B型钠尿肽与维持性血液透析患者预后相关性的Meta分析

Meta-analysis of B-type natriuretic peptide and prognosis of maintenance hemodialysis patients

目的系统评价维持性血液透析（MHD）患者循环中升高的B型钠尿肽（BNP）或N末端钠尿肽前体（NT．proBNP）是否是预测患者全因死亡、心血管疾病死亡或心血管事件的风险因素。方法电子检索CENTRAL、MedlineDatabase、EmbaseDatabase、CBMdisc、中国循证医学／Cochrane中心数据库（CEBM／CCD）、VIP等数据库，从创刊至2014年12月。收集所有评估BNP或NT．proBNP与MHD患者预后的相关研究，研究不限语种或是否使用盲法。数据由两名作者独立提取，并对文献质量进行评价。采用软件STATA10．0进行统计分析。结果初检874篇文献，其中英文711篇，中文163篇。符合纳入标准的有19篇文献，共6185例患者。Meta分析结果显示，（1）升高的BNP／NT．proBNP与全因死亡增加相关（HR：2．64，95％CI：1．73—4．02）；（2）升高的BNP／NT．proBNP与心血管事件增加相关（HR：5．35—7．04，95％CI：2．23—22．33）。结论BNP或NT．proBNP是MHD患者一种重要的风险预测工具。

Objective To determine whether elevated circulating B- type natriuretic peptide （BNP） or N-terminal B-type natriuretic peptide precursor （NT-proBNP） could predict long-term risks of all-cause mortality, cardiovascular mortality or cardiovascular events among maintenance hemodialysis （MHD） patients. Method Data updated by December 2014 in Cochrane Library, Medline Database, Embase Database, CBMdisc and CEBM/CCD were searched. Related research about the relation of BNP or NT- proBNP and the prognosis of MHD patients were included, regardless of language or whether blind method was used. The data were extracted independently by two reviewers. The methodological quality of trails was assessed by recommended evaluation standard. Statistical analysis was performed with STATA 10.0. Results There were 874 papers found by our search strategy, among which 711 articles were in English and 163 articles were in Chinese. Nineteen papers were eligible according to the inclusion criterion and a total of 6185 cases were included. The Meta-analysis results showed that： （1） Elevated BNP or NT- proBNP was significantly related to increased all-cause mortality （HR： 2.64, 95% CI： 1.73- 4.02）; （2） Elevated BNP or NT- proBNP was associated with increased cardiovascular events （HR： 5.35- 7.04, 95% CI： 2.23- 22.33）. Conclusion BNP or NT- proBNP is a promising prognostic tool to risk-stratify MHD patients.