N-末端脑钠肽前体对预测血液透析患者透析中低血压发生的意义

目的探讨血浆N-末端脑钠肽前体（NT-proBNP）在血液透析患者透析中低血压（IDH）发生的预测价值。方法将行血液透析的患者144例,根据透析过程中是否发生血压下降,分为IDH组和非IDH组。测定透析前后的血压、NT-proBNP,并记录心胸比、超滤量、超滤量占体质量百分比、低血容量发生次数,并分析NT-proBNP与IDH的相关性。结果透析期间,IDH的发生率为28．5％。与非IDH组比较,IDH组的年龄、NT-proBNP显著降低,超滤量、超滤量占体质量百分比、心胸比、低血容量发生次数明显升高（P〈0．05）。透析后,非IDH组SBP、DBP与透析前比较,无统计学差异（P〉0．05）,而IDH组则较透析前显著下降（P〈0．05）。采用多因素Logistic回归分析结果显示,在控制年龄、超滤量、超滤量占体质量百分比、心胸比、低血容量发生次数后,NT-proBNP对透析中发生IDH仍有预测价值,OR=0．412（95％CI 0．212-0．801）。结论NT-proBNP与血液透析患者容量负荷密切相关,NT-proBNP水平检测有助于评估患者透析中血容量的变化,预测IDH的发生。     

透析过程中NT-proBNP下降率在维持性血液透析心功能衰竭评价中的意义

目的分析透析过程中N末端B型利钠肽原(N-terminal pro-brain natriuretic peptide,NT-proBNP)下降率在维持性血液透析(maintenance hemodialysis,MHD)患者心功能衰竭评价中的意义。方法监测92例MHD患者血液透析0 h、1 h、2 h、3 h及停止透析时的NT-proBNP水平、超滤量;根据透析前血压情况分为MHD低血压组(48例)和MHD血压稳定组(44例),比较两组患者透析各时间段NT-proBNP水平的差异;计算透析过程中NT-proBNP变化率,分析两组各时间段NT-proBNP_(n小时)下降率与超滤量之间的相关性。结果 (1)MHD低血压组患者中有6例透析2 h停止透析,42例透析时间在3～4 h之间;MHD血压稳定组透析时间均达到4 h。(2)两组间在透析0 h、1 h、2 h、3 h及停止透析时的NT-proBNP水平有差异(P0.01)。(3)MHD血压稳定组透析1 h、2 h、3 h、4 h的NT-proBNP下降率与超滤量呈正相关(P0.05);MHD低血压组在透析1 h、2 h的NT-proBNP下降率与超滤量呈正相关(P0.01),透析3 h及停止透析时NT-proBNP下降率与超滤量无相关性(P0.05);MHD低血压组NT-proBNP下降率最低值为-96.3%,最高值为78.6%,不能耐受透析时NT-proBNP下降率均值为38.5%。结论 MHD低血压患者较MHD血压稳定患者心功能差、透析耐受性差,MHD血压稳定患者NT-proBNP下降率与容量负荷降低有关,MHD低血压患者NT-proBNP下降率不能反映患者容量负荷减轻程度。     

血压变异性、氨基末端脑利钠肽前体与维持性血液透析患者心血管事件的相关性分析

目的分析维持性血液透析(maintaining hemodialysis,MHD)患者血压变异性(blood pressure variability,BPV)、氨基末端脑利钠肽前体(N-terminal probrain natriuretic peptide,NT-proBNP)与心血管事件的相关性。方法回顾性分析2014年9月至2016年9月在武汉市蔡甸区人民医院接受MHD半年以上的212例终末期肾病伴高血压患者,其中发生心血管事件的91例患者作为观察组,同期未发生心血管事件的121例患者作为对照组。分析各组患者年龄、性别、糖尿病史、透析间期体质量增长率、血生化指标等临床资料。结果单因素分析表明,两组患者NT-proBNP水平、糖尿病史、透析间期体质量增长率,透析时SBP-SD、SBP-CV、DBP-SD、DBPCV差异有统计学意义(P 0. 05);多因素Logistic回归分析表明,较高的NT-proBNP、SBP-SD、DBP-SD为MHD患者心血管事件的主要危险因素(P 0. 05); ROC曲线示NT-proBNP、SBP-SD、DBP-SD预测MHD后心血管不良事件的最佳阈值分别为7. 32 ng/L、21. 60 mmH g、12. 54 mmH g。结论 MHD患者心血管事件与NT-proBNP水平、糖尿病史、透析间期体质量增长率及BPV相关,其中透析时高水平NT-proBNP、SBP-SD和DBP-SD作为发生心血管事件的主要危险因素应引起重视,且对心血管不良事件具有较好的预测价值。     

