N末端B型钠尿肽前体在血液透析隐性水肿患者中的临床应用效果

目的探讨血N末端B型钠尿肽前体（NT-proBNP）在维持性血液透析隐性水肿患者中的应用效果。方法检测32例临床无明显水肿、心力衰竭表现的维持性血液透析终末期肾脏病患者血NT-proBNP水平,同时监测患者体重（BW）、动态血压监测24 h平均收缩压/24 h平均舒张压（24 h MSBP/24 h MDBP）、血红蛋白（HGB）、白蛋白（ALB）、评估肾小球滤过率（eGFR）、24 h尿量（24 h UV）及心脏超声指标[室间隔厚度（IVST）、左室后壁舒张末厚度（LVPWT）、左室舒张末内径（LVEDd）],并计算左室质量指数（LVMI）,比较和分析治疗前后上述指标的检测结果。结果治疗前后的HGB、ALB、24 h UV、eGFR、LVMI比较差异无统计学意义（P〉0.05）;治疗后的24 h MSBP、24 h MDBP、BW及NT-proBNP水平低于治疗前,差异有统计学意义（P〈0.05）。NT-proBNP降幅与BW下降值呈正相关（r=0.397,P=0.025）,与24 h MSBP、24 h MDBP及LVMI下降值无相关性（P〉0.05）。结论要重视对血液透析隐性水肿患者干体重的定期评估,血NT-proBNP水平动态检测有助于判断患者的BW变化。

Clinical application effect of N-terminal pro-B-type natriuretic peptide in maintenance hemodialysis patients with recessive edema

Objective To evaluate the application effect of N-terminal pro-B-type natriuretic peptide（NT-proBNP）in maintenance hemodialysis（MHD）patients with recessive edema. Methods The level of blood NT-proBNP was tested pre-and post-dialysis until obtaining dry weight in 32 cases of MHD patients with recessive edema and without clinical manifestation of heart failure.Clinical data including body weight（BW）,24-hour mean systolic/diastolic blood pressure（24 h MSBP/24 h MDBP）,hemoglobin（HGB）,albumin（ALB）,estimated glomerular filtration rate（eGFR）,24 hours urine volume（24 h UV）was collected and analyzed respectively as well,ultrasonic cardiography（UCG） examination including interventricular septal thickness（IVST）,left ventricular posterior wall thickness（LVPWT）,left ventricular end-diastolic diameter（LVEDd）and left ventricular mass index（LVMI）was determined respectively.The detection result of index before and after treatment was compared and analysed. Results HGB,ALB,24 h UV,eGFR,LVMI before and after treatment was compared respectively,with no statistical difference（P〉0.05）.24 h MSBP,24 h MDBP,BW and NT-proBNP after treatment was lower than that before treatment respectively,with statistical difference（P〈0.05）.The decreasing range of blood NT-proBNP was positively correlated with BW-loss（r=0.397,P=0.025）,but no significant correlation with 24 h MSBP,24 h MDBP and LVMI（P〉0.05）. Conclusion Dry weight should be periodically evaluated in MHD patients with recessive edema,the decreasing range of blood NT-proBNP is helpful to estimate the change of patient′s BW