慢性肾脏病非透析患者脑钠素与动脉粥样硬化及心功能的关系

目的 研究脑钠素（BNP）与慢性肾脏病（CKD）非透析患者动脉粥样硬化及心功能不全的关系。 方法 采用双抗夹心免疫荧光法检测203例CKD非透析患者与16例高血压患者对照组全血BNP水平，分析其与颈动脉超声结果、心脏彩超结果及既往心血管疾病史的关系。 结果 CKD非透析患者BNP水平与对照组相比显著升高M（范围）：54.40(15.10～ 173.00) ng/L比9.35(7.35～15.00) ng/L，P < 0.01]。Spearman相关分析显示CKD患者BNP与颈动脉内膜中层厚度（IMT）、左室心肌重量指数（LVMI）等呈正相关。存在颈动脉斑块、左室肥厚或既往发生过心血管事件的患者血BNP水平显著增高。多元回归分析显示LVMI、既往心血管事件均是影响BNP水平的独立因素。 结论 CKD非透析患者BNP水平和动脉粥样硬化性疾病、左室肥厚及心功能不全相关，提示BNP水平可作为一项评价CKD非透析患者心功能及动脉粥样硬化的敏感生物学指标。

The relationship of BNP with atheroclerosis and cardiac function in non-dialysis chronic kidney disease patients

Objective To clarify the association of BNP with atherosclerotic cardiovascular disease(CVD) and cardiac dysfunction in predialysis patients with chronic kidney disease(CKD). Methods Whole blood concentration of BNP was detected by fluorescence immunoassay in a cohort of 203 non-dialysis CKD patients and 16 hypertensive controls. The relationship of BNP with carotid artery atherosclerosis evaluated by B-ultrasound, echocardiographic parameter and history of cardiovascular disease in CKD patients was examined. Results BNP level was significantly higher in CKD patients than that in control subjects 54.40(15.10~173.00) ng/L vs 9.35(7.35~15.00) ng/L, P<0.01]. Spearman correlation showed that the BNP level was positively correlated with carotid intima-media thickness (IMT) and left ventricle mass index (LVMI). BNP concentration was significantly higher in patients with carotid plaques, left ventricular hypertrophy (LVH) and cardiovascular disease (CVD) history. Multiple regression analysis revealed that LVMI and CVD history were independent determinants of BNP. Conclusions BNP level is significantly correlated with atherosclerotic cardiovescular disease, LVH and cardiac dysfunction. BNP may be a sensitive biomarker for the evaluation of atherosclerosis and cardiac function in non-dialysis CKD patients.