血NT-ProBNP对CKD非透析患者有效循环血容量评价的研究被引量：7

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摘要目的：通过测定慢性肾脏病（CKD）3~5期非透析者的血氨基末端脑钠肽前体（NT-pro BNP）水平和超声心动参数,探讨NT-pro BNP对CKD3~5期非透析患者的有效循环血容量评估价值,并进一步指导CKD的临床治疗。方法：选取在我科住院的CKD伴心功能正常的患者共91例,测定全血NT-pro BNP浓度和超声心动参数,并根据NT-pro BNP水平四分位法分组,比较各组间临床指标、超声心动图参数,分析NT-pro BNP水平与血容量的相关性;并观察利尿剂对NTpro BNP浓度的影响。结果：NT-pro BNP（ng/L）正常组（≤100）与升高各组（B组100~250,C组251~600,D组〉600）相比;血压、左室舒张末内径、左室收缩末容积、左室舒张末容积随NT-pro BNP浓度的升高而升高,差异具有统计学意义（P〈0.05）,D组与A组相比左室舒张末容积差异有统计学意义[（117.2±11.8）vs（94.4±7.2）,P〈0.001];NT-pro BNP升高的CKD患者,给予呋塞米24 h后,NT-pro BNP均出现显著性降低,1周后NT-pro BNP各组又恢复至干预前水平。结论：对CKD非透析患者,NT-pro BNP可以反映容量负荷水平,并作为血容量判断的标志物;利尿治疗可暂时性降低NT-pro BNP的水平,以降低BT-pro BNP为靶目标值的干预有望实现适度利尿和延缓肾功能进展。

作者周杨王瑞娟吕颖宓恩娜

机构地区宁波大学医学院附属医院肾内科

出处《中国中西医结合肾病杂志》 2016年第4期335-337,共3页 Chinese Journal of Integrated Traditional and Western Nephrology

基金宁波市社会发展项目(No.2011C50026)

关键词慢性肾脏病氨基末端脑钠肽前体左室舒张末容积血容量

分类号 R692 [医药卫生—泌尿科学]

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1Paniagua R, Ventura MD, Avila - Diaz M, et al. NT - proBNP, fluid volume overload and dialysis modality are independent pre- dictors of mortality in ESRD patients. Nephrol Dial Transplant, 2010,25(2) :551 -557.
2陈海燕,龚德华.应用生物电阻抗测量评估患者的容量状况[J].肾脏病与透析肾移植杂志,2014,23(4):377-381. 被引量：13
3Yamanouchi S, Kudo D, Endo T, et al. Blood N - terminal proB- NP as a potential indicator of cardiac preload in patients with high volume load. Tohoku J Exp Med, 2010,221 ( 3 ) : 175 - 180.
4Braunwald E. Biomarkers in Heart Failure. N Eng, l J Med,2008, 358(12) :2148 -2159.
5Valle R, Aspromonte N. Use of brain natriuretic peptide and bio- impedance to guide therapy in heart failure patients. Contrib Nephro1,2010,164:209 - 216.
6Pfisterer M, Buser P, Rickli H, et al. BNP - guided vs symptom -guided heart failure therapy: the Trial of Intensified vs Standard Medical Therapy in Elderly Patients Witl~ Congestive Heart Fail- ure (TIME - CHF) randomized trial. JAMA,2009,301 (4) :383 - 392.
7Tagore R, Ling H, Yang H, et al. Natriuretic peptides in Chronic Kidney Disease. Clin J Am Soc Nephrol, 2008,3 ( 6 ) : 1644 - 1651.
8Vickery S, Price CP, John L, et al. B - type natriuretic peptide and amino- terminal proBNP in patients with CKD:relationship to renal function and left ventricular hypertrophy. Am J Kidney Dis,2005,46 (4) : 610 - 620.
9Sheen V. The use of B - type natriuretic peptide to assess volume status in patients with end - stage renal disease. Am Heart J, 2007,153 (2) :244.
10梁献慧,王沛,殷瑶瑶,王瑞敏,陆晓青,刘章锁.N端脑钠肽前体在维持性血液透析患者非显性水肿容量负荷评估中的意义[J].中华肾脏病杂志,2014,30(9):660-664. 被引量：18

二级参考文献38

1Lazarus JM,Hampers C,Merrill JP.Hypertension in chronic renal failure.Treatment with hemodialysis and nephrectomy[J].Arch Intern Med,1974,133:1059-1066.
2Mark PB,Johnston N,Groenning BA,et al.Redefinition of uremic cardiomyopathy by contrast-enhanced cardiac magnetic resonance imaging[J].Kidney Int,2006,69:1839-1845.
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,2011,32:278-285.
4Dou Y,Liu L,Cheng X,et al.Comparison of bioimpedance methods for estimating total body water and intracellular water changes during hemodialysis[J].Nephrol Dial Transplant,2011,26:3319-3324.
5Woodrow G,Oldroyd B,Wright A,et al.The effect of normalization of ECW volume as a marker of hydration in peritoneal dialysis patients and controls[J].Perit Dial Int,2005,25 (suppl 3):S49-S51.
6Carlo C,Sachin S,Chang YC,et al.Application of body composition monitoring to peritoneal dialysis patients[J].Contrib Nephrol,2009,163:1-6.
7Peter W,Paul C,Ulrich M,et al.Importance of wholebody bioimpedance spectroscopy for the management of fluid balance[J].Blood Purif,2009,27:75-80.
8Gross ML,Ritz E.Hypertrophy and fibrosis in the cardiomyopathy of uremia-beyond coronary heart disease.Semin Dial,2008,21:308-318.
9David S,Kumpers P,Seidler V,et al.Diagnostic value of N-terminal pro-B-type natriuretic pep-tide (NT-proBNP) for left ventricular dysfunction in patients with chronic kidney disease stage 5 on haemodialysis[J].Nephrol Dial Transplant,2008,23:1370-1377.
10Abdeen O,Mullauey S,Maisel A.The use of B-type natriuretic peptide to assess volume status in patients with end-stage renal disease[J].Am Heart J,2007,153:244.el-e5.