血浆N末端B型利钠肽原与失代偿期乙肝肝硬化患者急性肾损伤的关系

Correlation of plasma N-terminal pro-brain natriuretic peptide with acute kidney injury in patients with decompensated hepatitis B-related liver cirrhosis

[目的]探讨血浆N末端B型利钠肽原(NT-proBNP)水平与失代偿期乙肝肝硬化患者发生急性肾损伤(AKI)的相关性。[方法]回顾性分析236例失代偿期乙肝肝硬化患者的临床资料,根据住院期间是否发生AKI,分为AKI组(n=75)和非AKI组(n=161),比较2组性别、年龄、血清尿素氮(BUN)、肌酐(SCr)、NT-proBNP、总胆红素(TBil)、白蛋白(ALB)、血氨、白细胞计数(WBC)、血红蛋白浓度(Hb)、血小板计数(PLT)、凝血酶原时间(PT)、凝血酶原时间国际标准化比值(INR)及Child-Pugh评分等的变化。2组间差异性比较采用成组资料t检验,多组间差异性比较采用单因素方差分析;Logistic回归分析筛选发生AKI的危险因素。[结果]AKI组BUN、Scr、NT-proBNP、Tbil、血氨、PT及Child-Pugh评分均高于非AKI组,而ALB、PLT则低于非AKI组。AKI组患者中,NT-proBNP、Child-Pugh评分随着AKI分期的增加而升高。多因素Logistic回归分析显示,血浆NT-proBNP水平(OR=2.133,95%CI:1.657~6.782,P=0.008)、Child-Pugh分级(OR=2.954,95%CI:1.865~9.353,P=0.013)是失代偿期乙肝肝硬化患者并发AKI的危险因素。[结论]失代偿期乙肝肝硬化合并AKI的患者血浆NT-proBNP水平明显升高,血浆NT-proBNP水平、Child-Pugh分级是失代偿期乙肝肝硬化患者发生AKI的危险因素。

[Objective]To investigate the correlation of plasma N-terminal pro-brain natriuretic peptide(NT-proBNP)with acute kidney injury(AKI)in patients with decompensated hepatitis B-related liver cirrhosis.[Methods]The clinical data of 236 patients with decompensated hepatitis B-related liver cirrhosis were retrospectively analyzed.All these patients were divided into AKI group(n=75)and non-AKI group(n=161)according to whether or not complicated with acute kidney injury.The differences of gender, age, blood urea nitrogen(BUN),serum creatinine(Scr),NT-proBNP,total bilirubin(TBil),albumin(ALB),blood ammonia, white blood cell count(WBC),hemoglobin concentration(Hb),platelet count(PLT),prothrombin time(PT),international standardized ratio(INR)and Child-Pugh score were compared between different groups.And Logistic regression analysis was used to analyze risk factors for AKI.[Results]The levels of BUN,Scr, NT-proBNP,TBil, blood ammonia, PT and Child-Pugh score in AKI group were higher than those in non-AKI group, but ALB,PLT were lower than those in non-AKI group.The level of plasma NT-proBNP and Child-Pugh score increased gradually with the stage of AKI.Multivariate Logistic regression analysis showed that plasma NT-proBNP level(OR=2.133,95%CI:1.657-6.782,P=0.008)and Child-Pugh grade(OR=2.954,95%CI:1.865-9.353,P=0.013)are the risk factors for AKI in patients with decompensated hepatitis B-related liver cirrhosis.[Conclusion]The level of plasma NT-proBNP is increased in patients with decompensated hepatitis B-related liver cirrhosis complicated with AKI.The level of plasma NT-proBNP and Child-Pugh grade are the risk factors for AKI in patients with hepatitis B-related liver cirrhosis.