维持性血液透析患者合并透析相关低血压的危险因素

目的探讨维持性血液透析(maintenance hemodialysis, MHD)患者发生透析相关低血压(intradialytic hypotension, IDH)的危险因素, 为防治提供依据。方法选取2021年5月至2022年5月间呼伦贝尔市扎赉诺尔区人民医院血液净化科收治的69例MHD患者为研究对象, 根据有无透析相关低血压发生将患者分为IDH组(26例)和无IDH组(43例), 比较IDH组和无IDH组患者的临床资料和实验室指标。采用多因素Logistic回归分析MHD患者并发IDH的危险因素。结果 MHD患者IDH的发生率为37.68%。IDH组年龄显著高于非IDH组(P< 0.05), 血红蛋白、肌酐、白蛋白、血清钠离子显著低于非IDH组(P<0.05)。Logistic回归分析结果显示, 血清钠离子低[比值比(OR)=1.185, 95%可信区间(CI)1.008～1.349, P=0.039]及透析前肌酐低(OR=1.003, 95%CI 1.001～1.006, P=0.005)是MHD患者并发IDH的危险因素。结论 MHD并发IDH患者的临床特点包括...     

血清FGF-23与维持性血液透析患者透中低血压发生的关系

目的：探讨维持性血液透析（ maintenance hemodialysis,MHD）患者发生透中低血压（ intradialytic hypotension, IDH）与血清中可溶性klotho（soluble klotho,sKl）和成纤维细胞生长因子23（fibroblast growth factor23,FGF23）之间的关系。方法：横断面收集MHD患者病情资料,根据最近1个月内透析记录,将MHD患者分成无透中低血压组（ N-IDH）和透析中低血压组（ IDH）。收集患者同期实验室检查结果,并采集患者血清样本,检测血清FGF23与sKl水平。比较N-IDH与IDH患者之间生化指标差异。结果：共收集临床信息完整及血清标本完整患者80例,其中IDH发生率为77.5%,独立样本t检验分析结果提示五个指标在N-IDH和IDH组之间差异存在统计学意义,血铁蛋白（P=0.046）、血三酰甘油（P=0.045）、血iPTH （P=0.047）、钙磷乘积（P=0.042）和血清FGF23（P〈0.001）。而sKl在两组间差异无统计学意义（P=0.747）。相关性检验提示IDH组的患者IDH发生频率与血清FGF23浓度的相关关系分析显示两者呈正相关（r=0.722,P〈0.001）。结论：本组病例提示血清FGF23的水平与MHD患者透析中低血压的发生密切相关。     

血液透析相关性低血压与中医证型分布及症状困扰的相关性研究

目的:探讨维持性血液透析(MHD)患者透析相关性低血压(IDH)与中医证型的分布规律及症状困扰的相关性。方法:纳入北京市中西医结合医院及北京中医药大学东直门医院行维持性血液透析治疗的慢性肾脏疾病患者142例,依据透析中低血压的发生情况分为IDH组与非IDH组,收集中医四诊、辨证分型及透析相关数据,应用"透析症状评估量表"(DSI)评估症状困扰。观察IDH患者的中医证型分布规律及症状困扰特点,分析IDH的危险因素。结果:(1)收集的142例MHD患者中IDH的发病率为40.6%。(2)IDH患者中医证型以虚实夹杂为主,脾肾气虚证(29.3%)、脾肾阳虚证(31.7%)及兼瘀血证(46.3%)所占比例最高。(3)症状困扰发生率前3名为疲惫乏(75%)、口干(71%)、皮肤干燥(70%),症状困扰严重程度前3例为便秘(2.44±1.21)、头晕(2.37±1.02)、易醒(2.37±1.06);IDH患者症状困扰得分更高。(4)logistic回归分析显示脾肾气虚证、脾肾阳虚证、兼瘀血证及疲乏、易怒为IDH发生的独立危险因素。结论:中医证型脾肾气虚证、脾肾阳虚证、兼血瘀证及疲乏、易怒与IDH的发生高度相关,可作为MHD患者发生IDH的预测因素。     

