应用生物电阻抗法评估血液透析患者NT-proBNP差值与体液成分的关系

The correlation between the changes of serum NT-proBNP after hemodialysis and the body fluid distribution evaluated by whole-body bioimpedance spectroscopy in maintenance hemodialysis patients

目的应用多频生物电阻抗的方法测量维持性血液透析(maintenance hemodialysis,MHD)患者透析前、后体液分布情况,再与透析前、后NT-proBNP的差值作比较,来探讨NT-proBNP差值与体液分布的关系。方法应用多频生物电阻抗测定84例透析患者透析前后MHD患者的体内水含量及分布,同时抽血测定其NT-proBNP值。计算透析前、后N末端脑钠肽前体(N-termind pro-brain natriuretic peptide,NT-proBNP)差值。应用相关分析各个指标之间的关系。结果透析前血清NT-proBNP与透析前身体水分总量(total water,TBW)、细胞外液(extracellular water,ECW)、细胞内液(intracellular water,ICW)、ECW/TBW无明显的相关性。透析后血清N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)与透析后ECW/TBW(r=0.251,P=0.025)呈正相关,与ICW呈显著的负相关(r=-2.333,P=0.037)。相关分析显示MHD患者透析前、后血清NT-proBNP的差与ECW(r=-0.235,P=0.036)、ECW/TBW(r=-0.252,P=0.024)、ECW/ICW(r=-0.228,P=0.042)呈显著负相关,与TBW(r=-0.121,P=0.284)和ICW(r=0.018,P=0.871)无明显的相关性。结论 NT-proBNP差值与MHD患者透析前后患者体液分布有较好的一致性,可以用于评价MHD患者的容量负荷。

Objective To evaluate the significance of N-terminal pro-brain natriuretic peptide （NT- proBNP） changes after a hemodialysis session in the assessment of body fluid distribution by comparing these changes with the values from whole-body bioimpedance spectroscopy in maintenance hemodialysis （MHD） patients. Method Whole-body bioimpedance spectroscopy and serum NT-proBNP were measured before and after hemodialysis sessions in 84 MHD patients. Body fluid content and distribution calculated from whole-body bioimpedance spectroscopy and the changes of NT-proBNP were compared in these patients. Results Before hemodialysis, serum NT-proBNP was insignificantly correlated with total body water （TBW）, extracellular water （ECW）, intracellular water （ICW） and ECW/TBW. After hemodialysis, serum NT- proBNP was positively correlated with ECW/TBW （1=0.251, P=0.025）, and negatively correlated with ICW （~=-2.333, P：-0.037）. Correlation analyses also demonstrated that the changes of serum NT-proBNP after he- modialysis were negatively correlated with ECW （r=- 0.235, P=-0.036）, ECW/TBW （r=-0.252, P=-0.024） and ECW/ICW （/=-0.228, P=-0.042）, but had no correlations with TBW （t=-0.121, P=-0.284） and ICW （r=0.018, P=- 0.871）. Conclusion The changes of serum NT-proBNP after hemodialysis were comparable with the changes of water distribution after hemodialysis, which may provide a new approach for the evaluation of volume overload in MHD patients.