as a sensi‐tive auxiliary diagnosis index for acute rejection after renal transplantation .Besides ,the plasma concentration of NT‐proBNP is more sensitive than BNP .