血容量反馈控制系统对改善血液透析中低血压的观察性研究

目的研究血容量反馈控制系统对改善维持性血液透析(maintenance hemodialysis, MHD)患者发生透析中低血压(intradialytic-hypotension, IDH)的作用。方法该研究采用前瞻性队列研究方法。选取2021年3月至2022年3月浙江大学医学院附属第一医院透析中心反复发生IDH的30例MHD患者, 以A-B-A倒返实验设计进行自身对照研究, 分别进行4周12次的基线期(A1)常规透析治疗、干预期(B)血容量反馈控制下的透析治疗以及再观察的倒返期(A2)常规透析治疗。统计并比较A1期、B期和A2期中患者平均IDH发生次数、IDH相关不良事件(因IDH并经临床判断需停止脱水且停止时间>10 min或需提前>10 min下机的事件, IDH-related adverse events, IDH-RAE)的发生频率。在共1 080次透析记录中, 以年龄、性别以及是否使用血容量反馈控制系统为自变量, 以是否发生IDH-RAE为因变量建立Logistic回归模型。结果本研究纳入的30例MHD患者中, 男性14例(46.7%), 女性16例(53....     

心脏移植术前血N端B型利钠肽原水平与术后早期受者存活率的关系

目的 探讨心脏移植术前血N端B型利尿钠肽原(NT-proBNP)水平与术后早期受者存活率的关系.方法 采用免疫法测定284例拟接受心脏移植的心力衰竭患者移植前血NT-proBNP水平,按NT-proBNP水平将284例患者分为≤5000 nmol/L组(≤5000组,237例)和＞5000 nmol/L组(＞5000组,47例),比较两组受者的术前一般情况、不同原发病者的NT-proBNP水平、两组围手术期体外膜肺氧合(ECMO)技术应用率及死亡率.采用Kaplan-Meier法计算两组受者1年存活率.结果 ＞5000组术前肺毛细血管楔压为(25.1±7.4)mm Hg(1 mm Hg=0.133 kPa),明显高于≤5000组的(21.4±9.2)mm Hg(P＜0.05)；心脏指数为(1.8±0.5)L·min-1·m-2,明显低于≤5000组的(2.1±0.6)L·min-1·m-2 (P＜0.05).＞5000组围手术期需用ECMO支持者占14.9％(7/47),ECMO相关死亡率为71.4％(5/7),1年存活率为91.3％；≤5000组围手术期需用ECMO支持者占6.8％(16/237),ECMO相关死亡率为12.5％(2/16),1年存活率为96.9％,2个组ECMO应用率、ECMO相关死亡率以及受者1年存活率的差异均有统计学意义(P＜0.05).结论 术前血NT-proBNP水平较高(＞5000 nmol/L)者围手术期ECMO应用率和1年死亡率均较高；术前测定血NT-proBNP水平有助于心脏移植时机的把握.     

维持性血液透析患者血氨基末端脑钠肽前体水平与肾性贫血的相关性

目的探讨维持性血液透析(MHD)患者发生肾性贫血的危险因素,分析其与血氨基末端脑钠肽前体(NT⁃proBNP)的相关关系。方法选取2018年8月至2018年11月期间在复旦大学附属华山医院接受MHD 3个月以上、病情稳定的患者为研究对象。按照血红蛋白(Hb)水平分为贫血组和非贫血组。回顾性收集患者一般资料、观察期内实验室检查及透析相关资料。Pearson相关分析法分析贫血指标与透析相关指标、血NT⁃proBNP水平的相关性;逐步多元线性回归法分析MHD患者发生贫血的危险因素。结果共160例MHD患者入选本研究,年龄(63.11±11.35)岁,男79例(49.4%),女81例(50.6%)。患者透析龄(118.01±82.32)个月,血红蛋白(110.09±13.48)g/L,NT⁃proBNP水平中位数为3985 ng/L。贫血组73例(45.6%),非贫血组87例(54.4%),贫血组血NT⁃proBNP水平显著高于非贫血组(t=-3.714,P<0.001)。MHD患者血红蛋白水平与每周透析时间(r=0.228)和血白蛋白(r=0.349)呈正相关,与血NT⁃proBNP水平呈负相关(r=-0.318);血细胞比容与每周透析时间(r=0.283)、血清钙(r=0.317)、血磷(r=0.264)、白蛋白(r=0.513)呈正相关(均P<0.05)。逐步多元线性回归分析结果显示,低血白蛋白、高NT⁃proBNP水平是MHD患者发生肾性贫血的独立危险因素。结论MHD患者NT⁃proBNP水平升高与血红蛋白水平降低相关,低血白蛋白、高NT⁃proBNP是MHD患者发生贫血的危险因素。提示肾性贫血的治疗需要考虑改善营养不良和高容量等因素。     

