期刊文献+

N端脑钠肽在评估维持性血液透析患者容量负荷变化中的临床价值 被引量:5

Clinical value of N-terminal pro-brain natriuretic peptide for assessment of volume load changes in patients with maintenance hemodialysis
下载PDF
导出
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
  • 引文网络
  • 相关文献

参考文献15

  • 1Rashidi MM,Freidoonimehr N,Momoniat E,et al.Study of nonlinear MHD tribological squeeze film at generalized mag- netic reynolds numbers using DTM[J].PLoS One,2015,10(8):e0135004.
  • 2Mark PB,Johnston N,Groenning BA,et al.Redefinition of uremic cardiomyopathy by contrast-enhanced cardiac mag- netic resonance imaging[J].Kidney Int,2006,69(10):1839-1845.
  • 3Dou Y,Cheng X,Liu L,et al.Development and validation of a new dry weight estimation method using single frequency bioimpedance in hemodialysis patients[J].Blood Purif,2011,32(4):278-285.
  • 4Vasan RS,Benjamin EJ,Larson MG,et al.Plasma natriuretic peptides for community screening for left ventricular hyper- trophy and systolic dysfunction:the Framingham heart study[J].JAMA,2002,288(10):1252-1259.
  • 5van de Pol AC,Frenken LA,Moret K,et al.An evaluation of blood volume changes during ultrafiltration pulses and natri- uretic peptides in the assessment of dry weight in hemodial- ysis patients[J].Hemodial Int,2007,11(1):51-61.
  • 6Wabel P,Chamney P,Moissl U,et al.Importance of whole- body bioimpedance spectroscopy for the management of fluid balance[J].Blood Purif,2009,27(1):75-80.
  • 7Grepaldi G,Soni S,Chionh CY,et al.Application of body composition monitoring to peritoneal dialysis patients[J].Contrib Nephrol,2009,163:1-6.
  • 8Gross ML,Ritz E,Hypertrophy and fibrosis in the cardiomy- opathy of uremia-beyond coronary heart disease[J].Semin Dial,2008,21(4):308-318.
  • 9Vanderheyden M,Bartunek J,Goethals M.Brain and other natriuretic peptides:molecular aspects[J].Eur J Heart Fail,2004,6(3):261-268.
  • 10Kohno M,Horio TjYokokawa K,et al.Brain natriuretic pep- tide as a marker for hypertensive left ventricular hypertro- phy:changes during I-year antihypertensive therapy with angiotensin-converting enzyme inhibitor[J].Am J Med,1995,98(3):257-265.

同被引文献52

引证文献5

二级引证文献33

;
使用帮助 返回顶部