慢性肾病合并心功能不全患者血清微炎症因子、N末端脑钠前体的变化及临床意义

Changes and clinical significance of microinflammatory factors and plasma NTpro-BNP in patients with chronic kidney disease complicated with cardiac insufficiency

目的探讨慢性肾病合并心功能不全患者血清微炎症因子、N末端脑钠前体(NTpro-BNP)的变化及临床意义。方法2021年6月—2022年6月选取慢肾病患者132例为研究对象,根据Framingham心功能诊断标准,将患者分为心功能正常组(n=75)和心功能不全组(n=57),另选取健康体检者80例为对照组,采用超声心动图测量心功能参数[心脏指数(CI)、每搏输出量(SV)、左心室射血分数(LVEF)、右心室射血分数(RVEF)],采用酶联免疫法测定微炎症因子[超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)]及血清NTpro-BNP,分析慢性肾病患者心功能指标与炎症因子及血清NTpro-BNP的关系,应用受试者特异性曲线(ROC)分析微炎症因子与血清NTpro-BNP在预测慢性肾病患者心功能不全中的应用价值。结果与对照组相比,慢性肾病患者心功能参数CI、SV、LVEF、RVEF显著下降(P<0.05),而慢性肾病心功能不全组CI、SV、LVEF、RVEF水平较心功能正常组下降(P<0.05),其中心功能不全组患者CI、SV、LVEF、RVEF水平随着心功能分级的升高而下降(P<0.05)。与对照组相比,慢性肾病患者hs-CRP、IL-6、TNF-α、NTpro-BNP水平升高(P<0.05),而慢性肾病心功能不全组hs-CRP、IL-6、TNF-α、NTpro-BNP水平较心功能正常组升高(P<0.05),而hs-CRP、IL-6、TNF-α、NTpro-BNP水平随着心功能分级的升高而升高(P<0.05)。慢性肾病患者CI、SV、LVEF、RVEF与hs-CRP、IL-6、TNF-α、NTpro-BNP成负相关(P<0.05)。经ROC分析可知,hs-CRP、IL-6、TNF-α、NTpro-BNP在慢性肾病合并心功能不全诊断中曲线下面积(AUC)依次为0.768、0.812、0.832、0.845。结论慢性肾病合并心功能不全患者伴随着炎症相关因子及NTpro-BNP表达上调,通过测定这些指标能有效预测慢性肾病患者心肌损伤程度。

Objective This paper aims to investigate the changes and clinical significance of micro-inflammatory factors and plasma N-terminal brain sodium precursor(NTpro-BNP)in patients with chronic kidney disease complicated with cardiac insufficiency.Methods Totally,132 cases of patients with chronic kidney disease were selected as the research objects from June 2021 to June 2022.The patients were divided into normal cardiac function group(n=75)and cardiac insufficiency group(n=57)according to the Framingham cardiac function diagnostic criteria.80 cases of healthy subjects were selected as control group.The levels of cardiac function parameters[cardiac index(CI),stroke volume(SV),left ventricular ejection fraction(LVEF),right ventricular ejection fraction(RVEF)]were measured by echocardiography.The levels of micro-inflammatory factors[high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),tumor necrosis factor alpha(TNF-α)]and plasma NTpro-BNP were determined by enzyme-linked immunosorbent assay.The relationship between cardiac function indexes and inflammatory factors and plasma NTpro-BNP in patients with chronic kidney disease was analyzed.The value of micro-inflammatory factors and plasma NTpro-BNP in predicting cardiac insufficiency in patients with chronic kidney disease was analyzed by receiver-specific curve(ROC).Results The levels of CI,SV,LVEF and RVEF in the patients with chron⁃ic kidney disease were decreased compared with the control group(P<0.05),while the levels of CI,SV,LVEF and RVEF of chronic kidney disease and cardiac insufficiency group were decreased compared with the normal cardiac function group(P<0.05).The levels of CI,SV,LVEF and RVEF in the central insufficiency group were decreased with the increase of cardiac function grade(P<0.05).The levels of hs-CRP,IL-6,TNF-αand NTpro-BNP in patients with chronic kidney disease were increased compared with the control group(P<0.05),while the levels of hs-CRP,IL-6,TNF-αand NTpro-BNP of cardiac function group were increased compared with the normal cardiac function group(P<0.05),while the levels of hs-CRP,IL-6,TNF-αand NTpro-BNP were increased with the increase of cardiac function grade(P<0.05).CI,SV,LVEF,and RVEF in patients with chronic kidney disease were negatively correlated with hs-CRP,IL-6,TNF-α,and NTpro-BNP(P<0.05).The areas under the curve(AUC)of hs-CRP,IL-6,TNF-α,and NTpro-BNP in the diagno⁃sis of chronic kidney disease complicated with cardiac insufficiency were 0.768,0.812,0.832,and 0.845 by ROC analysis.Conclusion Patients with chronic kidney disease and cardiac insufficiency are accompanied by up-regulation of inflammatory-related factors and plasma NTpro-BNP expression,and the determination of these indicators can effectively predict the degree of myocardial injury in patients with chronic kidney disease.