血清N末端脑钠肽前体联合心肌酶预测维持血液透析患者心力衰竭的价值

The value of serum N-terminal pro-brain natriuretic peptide combined with myocardial enzymes in predicting heart failure in patients with chronic kidney disease on maintenance hemodialysis

目的探讨血清N末端脑钠肽前体(NT-proBNP)联合心肌酶预测慢性肾病维持血液透析(MHD)患者心力衰竭的价值。方法2021年1月—12月选取慢性肾病MHD患者132例为研究对象,根据患者是否并发心力衰竭(HF)将患者分为未并发HF组(n=78)和合并HF组(n=54),另选取100例健康体检者为对照组,比较3组血清NT-proBNP、血清心肌酶[肌钙蛋白Ⅰ(cTnI)、肌酸激酶同工酶-MB(CK-MB)]、心功能指标[左心室射血分数(LVEF)、心排出量(CO)、心脏指数(CI)],采用受试者特异性曲线(ROC)分析血清NT-proBNP联合心肌酶指标预测慢性肾病MHD患者HF的价值。结果MHD合并HF组血清NT-proBNP、cTnI、CK-MB水平高于对照组和MHD未并发HF组(P<0.05),MHD未并发HF组血清NT-proBNP、cTnI、CK-MB水平高于对照组(P<0.05)。MHD合并HF组LVEF、CO、CI低于MHD未并发HF组和对照组(P<0.05)。经Pearson相关性分析可知,血清NT-proBNP、cTnI、CK-MB与LVEF、CO、CI成负相关(P<0.05)。经ROC曲线分析可知,血清NT-proBNP、cTn I、CK-MB三者联合诊断MHD合并HF时曲线下面积(AUC)最大,灵敏度和特异度分别为81.2%和82.4%。结论慢性肾病MHD并发HF患者血清NT-proBNP及心肌酶成异常升高趋势,对MHD并发HF具有较高诊断价值。

Objective This paper aims to investigate the value of serum N-terminal pro-brain natriuretic peptide(NT-proBNP)combined with myocardial enzymes in predicting heart failure in patients with chronic kidney disease on maintenance hemodialysis(MHD).Methods A total of 132 patients with chronic kidney disease on MHD were selected as the research objects and divided into the uncomplicated HF group(n=78)and the combined HF group(n=54)according to whether patients had complication of HF or not.Another 100 healthy subjects were selected as the control group.The ratio of serum NT-proBNP,serum myocardial enzymes[troponin I(cTnI),creatine kinase isoenzyme-MB(CK-MB)],cardiac function indexes[left ventricular ejection fraction(LVEF),cardiac output(CO),cardiac index(CI)]were analyzed.The value of serum NT-proBNP combined with myocardial enzymes in predicting HF in patients with chronic kidney disease on MHD was analyzed by receiver specific curve(ROC).Results The serum levels of NT-proBNP,cTnI and CK-MB in the MHD combined with HF group were higher than control group and MHD without HF group(P<0.05).The level of NT-proBNP,cTnI and CK-MB of MHD patients were higher than MHD patients with HF(P<0.05).The LVEF,CO,and CI in the MHD combined with HF group were lower than those in the MHD without HF group and the control group(P<0.05).Pearson correlation analysis showed that serum NT-proBNP,cTnI,and CK-MB were negatively correlated with LVEF,CO,and CI(P<0.05).ROC analysis showed that NT-proBNP,cTnI,and CK-MB combined to diagnose MHD with HF had the largest area under the curve(AUC),with sensitivity and specificity of 88.12% and 82.24%.Conclusion Serum NT-proBNP and myocardial enzymes in chronic kidney disease patients with MHD complicated with HF show an abnormal increase trend,which has a high diagnostic value for MHD complicated with HF.