维持性血液透析患者低血压的临床研究

目的:探讨血液透析中低血压的发生机制,提出防治措施.方法:收集长期接受透析的66例患者的临床资料,按有无透析低血压分为低血压组(29例)及对照组(37例),比较两组病因、年龄、透析间期体重增长率;透析中超滤量(UFV)、超滤率(UFR);血钠(Na )、白蛋白(Alb)、血红蛋白(Hb)、尿素氮(BUN)、血肌酐(Scr).结果:与对照组相比,合并糖尿病、左室肥厚及动脉硬化的老年人易发生透析低血压(P＜0.01);透析间期体重增长率(%),透析中UFV、UFR有统计学差异(P＜0.01);Na 、Alb、Hb有统计学差异(P＜0.05);BUN、Scr无差异(P＞0 05).结论:控制透析间期体重增长、减慢超滤速度,改变血液净化方法,采用序贯钠透析、低温透析,适当用药,改善心功能,纠正贫血、低蛋白血症及营养不良等可防治透析中低血压.     

Association of intradialytic hypotension and 5-year mortality in maintaining hemodialysis patients

Objective To assess the risk factors of intradialytic-hypotension (IDH) and the prognosis of IDH among maintenance hemodialysis (MHD) patients for the prevention and treatment of IDH. Methods 276 MHD patients were enrolled during Jan. 2009 to Mar. 2009. Intradialytic blood pressure was monitored during a 3-month period. IDH was defined as an event characterized by a sudden drop in systolic BP more than 20 mmHg or in mean artery pressure (MAP) more than 10 mmHg associated with clinical events and need for interventions. Dialysis-related information was collected. Kaplan-Meier method, log-rank test, logistic regression and Cox regression analyses were performed to examine the association between IDH and survival, using a follow-up through 31 May 2014. Results A total of 276 patients were recruited. The incidence rate of IDH was 40.9%. 163 patients with no-IDH (＜1/10 hypotensive events/3 months) served as controls. 113 patients with IDH (≥1/10 hypotensive events/3 months) were identified among all 276 patients. Multivariate logistic regression analysis showed that age, ultrafiltration rate, gender, serum NT-proBNP, serum albumin and aortic rool inside dimension (AoRD) were associated with IDH among MHD patients. During the 5-year follow-up, 74 patients died, with a mortality rate 5.2 per 100 person-year. Kaplan-Meier survival curve showed significant difference of overall and CV mortality rates between 2 groups. The multivariate Cox regression model indicated that IDH increased the risk of death (HR=1.572, 95%CI 1.077-2.293, P=0.019). So did the rise of LVMI (HR=1.010, 95%CI 1.009-1.085, P=0.020). Conclusion Elderly, female, high ultrafiltration rate, high level of serum NT-proBNP, hypoalbuminemia and shorter AoRD are independent risk factors for IDH among MHD patients. LVMI can predict the outcome of MHD patients. Intradialytic hypotension is an independent risk factor for long-term mortality in MHD patients.     

The effect of frequent or occasional dialysis-associated hypotension on survival of patients on maintenance haemodialysis.

