维持性血液透析患者血浆同型半胱氨酸和血清脑钠肽检测的临床意义

目的：探讨维持性血液透析（maintenance hemodialysis,MHD）患者血浆同型半胱氨酸（homocysteine,Hcy）和血清脑钠肽（brain natriuretic peptide,BNP）水平与心血管疾病（cardiovascular disease,CVD）之间的关系。方法将95例 MHD患者分为心血管疾病组（CVD组）55例和无心血管疾病组（NCVD组）40例；另选30名健康对照者（健康对照组）,检测各组血浆 Hcy、血清BNP、血肌酐（SCr）、血糖（glucose,GLU）、血白蛋白（albumin,Alb）、血脂并进行比较。结果 MHD患者血浆 Hcy [（26.89＆#177;10.12）μmol/L]明显高于健康对照组[（8.05＆#177;2.53）μmol/L]（P〈0.01）；血清 BNP [（1275.02＆#177;1123.94）pg/ml]显著高于对照组[（57.82＆#177;34.61）pg/ml]（P〈0.01）；其中 CVD 组血浆 Hcy[（31.73＆#177;10.18）μmol/L]高于 NCVD 组[（20.24＆#177;5.01）μmol/L]（P〈0.01）；血清 BNP [（1957.49＆#177;1001.83）pg/ml]高于 NCVD组[（336.61＆#177;308.22）pg/ml]（P〈0.01）。以健康对照组血浆 Hcy 均数＋2倍标准差（x＋2s）（13.11μmol/L）为95%可信度上限,超过此值确定为高同型半胱氨酸血症（Hyperhomocysteinemia,HHcy）。95例 MHD患者 HHcy发生率为87.37%（83/95）；其中CVD组 HHcy占94.55%（52/55）,NCVD 组占77.50%（31/40）,均明显高于正常对照组6.67%（2/30）（均 P〈0.01）。CVD 组和 NCVD 组 SCr、GLU、Alb 及血脂比较,差异无统计学意义（P〉0.05）。CVD组血浆 Hcy与 SCr、Alb呈正相关（r=0.380、0.354,P〈0.01）,NCVD组血浆 HcyA与BNP、SCr、Alb呈正相关（r=0.341、0.337、0.389,P〈0.05）,血清 BNP 与 Hcy、SCr 呈正相关（r=0.341、0.389,P〈0.05）；血浆 Hcy、血清BNP与其余各血生化指标间无相关性（P〉0.05）。结论血浆 Hcy、血清BNP水平可作为 MHD患者CVD危险因素的预测指标。

The clinical significance of plasma HCY and serum BNP detection in maintenance hemodialysis patients

Objective To study the relationship between plasma homocysteine （Hcy）and ser-um brain natriuretic petide （BNP）and the cardiovascular disease （CVD）in maintenance hemodialysis （MHD）patients.Methods Ninety-five patients with MHD were selected （MHD group）and divided into CVD group （including 55 cases）and NCVD group （including 40 cases）according to the incidence of CVD.Thirty healthy volunteers served as control group.Plasma HCY,serum BNP,serum creatinine （SCr）,blood glucose （GLU）,serum albumin （Alb）and blood lipid levels were measured and com-pared between MHD group and control group.Results The level of plasma HCY in MHD group was significantly higher than in control group [（26.89＆#177;10.12）vs.（8.05＆#177;2.53）μmol/L,P〈0.01]. The level of serum BNP in MHD group was significantly higher than in control group [（1 275.02 ＆#177;1 123.94）vs.（57.82＆#177;34.61）pg/ml,P〈0.01].In MHD group,the level of plasma HCY in CVD subgroup was significantly higher than in NCVD subgroup [（31.73＆#177;10.18）vs.（20.24＆#177;5.01）μmol/L,P〈0.01].The plasma Hcy in the control group x＆#177;2s （13.11μmol/L）was standardized as 95% confidence limit,and that exceeding this value was determined as HHcy.The incidence of HHcy in MHD group was 87.37% （83/95）,and that in CVD subgroup and NCVD subgroup was 94.55%（52/55）and 77.50% （31/40）respectively,both were significantly higher than in control group [6.67% （2/30）,P〈0.01].There was no significant difference in SCr,GLU,Alb and blood lipid be-tween CVD subgroup and NCVD subgroup （P〉0.05）.In MHD group,the level of plasma Hcy in CVD subgroup was positively correlated with SCr and Alb （r=0.380 and 0.354,P〈0.01）.The level of plasma Hcy in NCVD subgroup was positively correlated with SCr,Alb and BNP （r=0.341,0.337 and 0.389,P〈0.05）.The level of BNP was positively correlated with plasma Hcy and SCr （r=0.341 and 0.389,P〈0.05）.There was no correlation between plasma Hcy,BNP and the r