摘要
目的探讨N端脑钠肽(NT-pro BNP)在评估维持性血液透析(MHD)患者容量变化中的临床价值。方法选取120例MHD非显性水肿患者,采用生物电阻技术测定患者多余细胞外液(OH值),计算干体重(△OH值),根据△OH值将患者分为干体重超负荷组(H组,n=86)和干体重达标组(A组,n=34),并对H组患者进行3个月的干体重调整,再根据△OH值将H组分为干体重达标亚组46例(HA组)及干体重超负荷亚组40例(HH组)。采用胶体金法测定各组患者透析前血NT-pro BNP水平;分析MHD患者NT-pro BNP水平和△OH、调整干体重3个月后H组患者NT-pro BNP和△OH的相关性,并且利用受试者工作特征(ROC)曲线分析NT-pro BNP诊断MHD患者容量超负荷的预测值及其灵敏度和特异度。结果 H组的NT-pro BNP中位数为1 451.11 pg/ml,高于A组的901.43 pg/ml(P<0.05)。调整干体重3个月后H组患者PT-pro BNP水平中位数为1 123.32 pg/ml,较前下降(P<0.05),其中HH组NT-pro BNP水平高于HA组(P<0.05)。相关性分析显示,MHD患者基线△OH与基线NT-pro BNP呈正相关关系(P<0.001),调整干体重后H组△OH与NT-pro BNP呈正相关性(P<0.001)。ROC曲线分析结果显示,NT-pro BNP判断MHD患者容量超负荷的临界值为1 014.49 pg/ml,灵敏度为80.00%,特异度为91.20%,曲线下面积为0.895(P<0.001)。结论非显性水肿MHD患者NT-pro BNP水平随着容量负荷的升高而增高,可作为评估容量负荷变化的临床指标之一。
Objective To explore the clinical value of N-terminal pro-brain natriuretic peptide( NT-proBNP) for the assessment of volume load changes in patients with maintenance hemodialysis(MHD).Methods One hundred and twenty patients with non-dominant edema undergoing MHD were enrolled.Bioimpedance measurements were performed for detecting overhydration(OH),and then the dry weight(△OH) was calculated.Patients were divided into dry weight overload group ( Group H, n=86 ) and normal dry weight group (Group A,n=34) according to △OH.After the adjustment of dry weight for 3 months,the patients in Group H were divided into dry weight overload subgroup( Group HH, n =40 ) and normal dry weight subgroup ( Group HA, n =46 ) according to △OH.The level of NT-proBNP was detected by colloidal gold method before hemodialysis in all groups.The correlation of NT-proBNP level of MHD patients or patients in Group H after the 3-month adjustment of dry weight with△OH was assessed.Receiver operating characteristic( ROC) curve was used to analyze the predicted value,sensitivity and specificity of NT-proBNP for the diagnosis of volume overload in MHD patients. Results The median NT-proBNP level in Group H was 1 451.11 pg/ml,which was higher than that in Group A(901.43 pg/ml)(P〈0.05). After 3 months of dry weight adjustment,the median NT-proBNP level in Group H(1 123.32 pg/ml) decreased significantly(P〈0.05).The NT-proBNP level in Group HH was higher than the level in Group HA(P〈0.05).The correlation analysis showed that baseline NT-proBNP level positively correlated with baseline△OH in patients with MHD(P〈0.001).After the adjustment of dry weight,NT-proBNP level positively correlated with△OH in Group H(P〈0.001).ROC curve showed that the critical value of NT-proBNP for the diagnosis of volume overload in MHD patients was 1014.49pg/ml,and the sensitivity,specificity and the area under curve were 80.00%,91.20%and 0.895,respectively (P〈0.001).Conclusion NT-proBNP level increases with the increasing volume load in patients with non-dominant edema undergoing MHD.It can be a clinical index for assessing the changes of volume load.
出处
《广西医学》
CAS
2015年第10期1416-1419,共4页
Guangxi Medical Journal
关键词
维持性血液透析
N端脑钠肽
多余细胞外液
干体重
容量负荷
Maintenance hemodialysis
N-terminal pro-brain natriuretic peptide
Overhydration
Dry weight
Volume load