BACKGROUND: While frequent or occasional symptomatic intradialytic hypotension (IDH) may influence patient well-being, its effects on survival-independent of comorbidities-has not previously been investigated. In this study, therefore, our objective was to assess the effect of frequent IDH (f-IDH) or occasional IDH (o-IDH) on survival. METHODS: During a 10 month run-in period in 1998, 77 patients with f-IDH (> or =10 hypotensive events/10 months, responding only to medical intervention) and 101 patients with o-IDH (1 or 2 events/10 months) were identified among all 958 patients of a dialysis network. Eighty-five patients who had no hypotensive episodes (no-IDH) during this run-in phase served as controls. Patients were followed for a median of 27 months (range: 0.3-37) and survival of patients in the three groups was compared by log-rank test. Independent association of f-IDH and o-IDH with survival, compared with no-IDH, was assessed by a proportional hazards model that included patient demographics, laboratory data and antihypertensive medication as well as comorbidity. RESULTS: Forty-five patients (58%) with f-IDH, 47 (47%) with o-IDH and 33 (39%) with no-IDH died during the follow-up. Mortality rates (deaths/100 patient years) were 37 (log-rank P = 0.013 vs no-IDH), 26 (log-rank P = 0.375 vs no-IDH) and 21 in the three groups, respectively. This indicates significantly decreased survival in patients with f-IDH as compared to those with no-IDH. In multivariate proportional hazards regression, however, where age, sex, time spent on dialysis, presence of coronary heart disease, diabetes, Kt/V, albumin level and use of beta-blockers, calcium-channel blockers and long-acting nitrates has been adjusted for, neither f-IDH nor o-IDH was associated with survival. CONCLUSIONS: Mortality in patients with f-IDH is significantly higher than in those without such events. After adjustments for covariates, however, there is no independent effect of frequent or occasional episodes of IDH on mortality.     

Analysis of cystatin C combined with amino-terminal pro-brain natriuretic peptide to predict cardiovascular risk in maintenance hemodialysis patients

Objective To research the relationship between the serum level of cystatin C (Cys-C), N-terminal pro brain natriuretic peptide (NT-proBNP) and the cardiovascular (CV) events in maintenance hemodialysis (MHD) patients, looking for a new and effective biological prediction method for cardiovascular disease (CVD). Methods According to the excluded criteria and included criteria, a total of 126 patients [male 67(53.2%), female 59 (46.8%)] were included in this study, screening out of 452 MHD patients from 3 blood purification centre, no secondary hyperparathyroidism, blood pressure controlled, hemoglobin standard, no lipid abnormalities, and without history of coronary heart disease, heart failure and arrhythmia. Participants adopted 3 dialysis treatment, including hemodialysis, hemoperfusion and hemodiafiltration. Every 3 months before the dialysis, the Cys-C, NT-proBNP, serum phosphorus, serum intact parathyroid hormone (iPTH), hemoglobin and electrocardiogram were detected. The heartbeat ultrasound was examined every 6 months, observed for 24 months and followed up for 3 years, recording the incidence and the inspection results. The correlation and the occurrence of CVD were analyzed by conducting a multiple factor logistic regression analysis. The forecast performance of Cys-C, NT-proBNP was evaluated by using receiver operating characteristic (ROC) curves and area under curves (AUC). Results Eighteen episodes of CV events occurred in 126 patients during the experiment and follow-up, including 8 episodes of heart failure, 4 episodes of myocardial infarction, 6 episodes of arrhythmia. Detection indexes had no statistically significant correlation (P＞0.05), and the results of ECG and ultrasound heartbeat graph showed that no significant difference in cardiac structure and function before treatment (P＞0.05). After 24 months duration, the research showed that the level of serum calcemia was lower, and the levels of phosphorus and iPTH were higher in hemodialysis group compared with that in the other 2 groups, and the differences had statistical significance (P＜0.05). Themedian levels of Cys-C and NT-proBNP were 8.59 (9.74, 7.10) mg/L and 7 739 (9 887, 6 736) ng/L in the patients CV events occurred. Non conditional multivariate logistic regression analysis demonstrated that the increasing interdialytic weight, Cys-C, NT-proBNP, iPTH, dialysis hypotension were theindependent risk factors of CV occurrence. AUCs to predict CVD occurrence in MHD patients was 0.64 (95%CI 0.53-0.71, P＜0.05) and 0.79 (95%CI 0.72-0.89, P＜0.01) using Cys-C and NT-proBNP respectively. The cut-off values of serum Cys-C and NT-proBNP for CVD occurrence were 8.59 mg/L and 7 739 ng/L, with a sensitivity of 84.3% and a specificity of 92.7%. Conclusions Cys-C, NT-proBNP can be used to predict the risk of CV events in dialysis patients.     

