生物电阻抗分析仪和N末端脑钠肽前体在维持性血液透析患者容量负荷与心功能评估中的应用

Evaluation of electrical bioimpedance analyzer and NT-proB NP on load capacity and cardiac function in patients with MHD

目的:探讨生物电阻抗分析仪和N末端脑钠肽前体(NT-pro BNP)在维持性血液透析(MHD)患者容量负荷与心功能评估中的应用价值。方法:选取64例MHD患者为透析组,同时选取58名健康志愿者为对照组。采用生物电阻抗分析仪测量两组细胞外液(ECW)及身体水分总量(TBW);采用电化学发光法检测透析组患者透析前及透析3个月后血浆NT-pro BNP水平;应用彩色多普勒超声心动仪测定左心室舒张末内径(LVDd)、左心室收缩末内径(LVDs)、左心室后壁厚度(LVPWT)、左心室心肌质量指数(LVMI)以及左心室射血分数(LVEF)。肾小球滤过率估计值(e GFR)根据肾脏病饮食改良(MDRD)公式测定。结果:1MHD患者透析后与透析前比较,血NT-pro BNP水平、TBW以及ECW/TBW明显降低,其差异显著(t=7.462,t=2.321,t=4.605;P<0.05);LVPMT、LVMI及LVEF明显改善,其差异显著(t=3.982,t=4.736,t=3.837;P<0.05),而LVDd与LVDs变化不明显;2MHD患者治疗后与对照组比较,其TBW、ECW/TBW无明显差异(t=1.098,t=0.503;P>0.05),提示治疗后患者的容量负荷参数已接近正常人群水平;3血NT-pro BNP水平与ECW/TBW、NYHA分级、LVDd、LVDs、LVPWT以及LVMI呈正相关(r=0.246,r=0.809,r=0.341,r=0.249,r=0.253,r=0.329;P<0.05),与e GFR和LVEF呈负相关(r=-0.513,r=-0.360;P<0.05)。结论:生物电阻抗和NT-pro BNP可有效用于MHD患者容量负荷及心功能评估,对于制定个体化治疗方案有一定应用价值。

Objective To explore the evaluation value of electrical bioimpedance analyzer and NT-proBNP on loadcapacity and cardiac function in patients with MHD. Methods： 64 cases of patients with MHD were choosed as theresearch objects （dialysis group）, and 58 case of random healthy volunteers as the control group. Extracellular water （ECW）and total body water （TBW） were measured by the electrical bioimpedance analyzer in the two groups. The plasma NTproBNPlevels before and after dialysis in dialysis group were determinated by the electrochemical luminescence method.The color doppler ultrasound cardiograph can detect left ventricular end-diastolic diameter （LVDd）, left ventricular endsystolicdimension （LVDs）, left ventricular posterior wall thickness （LVPWT）, left ventricular mass index （LVMI） andleft ventricular ejection fraction （LVEF）. Estimated glomerular filtration rate （eGFR） was determined according to aModification of Diet in Renal Disease（MDRD） formula. Results： 1）The plasma NT - proBNP levels, TBW and ECW/TBWbefore dialysis were lower obviously than that after dialysis （t=7.462, t=2.321, t=4.605; P〈0.05）. MHD, LVPMT, LVMIand LVEF improved obviously （t=3.982, t=4.736, t=3.837; P〈0.05）, while LVDd, LVDs did not change significantly. 2）Compared with the control group, TBW, ECW/TBW after treatment had no obvious difference （t=1.098, t=0.503; P〉0.05）in dialysis group, and it hinted that the capacity load parameter was close to normal level. 3）The plasma NT-proBNP levelwas positively correlated with ECW/TBW, NYHA classification, LVDd, LVDs, LVPWT and LVMI （r=0.246, r=0.809,r=0.341, r=0.249, r=0.253, r=0.329; P〈0.05）, and negatively correlated with eGFR and LVEF （r=-0.513, r=-0.360;P〈0.05）. Conclusion： The electrical bioimpedance and NT-proBNP can be used to assess the capacity load and cardiacfunction in patients with MHD, and it has certain application value to formulate individualized treatment scheme.