血液透析患者心力衰竭与B型脑钠肽的关系分析

Analysis of the relationship between heart failure and B-type brain natriuretic peptide in patients with hemodialysis

目的分析血液透析患者心力衰竭(HF)与B型脑钠肽(BNP)的关系。方法选取萍乡市人民医院2019年1月~2020年8月收治的60例血液透析患者,根据左心室射血分数(LVEF)水平将并发HF的患者(LVEF<50%)归为观察组(30例),将未并发HF的患者(LVEF≥50%)归为对照组(30例)。两组入院后均进行LVEF、BNP水平检测,观察组予以常规抗HF治疗及慢性肾衰竭一体化治疗,对照组予以常规血液透析以及慢性肾衰竭一体化治疗。记录两组入院时LVEF水平;对比两组入院时、干预治疗后BNP水平,分析血液透析患者LVEF与BNP水平的关系,并绘制受试者工作特征(ROC)曲线分析BNP水平对血液透析患者发生HF的预测价值。结果观察组入院时LVEF水平低于对照组,差异有统计学意义(P<0.05);观察组入院时与治疗后BNP水平均高于对照组,且观察组治疗后的BNP水平低于入院时,差异有统计学意义(P<0.05);对照组治疗后的BNP水平与入院时比较,差异无统计学意义(P>0.05)。相关性分析发现,血液透析患者入院时LVEF水平与BNP水平呈负相关(r=-0.806,P<0.001)。绘制ROC曲线分析BNP水平预测血液透析患者HF发生的曲线下面积为0.952,预测价值较高,对应的最佳阈值为222.35 ng/dL,敏感度为96.70%,特异度为46.70%。结论BNP水平可有效判断血液透析患者的HF进展,临床可根据BNP水平予以相关干预,改善血液透析患者预后,值得临床推广。

Objective To analyze the relationship between heart failure(HF)and B-type brain natriuretic peptide(BNP)in patients with hemodialysis.Methods From January 2019 to August 2020,a total of 60 new found of patients with hemodialysis in Pingxiang People′s Hospital were selected,according to the left ventricular ejection fraction(LVEF)levels,patients with HF(LVEF<50%)were classified as the observation group(30 cases),and those without HF(LVEF≥50%)were classified as the control group(30 cases).Both groups were tested for LVEF,BNP levels after admission,the observation group was received conventional anti-HF treatment and integrated treatment of chronic renal failure,and the control group was received conventional hemodialysis and integrated treatment of chronic kidney disease.LVEF levels of the two groups at admission were recorded;the BNP levels of the two groups at admission and after intervention treatment were compared.The relationship between LVEF and BNP levels in patients with hemodialysis were analyzed,and a receiver operating curve(ROC)curve was drawn to analyze the predictive value of BNP levels for HF in patients with hemodialysis.Results LVEF level of observation group at admission was lower than that of control group,the difference was statistically significant(P<0.05);the BNP levels of observation group at admission and after treatment were higher than those of control group,and the BNP level of the observation group after treatment was lower than that at admission,the differences were statistically significant(P<0.05);the BNP level after treatment in the control group was compared with that at admission,the difference was not statistically significant(P>0.05).Correlation analysis showed that LVEF level was negatively correlated with BNP level at admission(r=-0.806,P<0.001).The ROC curve was drawn and analyzed that the BNP level predicted the area under the curve of HF in patients with hemodialysis was 0.952,which had high predictive value,the corresponding optimal threshold was 222.35 ng/dL,the sensitivity was 96.70%,and the specificity was 46.70%.Conclusion The level of BNP can effectively judge the progress of HF in patients with hemodialysis.High level of BNP is an influencing factor of HF in patients with hemodialysis.Clinical interventions can be made in advance based on the level of BNP to improve the prognosis of patients.It is worthy of clinical promotion.