血清miR-210、miR-423联合氨基末端脑利钠肽前体诊断维持性血液透析心血管事件的价值

目的 探讨血清miR-210、miR-423水平联合氨基末端脑利钠肽前体（NT-proBNP）诊断维持性血液透析（MHD）患者心血管事件发生的价值。方法 选取2016年1月至2019年12月海口市骨科与糖尿病医院收治的152例MHD患者,根据在随访6个月期间是否发生心血管事件将患者分为心血管事件组（60例）和无心血管事件组（92例）。采用实时定量PCR法检测两组血清miR-210、miR-423水平,采用酶联免疫吸附法测定NT-proBNP水平。应用多因素logistic回归分析MHD患者发生心血管事件的危险因素。采用受试者工作特征（ROC）曲线分析血清miR-210、miR-423及NT-proBNP水平诊断MHD患者心血管事件发生的价值。结果 心血管事件组的血清miR-210、miR-423及NT-proBNP水平均明显高于无心血管事件组（均P<0.001）。多因素logistic回归分析显示,血清miR-210（OR=2.318,95%CI：1.698～5.112）、miR-423（OR=1.850,95%CI：1.294～3.486）及NT-proBNP（OR=2.627,95%CI：1.815～6.102）水平升高是MHD患者发生心血管事件的危险因素（均P<0.05）。ROC曲线分析显示,miR-210、miR-423联合NT-proBNP诊断MHD患者心血管事件发生的曲线下面积（0.938,95%CI：0.879～0.993）最大,高于三项指标的单项诊断（均P<0.05）,其灵敏度和特异度分别为97.0%和84.6%。结论 发生心血管事件患者的血清miR-210、miR-423及NT-proBNP水平明显升高,是MHD患者发生心血管事件的危险因素,三项联合检测有助于诊断心血管事件的发生。     

Investigation of optimum N-terminal probrain natriuretic peptide level in patients on maintained hemodialysis

Background: Serum N-terminal probrain natriuretic peptide (NT-proBNP) level is known to be strongly associated with fluid overload, and serves as a guide for fluid management in patients on hemodialysis (HD). This study aimed at investigating the relationship between NT-proBNP level and blood pressure (BP), ultrafiltration/dry weight ratio as well as hemoglobin, and to explore the optimal cutoff point of NT-proBNP level in Chinese patients on HD.

Methods: A total of 306 patients on maintained HD for stage 5 chronic kidney disease (CKD) were included in this prospective study. Their average ultrafiltration/dry weight ratio and BP before dialysis were recorded. The serum NT-proBNP, hemoglobin, serum calcium, and phosphorus were detected. The cutoff value for NT-proBNP level was calculated using receiver operating characteristic (ROC) analysis.

Results: The high NT-proBNP level was associated with high BP and ultrafiltration/dry weight ratio, and low hemoglobin level. The optimal cutoff point of NT-proBNP level for patients on maintained HD was 5666?pg/mL, with a sensitivity of 78.5%, specificity of 43.9%, and area under the curve (AUC) of 0.703 (<0.001).

Conclusions: NT-proBNP level ≤5666?pg/mL was recommended to achieve the target BP, hemoglobin level, and ultrafiltration/dry weight ratio in patients on maintained HD with an ejection fraction (EF) >50%.     

Diagnostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) for left ventricular dysfunction in patients with chronic kidney disease stage 5 on haemodialysis.

