肾功能不全患者N端B型脑利钠肽前体和肌红蛋白水平的变化及临床意义

Change and clinical significance of N-terminal brain natriuretic peptide precursor and myoglobin in patients with renal insufficiency

目的探讨肾功能不全患者N端B型脑利钠肽前体(NT-proBNP)和肌红蛋白水平的变化及临床意义。方法根据美国慢性肾脏病分期,利用估算肾小球滤过率(eGFR)水平将389例肾科住院患者分为五组:A组41例,eGFR≥90 mL·min^-1·1.73m^-2;B组34例,60 mL·min^-1·1.73m^-2≤eGFR<90 mL·min^-1·1.73m^-2;C组65例,30 mL·min^-1·1.73m^-2≤eGFR<60 mL·min^-1·1.73m^-2;D组104例,15 mL·min^-1·1.73m^-2≤eGFR<30 mL·min^-1·1.73m^-2;E组145例,eGFR<15 mL·min^-1·1.73m^-2。比较五组患者NT-proBNP和肌红蛋白水平,分析NT-proBNP和肌红蛋白与SCr和eGFR的相关性。结果A、B、C、D和E组NT-proBNP水平分别为247.4(86.1,1494.5)ng/L、431.7(124.3,1387.0)ng/L、621.7(234.5,3404.5)ng/L、1568.0(620.9,5440.3)ng/L和8571.0(4914.0,15832.5)ng/L,肌红蛋白水平分别为19.0(14.0,26.5)μg/L、22.5(18.5,35.3)μg/L、51.0(29.5,107.0)μg/L、56.0(37.5,86.8)μg/L和110.0(76.0,182.5)μg/L。E组NT-proBNP和肌红蛋白水平高于C、D组(P<0.05)。NT-proBNP和肌红蛋白均与SCr呈正相关(rs=0.631和0.620,P<0.05),与eGFR呈负相关(rs=-0.640和-0.601,P<0.05)。结论NT-proBNP和肌红蛋白水平随着肾脏疾病的进展而增加,动态检测有助于早期发现肾功能不全患者的心血管疾病。

Objective To investigate the change and clinical significance of N-terminal brain natriuretic peptide precursor(NT-proBNP)and myoglobin in the patients with renal insufficiency.Methods According to the US CKD staging,389 hospitalized patients in nephrology department were divided into five groups of A(eGFR≥90 mL·min^-1·1.73 m^-2,41 cases),B(60 mL·min^-1·1.73 m^-2≤eGFR<90 mL·min^-1·1.73 m^-2,34 cases),C(30 mL·min^-1·1.73 m^-2≤eGFR<60 mL·min^-1·1.73 m^-2,65 cases),D(15 mL·min^-1·1.73 m^-2≤eGFR<30 mL·min^-1·1.73 m^-2,104 cases)and E(eGFR<15 mL·min^-1·1.73 m^-2,145 cases).The levels of NT-proBNP and myoglobin were compared among five groups,and the correlations of NT-proBNP and myoglobin with SCr and eGFR were analyzed.Results The NT-proBNP level in groups of A,B,C,D and E was 247.4(86.1,1494.5)ng/L,431.7(124.3,1387.0)ng/L,621.7(234.5,3404.5)ng/L,1568.0(620.9,5440.3)ng/L and 8571.0(4914.0,15832.5)ng/L,respectively.The myoglobin level in groups of A,B,C,D and E was 19.0(14.0,26.5)μg/L,22.5(18.5,35.3)μg/L,51.0(29.5,107.0)μg/L,56.0(37.5,86.8)μg/L and 110.0(76.0,182.5)μg/L,respectively.The levels of NT-proBNP and myoglobin were higher in group E than those in groups of C and D(P<0.05).NT-proBNP and myoglobinin were positively correlated with SCr(rs=0.631 and 0.620,P<0.05)and negatively correlated with eGFR(rs=-0.640 and-0.601,P<0.05).Conclusion The levels of NT-proBNP and myoglobin are increased with the progression of kidney disease,which is helpful for early detection of cardiovascular diseases in the patients with renal insufficiency.