N-末端前体脑钠肽对终末期肾脏病患者心力衰竭的诊断价值研究

目的 探讨N-末端前体脑钠肽(NT-proBNP)在终末期肾脏病(ESRD)患者合并心力衰竭时的早期诊断价值。评估ESRD患者血浆NT-proBNP诊断心力衰竭的临界值。方法 选取2012年1月至2013年3月大连医科大学附属第二医院肾内科的CKD 5期患者63例，根据临床症状体征、超声心动图以左室射血分数(LVEF)下降分为肾衰心力衰竭组(31例)和单纯肾衰组(32例)，同时选取心内科心力衰竭患者(32例)，另外选取同期体检人员为对照组(30例)，采用双抗体夹心原理的一步法酶免疫法测定血浆NT-proBNP水平。结果 肾衰心力衰竭组、单纯肾衰组、单纯心力衰竭组及正常对照组血浆NT-proBNP分别为(40 414.99±35 160.62)ng/L、(16 884.37±16 362.34)ng/L、(3229.19±2606.05)ng/L和(98.26±15.63)ng/L，两两比较差异均有统计学意义。以慢性肾衰心力衰竭组为实验组分析ROC曲线下面积为0.726，95%的可信区间0.602～0.849。当临界值为9934.75 ng/L时，计算NT-proBNP对肾衰心力衰竭中的诊断价值：灵敏度83.9%，特异度78.1%，正确诊断指数1.62。阳性预测值为79%，阴性预测值为83%。结论 血浆NT-proBNP受肾功能的影响；肾功能损害时诊断心力衰竭时NT-proBNP临界值应相应提高；NT-proBNP测定诊断终末期肾脏病患者心力衰竭有较高的准确性。

clinical diagnostic value of N-terminal pro-brain natriuretic peptide in end-stage renal disease patients complicated with heart failure.

Abstract：Objective To evaluate the value of N-terminal pro-brain natriuretic peptide (NT-proBNP) for the diagnosis of heart failure in patients with end-stage renal disease (ESRD) and find the cut-off value of plasma NT-proBNP in diagnosing this disease.Methods A total of 63 ESRD patients admitted in the Nephrology Department of the Second Affiliated Hospital of Dalian Medical University from 2012 January to 2013 March were enrolled.ESRD patients was divided into 2 groups： Isolated renal failure group with 32 patients having isolated renal failure.Renal failure and heart failure with 31 patients diagnosed with heart failure with the symptoms or ultrasonic heartbeat graph at left ventricular ejection fraction (LVEF).Meanwhile，32 patients with pure heart failure were selected from the Cardiology Department of the same hospital.Another 30 normal individuals received body examination in our hospital were enrolled as the control group.The levels of NT-proBNP were measured by double antibody sandwich method in all the groups.Results The levels of NT-proBNP were (16 884.37±16 362.34)ng/L，(3229.19±2606.05)ng/L，and (40 414.99 ± 35 160.62)ng/L in the isolated renal failure group，the pure heart failure group，and the renal failure and heart failure group respectively，significantly higher than those in the control group (［98.26±15.63］ng/L，all P<0.05).The levels of NT-proBNP were decreased successively in the renal failure and heart failure group，the isolated renal failure group and the pure heart failure group，and the differences were significant (P<0.05).The area under the ROC curve for NT-proBNP levels as a diagnostic indicator for heart failure in ESRD patients was 0.726，and asymptotic 95% confidence interval (95%CI) was 0.602-0.849.The cut-off value was 9934.75 ng/L.Their sensitivity，specificity，positive predictive value，negative predictive value and Youden’s index were 83.9%，78.1%，79%，83% and 1.62 respectively.Conclusion Plasma levels of NT-proBNP are influenced by cardiac function and renal function.The cut-off value of NT-proBNP in renal failure patients with heart failure should be higher than normal.The levels of plasma NT-proBNP have a high diagnostic value for heart failure in ESRD patients.