BACKGROUND: Natriuretic peptides such as N-terminal pro-B-type natriuretic peptide (NT-proBNP) have become increasingly important in diagnosing left ventricular dysfunction (LVD), however, in patients with chronic kidney disease (CKD), their use is confounded by concomitant volume overload and reduced renal excretion. We hypothesized that a serum NT-proBNP cut-off value adjusted for patients with CKD could serve as a biochemical marker to detect LVD in patients on haemodialysis treatment regardless of chronic fluid overload. METHODS: We assessed LV function using trans-thoracic echocardiography and indices of hydration status such as extracellular water (ECW) using bioelectrical impedance analysis (BIA) in 62 stable patients on maintenance haemodialysis. NT-proBNP cutoff values for LVD with different specificities and sensitivities were calculated by ROC curves. RESULTS: We found a significant inverse correlation between LV ejection fraction (EF) and NT-proBNP levels (r = -0.77, P < 0.0001). In the multivariate regression analysis NT-proBNP was the only independent predictor of EF (r = 0.699, P < 0.0001). NT-proBNP levels were significantly higher (P < 0.0001) in patients with LVD (n = 15; 32 760 +/- 6605 ng/L) compared to those without LVD (n = 47; 2835 +/- 428 ng/L). An NT-proBNP cut-off value of 7168 ng/L resulted in 90% specificity and 79% sensitivity for the presence of LVD, i.e. an EF <45% (AUC(ROC): 0.95 +/- 0.03, P < 0.0001). Furthermore, in patients with LVD we found a significant relationship between serum NT-proBNP and markers of fluid overload such as the ECW/body weight ratio (P < 0.0001) and the grade of peripheral oedema (P = 0.007), but not in patients without LVD. CONCLUSION: A serum NT-proBNP cut-off value of >/=7200 ng/L discriminates CKD stage 5 patients without LVD from those with LVD. In those patients with LVD, persistent post-dialytic volume overload correlates with elevated NT-proBNP levels.     

血浆N-末端脑钠肽前体水平与维持性血液透析患者容量状态无关

目的 测定维持性血液透析患者生物电阻抗与血浆N-末端脑钠肽前体水平透析前后的变化,评价N-末端脑钠肽前体水平在血透患者中血容量评估的应用价值.方法 选取我院血液净化中心30例病情稳定的维持性血液透析患者,留取透析前后血标本测定N-末端脑钠肽前体.应用生物电阻抗(英国BodyStat公司QUADSCAN 4000多频生物电阻抗分析仪)测量透析前后体水量.结果 透析后N-末端脑钠肽前体水平较透析前明显升高[分别为(6 478.93±7 503.48)与(4 692.83±4 290.62) pg/ml,P＜0.01].透析后身体成分监测值较透析前明显降低[(-0.987± 1.451)与(0.964± 1.581),P＜0.01].结论 N-末端脑钠肽前体的血浆水平与维持性血透患者血容量无关.     

Analysis of impact factors of serum N-terminal pro-brain natriuretic peptide in patients with renal failure in non-dialysis phase

Objective To analyze the impac factors of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with renal failure in non-dialysis phase, and to determine the cut-off point of as a diagnostic values in these patients with heart failure (HF). Methods Cross-sectional study was applied. Clinical data of 145 patients (37 cases of CKD4, 89 cases of CKD5, and 19 cases of acute renal injury (AKI) with renal failure in non-dialysis phase were collected. Comparison between groups and lineal regression analysis were utilized to investigate the impact factors of NT-proBNP, and the receiver operating characteristic curve (ROC curve) to select a better cut-off point of diagnosis in these patients with HF. Results (1) Compared with patients without HF, patients with HF had significantly higher edema, cardiac troponin I, serum phosphorus concentration, and left atrial diameter (LA), while ALB and left ventricular ejection fraction (LVEF) were decreased (P＜0.05). (2) The NT-proBNP was divided into 4 groups with four points: First groups of 36 cases, NT-proBNP 1 -862 ng/L, second groups 37 cases, 866-2670 ng/L, third groups 37 cases, 2790-20 000 ng/L, fourth groups 35 cases, 20 900-35 000 ng/L. With the increase of NT-proBNP levels, the occurrence of AKI and CKD4 decreased gradually while the occurrence of CKD and edema were significantly increased (P＜0.01). Systolic blood pressure, troponin I, uric acid, serum phosphorus, parathyroid hormone, 24 hours urine protein, LA, interventricular septum thickness (IVS), left ventricular posterior wall thickness (LVPW) level gradually increased. Hb, ALB, calcium, CO2, eGFR, LVEF significantly decreased (P＜0.01). The serum NT-proBNP of patients with HF was significantly higher than that of patients without HF (19 150 ng/L vs 1530 ng/L, P＜0.01). The serum NT-proBNP of patients with edema was significantly higher than that in patients without edema (5460 ng/L vs 1630 ng/L, P＜0.01). (3) Single factor linear regression analysis indicated that higher NT-proBNP was positive correlated with HF, edema, cardiac troponin I, uric acid, serum phosphorus, LA, IVS and LVPW (P＜0.05), while negative correlated with Hb, eGFR, ALB, serum calcium, CO2, LVEF (P＜0.05), and not correlated with eGFR, uric acid, serum calcium (P＞0.05). (4) The best cut-off point of NT-proBNP predicting HF in patients with renal failure in non-dialysis phase was 3805 ng/L, AUC=0.848, 95%CI 0.786-0.910. Sensitivity was 82.4%, specificity 74.5%, positive predictive value 62.1%, negative predictive value 87.3%, positive likelihood ratio 3.2, negative likelihood ratio 0.24. Conclusions The level of NT-proBNP＞20 000 ng/L is mainly found in end-stage renal disease patients with HF. HF is a main factor for the increase of NT-proBNP in patients with renal failure in non-dialysis phase. High phosphorus viremia, anemia, and hypoalbuminemia are closely related to NT-proBNP. Therefore NT-proBNP predicting HF should take into account the effects of these confounding factors in these patients.     

