NT-proBNP与维持性血液透析患者预后的相关性研究

目的探讨维持性血液透析患者血清中N末端B型钠尿钛前体（N-terminal pro-B-type natriuretic peptide，NT-proBNP）水平及其变化对患者预后的影响。 方法选取天津医科大学第二医院2013年12月至2014年12月收治的300例维持性血液透析患者，分别测定患者入组时和6个月后血清NT-proBNP水平，并随访1年，分析NT-proBNP水平及其变化与患者并发症、死亡发生的关系，以及与生存预后的关系。 结果300例维持性血液透析患者的NT-proBNP水平均高于正常值。（1）有、无并发症透析患者的原发病、血管通路及NT-proBNP水平均存在明显差异，差异有统计学意义（χ²=7.670、5.293，Z=-2.374、-2.787；P<0.05或0.01），其余各相关因素的差异均无统计学意义（均P>0.05）；以性别、年龄、原发病、血管通路、透析龄、基线及6个月后NT-proBNP为自变量，以是否发生心脑血管并发症为因变量做Logistic回归分析，未发现各因素与心脑血管并发症发生有关（均P>0.05）。（2）存活透析患者与死亡透析患者的原发病、血管通路及NT-proBNP水平均存在明显差异，差异有统计学意义（χ²=8.572、5.911，Z=-4.447、-5.086；P<0.05或0.01），其余各相关因素的差异均无统计学意义（均P>0.05）；以性别、年龄、原发病、血管通路、透析龄、基线及6个月后NT-proBNP为自变量，以是否死亡为因变量做Logistic回归分析，结果显示血管通路、透析龄、基线及6个月后NT-proBNP与死亡风险有关（P<0.05或0.01）。（3）半年内NT-proBNP的升高幅度<1 000 ng/L的患者，其并发症及死亡发生率高于升高幅度≥1 000 ng/L的患者，但差异无统计学意义（χ²=1.05，P>0.05）。（4）Kaplan-Meier生存分析显示，NT-proBNP≥5 000 ng/L患者的平均生存时间较NT-proBNP<5 000 ng/L患者短，差异有统计学意义（χ²=9.964,P<0.05）。 结论维持性血液透析患者NT-proBNP水平升高，其升高幅度与心脑血管并发症和死亡风险呈正相关。

Correlation study of NT-proBNP on prognosis of maintenance hemodialysis patients

ObjectiveTo evaluation the correlation of serum NT-proBNP and its changes on prognosis of maintenance hemodialysis patients. MethodsWe randomly selected 300 cases of maintenance hemodialysis patients from blood purification center in our hospital. Serum NT-proBNP concentrations were determined at the beginning and after 6 months of dialysis respectively, and followed up the subjects for 1 year. complications and mortality were analyzed the as the effects of NT-proBNP levels and its changes.T-test was further used to dertermined differences between two groups which appeared normal distribution, Rank sum test was further used to dertermined differences between two groups which appeared non-normal distribution. Chi-Square was further used to dertermined differences between count data. Logistic regression analysis was used to test the influence factors. ResultsNT-proBNP levels of 300 maintenance dialysis patients were significantly increased.(1) The primary disease, vascular access and the NT-proBNP levels are associated with cardio cerebral vascular complication in these patients (χ²=7.670、5.293,Z=-2.374,-2.787;P<0.05 or 0.01). All other factors were not correlated with the complications (P>0.05). Sex, age, primary diseases, vascular access, year of dialysis, NT-proBNP at baseline and 6 months after dialysis were not associated with cardio cerebral vascular complication when using cardio cerebral vascular complications as the dependent factor to do the Logistic regression analysis (P>0.05). (2) Primary disease, vascular access and the NT-proBNP levels are associated with survival in these patients (χ²=8.572, 5.911,Z=-4.447,-5.086;P<0.05 or 0.01). Logistic regression analysis showed that vascular access, the year of dialysis and the NT-proBNP levels associated with the risk of death in patients when using survival as the dependent factor (P<0.05 or 0.01). (3) Within half year, NT-proBNP increased less than 1 000ng/L has increased cerebrovascular complications and death rate compared with NT-proBNP increased more than 1 000ng/L, but no statistic significance (χ²=1.05,P>0.05). (4) Kaplan-Meier survival analysis showed that NT-proBNP more than 5 000ng/L of patients with an shorter survival time than NT-proBNP lower than 5 000ng/L (χ²=9.964,P<0.05). ConclusionThe level of NT-proBNP in maintenance hemodialysis patients was increased. The increased NT-proBNP was associated with the risk of cardio cerebral vascular complications and death in hemodialysis patients.