多种因素对呼吸困难住院患者脑利钠肽水平的影响

目的探讨不同临床指标对伴呼吸困难的住院患者血清脑利钠肽(BNP)水平的影响。方法回顾性分析2008年1月至2009年1月以呼吸困难为主要表现的住院患者327例,收集病史以及呼吸困难时白细胞、血红蛋白、肾功能、总胆红素、白蛋白、血氧分压、左心室射血分数、下腔静脉内径和肺动脉收缩压等临床资料,多元回归分析探讨上述指标对BNP水平的影响。结果左心室射血分数、肾功能、肺动脉收缩压、白蛋白、总胆红素、下腔静脉宽度及血红蛋白对BNP水平均有独立影响,其中最重要的影响因素是左心室射血分数和肾功能,不同肾小球滤过率(GFR)时,BNP水平不同,肺动脉收缩压对BNP有轻度影响,其余指标虽有统计学意义,但临床意义不大。年龄、性别、白细胞及血氧分压水平对BNP无明确影响。结论在解读BNP数值时,需计算患者的GFR值,并结合患者的具体临床情况,得出真实可靠的结论。

Impacts of different clinical indexes on brain natriuretic peptide in patients with dyspnea

Objective To evaluate the impacts of different clinical and biochemistry indexes on brain natriuretie peptides （BNP） in patients with dyspnea. Methods We respectively reviewed 327 inpatients with dyspnea in Peking Union Medical College Hospital, and analyzed the impacts of white blood cell （WBC）count, hemoglobin, total bilirubin, albumin, renal function, ejection fraction, pulmonary artery systolic pressure, width of inferior vena cava and arterial partial pressure of oxygen on BNP. Results Multiple regression analysis confirmed that ejection fraction （ EF）, GFR, pulmonary pressure, albumin, total bilirubin, width of inferior vena cava and hemoglobin had independent impacts on BNP, and left ventricular function was the main determinant for BNP, while renal function have moderate effect on BNP, different GFR had different baseline BNP. And BNP also slightly altered with pulmonary artery systolic pressure. We did not find that age, sex or WBC count had any association with BNP. Conclusions BNP value should be interpreted together with GFR and other clinical conditions to come out with proper results.