Meta-analysis of B-type natriuretic peptide and prognosis of maintenance hemodialysis patients

Objective To determine whether elevated circulating B-type natriuretic peptide(BNP) or N-terminal B-type natriuretic peptide precursor (NT-proBNP) could predict long-term risks of all-cause mortality, cardiovascular mortality or cardiovascular events among maintenance hemodialysis (MHD) patients. Method Data updated by December 2014 in Cochrane Library, Medline Database, Embase Database, CBMdisc and CEBM/CCD were searched. Related research about the relation of BNP or NT-proBNP and the prognosis of MHD patients were included, regardless of language or whether blind method was used. The data were extracted independently by two reviewers. The methodological quality of trails was assessed by recommended evaluation standard. Statistical analysis was performed with STATA 10.0. Results There were 874 papers found by our search strategy, among which 711 articles were in English and 163 articles were in Chinese. Nineteen papers were eligible according to the inclusion criterion and a total of 6185 cases were included. The Meta-analysis results showed that: (1) Elevated BNP or NT-proBNP was significantly related to increased all-cause mortality (HR: 2.64, 95% CI: 1.73-4.02); (2) Elevated BNP or NT-proBNP was associated with increased cardiovascular events (HR: 5.35-7.04, 95% CI: 2.23-22.33). Conclusion BNP or NT-proBNP is a promising prognostic tool to risk-stratify MHD patients.     

NT-proBNP联合BIA法对维持性血液透析患者容量超负荷及心功能损伤风险的预测作用

目的探讨N端脑钠肽前体(NT-proBNP)联合生物电阻抗法(BIA)对维持性血液透析(MHD)患者容量超负荷及心功能损伤的预测作用。 方法选取医院2018年1月至2020年1月收治的50例终末期肾脏病患者作为研究对象，研究设计为横断面研究，均实施MHD治疗。实施MHD前记录患者基线资料，MHD治疗结束前评估患者容量超负荷及心功能损伤状况。分析细胞内水分(ICW)、细胞外水分(ECW)、NT-proBNP对MHD患者容量超负荷及心功能损伤的预测价值。 结果50例MHD患者中：19例容量超负荷，31例容量负荷正常；7例心功能损伤，43例心功能正常。与容量负荷正常组相比，容量超负荷组的NT-proBNP、ECW升高，ICW降低(P<0.05)；与心功能正常组相比，心功能损伤组的NT-proBNP升高，ICW降低(P<0.05)。Logistics回归分析结果显示，ICW增高是MHD患者发生容量超负荷的保护因素(OR<1，P<0.05)，而ECW、NT-proBNP增高则是其危险因素(OR>1，P<0.05)；ICW增高是MHD患者发生心功能损伤的保护因素(OR<1，P<0.05)，而NT-proBNP增高是其危险因素(OR>1，P<0.05)。分析受试者工作曲线(ROC)发现，MHD患者治疗前NT-proBNP、ICW、ECW水平预测容量超负荷及心功能损伤发生风险的曲线下面积(AUC)均>0.70，提示其均有中等预测作用。 结论NT-proBNP联合BIA法对MHD患者容量超负荷及心功能损伤发生风险具有一定的预测作用。