B型利钠肽在慢性肾脏病非透析人群中的应用性研究

An applied study of B-type natriuretic peptide in a non-dialysis population with chronic kidney disease

2018年度美国肾脏数据系统的报告显示有超过3000万美国成年人可能患有慢性肾脏病(chronic kidney disease,CKD),而心血管疾病(cardiovascular disease,CVD)是CKD患者死亡的主要原因,故早期识别CVD的临床表现并尽早对CVD进行干预是至关重要的。心脏生物标记物,如B型利钠肽(B-type natriuretic peptide,BNP)和N末端B型利钠肽原(N-terminal pro-Btype natriuretic peptide,NT-proBNP),通常用于诊断有症状患者的充血性心力衰竭(congestive heart failure,CHF),有足够的证据表明这些生物标记物可用于评估病情的严重程度及其预后。然而,在CKD患者中,由于肾脏清除率的下降可能会影响这些生物标志物的血浆水平,使得BNP在诊断效用、评估预后上面临着挑战,在CKD非透析人群中难以区分心源性引起的心衰和肾源性所致的慢性BNP升高。本综述通过详细地回顾BNP的生理作用,并就CKD非透析人群中发生CVD的特点,BNP的变化情况、影响因素及可能的机制,对CVD的预测作用作一简单论述。

The 2018 US Kidney Data System report shows that more than 30 million US adults may suffer from chronic kidney disease(CKD),and cardiovascular disease(CVD)is the main cause of death from chronic renal failure.Therefore,early identification of clinical manifestations of CVD and early intervention in CVD are of vital importance.Cardiac biomarkers,such as B-type natriuretic peptide(BNP)and N-terminal pro-B-type natriuretic peptide(NT-proBNP),are commonly used to diagnose congestive heart failure(CHF)in symptomatic patients.There is sufficient evidence that these biomarkers can be used to assess the severity of the disease and its prognosis.However,in CKD patients,because the decrease of renal clearance rate may affect the plasma level of these biomarkers,BNP faces challenges in diagnosis utility and prognosis evaluation.It is difficult to distinguish cardiac-induced heart failure from renal-induced chronic BNP elevation in non-dialysis CKD patients.This review reviews the physiological functions of the natriuretic peptide BNP in detail,and briefly discusses the characteristics of CVD in a non-dialysis CKD population,the changes of BNP,influencing factors and possible mechanisms,and its predictive significance for CVD.