运用N-末端脑钠肽评估维持性血液透析患者干体质量

N-terminal brain natriuretic peptide used for evaluation of dry weight in patients undergoing maintenance hemodialysis

目的观察N-末端脑钠肽(N-terminal brain natriuretie peptide,NT-proBNP)运用于维持性血液透析患者干体质量的评估并分析临床意义。方法 48例行维持血液透析患者分为干体质量组(Ⅰ组,24例),容量超负荷组(Ⅱ组,24例)。治疗前比较两组年龄、平均动脉压、心胸比例、左室射血分数、左室容积、NT-proBNP、血肌酐、尿素氮、估算肾小球滤过率。两组常规透析前后检测NTproBNP、血肌酐、尿素氮,计算尿素清除指数(the urea clearance index,Kt/V)值,并于下次透析前检测NT-proBNP、血肌酐、尿素氮。结果Ⅰ、Ⅱ两组患者间性别、年龄、左室射血分数、左室容积、透析之前血肌酐、尿素氮及估算肾小球滤过率比较,差异均无统计学意义(均P>0.05);平均动脉压[(88.10±10.16)mm Hg、(93.92±8.03)mm Hg]、心胸比例[(48.80±6.11)%、(53.25 4-2.72)%]及NT-proBNP[(3 827.67±712.12)ng/L、(5 793.58±945.20)ng/L],Ⅰ组小于Ⅱ组,差异有统计学意义(P<0.05或P<0.01);透析后两组间NT-proBNP[(1847.77 4-802.54)ng/L、(3 023.58±876.56)ng/L]、血肌酐[(287.26±62.86)μmol/L、(298.86±74.57)μmol/L]比较,差异有统计学意义(P<0.01)。下次透析前测NT-proBNP、血肌酐值,与上次透析前比较,差异均无统计学意义(均P>0.05)。Ⅰ、Ⅱ两组NT-proBNP值远高于正常值范围。结论在非显性水肿的维持性血液透析的患者中,NT-proBNP增高提示容量超负荷普遍存在。NT-proBNP可用来评估非显性水肿的维持性血液透析的容量负荷,但具有局限性,可辅助调节干体质量。维持性血液透析干体质量的确定需要查体及多项检测综合判断。

Objective To observe N-terminal brain natriuretic peptide （NT-proBNP） used for evaluation of dry weight in maintenance hemodialysis （MHD） patients and analyze the clinical significance. Methods Forty-eight patients undergoing MHD were divided into dry weight group （n = 24） and capacity overload group （n = 24）. The age, mean arterial pressure （MAP）, eardiothoracic ratio, left ventricular ejection fraction （LVEF）, left ventricular volume （LV）, N-terminal brain natriuretic peptide, serum treat^nine, urea nitrogen, and estimated glomerular filtration rate （eGFR） were compared between the two groups before treatment. NT-proBNP, serum creatinine and urea nitrogen were detected before and after routine dialysis in the two groups and the urea clearance index （Kt/V） was calculated, and NT-proBNP, serum creatinine and urea nitrogen were detected before the next dialysis. Results There were no significant differences in age, LVEF, LV and serum creatinine, urea nitrogen, eGFR before dialysis between two groups. MAP E（88, 10 ± 10. 16） mm Hg vs. （93.92 ± 8. 03） mm Hg], cardiothoracic ratio [（48. 80± 6. 11）% vs. （53. 25± 2. 72）%] and NT-proBNP [（3 827. 67 ± 712. 12） ng/L vs. （5 793.58 ± 945.20） ng/L] in dry weight group were significantly reduced as compared with capacity overload group （P〈0. 05 or P〈0. 01）. There were statistically sig- nificant differences in the changes of NT-proBNP [（1 847. 77± 802. 54） ng/L vs. （3 023. 58±876. 56） ng/L] and serum creatinine [（287. 26± 62. 86） μmol/L vs. （298. 86± 74. 57） μmol/L] between the two groups after dialysis （P〈0. 01）. There was no statistically significant difference in the NT-proBNP and serum creatinine detected before the next dialysis from the previous dialysis （P〉 0. 05）. The median of NT-proBNP values in the two groups was significantly higher than the normal value range. Conclusions The NT-proBNP increased, indicating capacity overload was ubiquitous in MHD patients with no dominant edema. NT-proBNP could be used to evaluate the no dominant edema capacity load of MHD patients, but there were limitations. Physical examination and multiple detec- tion comprehensive evaluation are used to determinate dry weight of MHD patients.