肺部超声B线数量与腹膜透析患者水肿指数、NT-proBNP相关性及在容量超负荷中的评估效能

Correlation between the Number of Lung Ultrasound B-Lines and Edema Index,NT-proBNP in Patients Undergoing Peritoneal Dialysis and Its Evaluation Efficacy in Volume Overload

目的探讨肺部超声B线数量与腹膜透析患者水肿指数、N末端脑钠肽前体(NT-proBNP)相关性及在容量超负荷中评估效能。方法按照1∶1选取2022年1月—2023年8月收治的50例尿毒症腹膜透析容量超负荷患者(超负荷组)、50例尿毒症腹膜透析容量非超负荷患者(对照组)作为研究对象,采用肺部超声检测2组B线数量。以Pearson简单线性关系分析B线数量与水肿指数、NT-proBNP水平的相关性,比较2组基线资料以及透析前后B线数量、水肿指数、NT-proBNP,偏相关性分析腹膜透析患者容量超负荷的相关影响因素,受试者工作特征曲线分析B线数量、水肿指数、NT-proBNP预测容量超负荷价值。结果透析前后B线数量与水肿指数、NT-proBNP均呈显著正相关(P<0.01);超负荷组血清白蛋白、尿素清除指数(Kt/V)低于对照组(P<0.01)。超负荷组透析前后B线数量、水肿指数、NT-proBNP均高于对照组,且2组透析后上述指标低于透析前(P<0.05)。校正了血清白蛋白、Kt/V后,B线数量、水肿指数、NT-proBNP仍与腹膜透析患者容量超负荷呈正相关(P<0.01)。B线数量、水肿指数、NT-proBNP预测腹膜透析患者容量超负荷的曲线下面积(AUC)分别为0.784、0.709、0.810,而三者联合的AUC为0.936,其预测敏感度为88.00%,特异度为90.00%(P<0.01)。结论肺部超声检测B线数量与腹膜透析患者水肿指数、NT-proBNP密切相关,均与患者容量超负荷有关,三者联合检测可提高对腹膜透析患者容量超负荷的预测能力,可为容量管理提供客观参考信息和决策支持。

Objective To investigate the correlation between the number of lung ultrasound B-lines and the edema index,N-terminal pro-brain natriuretic peptide(NT-proBNP)in patients undergoing peritoneal dialysis,and to evaluate its efficacy in assessing volume overload.Methods A total of 50 patients with uremia undergoing peritoneal dialysis with volume overload(overload group)and 50 patients with uremia undergoing peritoneal dialysis without volume overload(control group)were selected at a ratio of 1∶1 from January 2022 to August 2023 as the research subjects.Lung ultrasound was used to detect the number of B-lines in both groups.Pearson simple linear correlation analysis was used to analyze the correlation of the number of B-lines with the edema index and NT-proBNP levels.The baseline data of the two groups,as well as the number of B-lines,edema index,and NT-proBNP before and after dialysis,were compared.Partial correlation analysis was used to analyze the relevant factors affecting volume overload in patients undergoing peritoneal dialysis.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of the number of B-lines,edema index,and NT-proBNP for volume overload.Results Before and after dialysis,the number of B-lines was significantly and positively correlated with edema index and NT-proBNP(P<0.01).The serum albumin and dialyzer clearance of urea multiplied by dialysis time and normalized for urea distribution volume(Kt/V)in the overload group were lower than those in the control group(P<0.01).The number of B-lines,edema index,and NT-proBNP in the overload group before and after dialysis were higher than those in the control group,and these indicators were lower after dialysis in both groups(P<0.05).After adjusting for serum albumin and Kt/V,the number of B-lines,edema index,and NT-proBNP were still positively correlated with volume overload in patients undergoing peritoneal dialysis(P<0.01).The area under the ROC curve of the number of B-lines,edema index,and NT-proBNP for predicting volume overload in patients undergoing peritoneal dialysis were 0.784,0.709,and 0.810,respectively,while the AUC of the combination of the three was 0.936,with a predictive sensitivity of 88.00%and specificity of 90.00%(P<0.01).Conclusion The number of lung ultrasound B-lines is closely related to the edema index and NT-proBNP in patients undergoing peritoneal dialysis,and is associated with volume overload in patients.The combined detection of the three can improve the predictive ability of volume overload in patients undergoing peritoneal dialysis and provide objective reference information and decision support for volume management.