透析过程中NT-proBNP下降率在维持性血液透析心功能衰竭评价中的意义

The significance of NT-proBNP decline in the evaluation of heart failure during maintenance hemodialysis

目的分析透析过程中N末端B型利钠肽原(N-terminal pro-brain natriuretic peptide,NT-proBNP)下降率在维持性血液透析(maintenance hemodialysis,MHD)患者心功能衰竭评价中的意义。方法监测92例MHD患者血液透析0 h、1 h、2 h、3 h及停止透析时的NT-proBNP水平、超滤量;根据透析前血压情况分为MHD低血压组(48例)和MHD血压稳定组(44例),比较两组患者透析各时间段NT-proBNP水平的差异;计算透析过程中NT-proBNP变化率,分析两组各时间段NT-proBNPn小时下降率与超滤量之间的相关性。结果(1)MHD低血压组患者中有6例透析2 h停止透析,42例透析时间在3~4 h之间;MHD血压稳定组透析时间均达到4 h。(2)两组间在透析0 h、1 h、2 h、3 h及停止透析时的NT-proBNP水平有差异(P<0.01)。(3)MHD血压稳定组透析1 h、2 h、3 h、4 h的NT-proBNP下降率与超滤量呈正相关(P<0.05);MHD低血压组在透析1 h、2 h的NT-proBNP下降率与超滤量呈正相关(P<0.01),透析3 h及停止透析时NT-proBNP下降率与超滤量无相关性(P>0.05);MHD低血压组NT-proBNP下降率最低值为-96.3%,最高值为78.6%,不能耐受透析时NT-proBNP下降率均值为38.5%。结论 MHD低血压患者较MHD血压稳定患者心功能差、透析耐受性差,MHD血压稳定患者NT-proBNP下降率与容量负荷降低有关,MHD低血压患者NT-proBNP下降率不能反映患者容量负荷减轻程度。

Objective To analyze the significance N-terminal pro-brain natriuretic peptide (NT-proBNP) decline in evaluation of heart failure during hemodialysis in patients with maintenance hemodialysis (MHD). Methods The level of NT-proBNP and ultrafiltration at 0 h, 1 h, 2 h, 3 h and end of hemodialysis were monitored in 92 patients with MHD. According to the conditions of blood pressure before dialysis, the patients were divided into hypotension group (48 cases) and stable blood pressure group (44 cases). NT-proBNP levels at various time points of dialysis were compared between the two groups. The rate of the rates of change of NT-proBNP changes at various timepoints were calculated, and correlation of NT-proBNP decline rates at various timepoints with ultrafiltration, was analyzed. Results (1) There was six patients in the hypotension group stopped at 2 hours of dialysis,and 42 ones performed dialysis for 3-4 hours. In the blood pressure stable group hemodialysis for all the patients lasted 4 hours.(2) There were differences in NT-proBNP levels between the two groups at 0, 1 h, 2 h, 3 h and end of dialysis (P<0.01).(3) The NT-proBNP decline rates at 1 h, 2 h, 3 h and 4 h of dialysis in the stable blood pressure group had positive correlation with the ultrafiltration volume (P<0.05). The NT-proBNP decrease rates at 1 h and 2 h of dialysis in the hypotension group was positively correlated with the ultrafiltration volume (P<0.01). The NT-proBNP decrease rates at 3 h and end of dialysis in the hypotension group had no correlation with the ultrafiltration volume (P>0.05). The lowest NT-proBNP decline rate in the hypotension group was -96.3%, the highest value was 78.6%, and the mean decrease rate of NT-proBNP was 38.5% when dialysis was intolerable in the hypotension group. Conclusions Hypotension patients with MHD have poor cardiac function and poor dialysis tolerance compared to stable blood pressure patients with MHD. NT-proBNP decline in patients with stable blood pressure and MHD is associated with reduced volume load, NT-proBNP decline rate in hypotension patients with MHD does not reflect the degree of volume load decrease.