心力衰竭患者NT-proANP、NT-proBNP和NT-proCNP与肾功能指标的相关性分析

Correlations of NT-proANP,NT-proBNP and NT-proCNP to Renal Function Indicators in Patients with Heart Failure

目的探讨血肌酐轻度升高或正常心力衰竭(心衰)患者氨基末端A型利钠肽(NT-proANP)、氨基末端B型利钠肽(NT-proBNP)和氨基末端C型利钠肽(NT-proCNP)与肾功能指标(肌酐、尿素氮、肾小球滤过率(eGFR))的相关性。方法测定112例血肌酐<2 mg·dL-1(176.8μmol·L-1)的心衰患者(心衰组)和44例行冠状动脉造影除外冠心病的正常对照者(对照组)的肾功能指标、血肌酐和尿素氮。心衰组按肾功能指标再分为3个亚组,分析NT-proANP、NT-proBNP、NT-proCNP与肾功能指标的相关性及其影响因素。结果与对照组相比,心衰组的肌酐、尿素氮、NT-proANP、NT-proBNP、NT-proCNP值均明显升高,而eGFR明显降低(均P<0.05)。相关性分析:心衰患者Log NT-proANP、Log NT-proBNP和Log NT-proCNP分别与肌酐、尿素氮呈正相关(r=0.221~0.528,均P<0.05);分别与eGFR呈负相关(r=-0.303~-0.369,均P<0.01)。多元回归分析:是否使用利尿剂、尿素氮和NYHA分级为NT-proANP和NT-proBNP的独立影响因素,而肌酐为NT-proCNP的独立影响因素(均P<0.05)。结论肾功能正常或伴有轻度肾功能不全的心衰患者,利钠肽水平与肾功能指标密切相关,对该类患者应关注肾功能指标对利钠肽的影响。

Objective To investigate the relationships of N-terminal pro-A-type natriuretic peptide(NT-proANP),N-terminal pro-B-type natriuretic peptide(NT-proBNP)and N-terminal pro-C-type natriuretic peptide(NT-proCNP)to renal function indicators in heart failure patients with normal or slight blood creatinine elevation.Methods The levels of creatinine and urea nitrogen and estimated glomerular filtration rate(eGFR)were measured in 112 heart failure patients with serum creatinine<2 mg·dL-1(176.8μmol·L-1)and 44 normal controls without coronary heart disease.According to the renal function indexes,these heart failure patients were further divided into three subgroups to analyze the relationships of NT-proANP,NT-proBNP and NT-proCNP to renal function indexes and their influencing factors.Results Compared with the control group,the levels of creatinine,urea nitrogen,NT-proANP,NT-proBNP and NT-proCNP increased but the eGFR decreased in the heart failure group(P<0.05).Correlation analysis showed that Log NT-proANP,Log NT-proBNP and Log NT-proCNP were positively correlated with urea nitrogen and creatinine(r=0.221-0.528,all P<0.05),but negatively related to eGFR(r=-0.303--0.369,all P<0.01).Multivariate regression analysis showed that NYHA classification,urea nitrogen and diuretic use were independent influencing factors for NT-proANP and NT-proBNP and creatinine was an independent influencing factor for NT-proCNP(P<0.05).Conclusion The level of natriuretic peptide is closely related to renal function indicators in heart failure patients with normal renal function or mild renal insufficiency.Therefore,more attention should be paid to the influence of renal function indexes on natriuretic peptide.