维持性血液透析与腹膜透析患者血清N末端B型钠尿肽原水平的比较及影响因素探讨

目的比较分析维持性血液透析(MHD)及维持性腹膜透析(MPD)患者血清N末端B型钠尿肽原(NT-proBNP)水平,并探讨影响NT-proBNP水平的因素。方法回顾性分析我院透析中心2011年1月至2014年4月期间终末期肾病进行维持透析治疗的患者临床资料,分为MHD组及MPD组,比较两组患者血清NT-proBNP、超声心动图及相应临床参数,分析并探讨NT-proBNP的影响因素。结果 MHD组NT-proBNP水平、右心房横径、24 h尿量、C反应蛋白(CRP)与MPD组比较,差异均具有统计学意义(P<0.05)。Pearson直线相关分析显示:NT-proBNP与左心室射血分数(LVEF)及尿量显著负相关(r值分别为-0.380、-0.417,P均<0.01),与透析龄、右心房横径(RA)、左心房前后径(LA)、左心室收缩末前后径(LVDS)显著正相关(r值分别为0.343、0.247、0.288、0.341,P均<0.05);NT-proBNP与CRP呈正相关,但不具有统计学意义(P=0.059)。广义线性模型多因素回归分析显示:NT-proBNP与LVEF独立相关(回归系数为-640.641,P<0.01),与其他因素相关性不具有统计学意义。结论 MHD患者较MPD患者的血清NT-proBNP水平明显升高,可能与MHD患者右心房横径较大,残余尿量较少,微炎症状态有关。维持性透析患者NT-proBNP水平与LVFF独立相关,NT-proBNP可作为评估维持性透析患者左心室收缩功能的有效指标。

Comparison of N-terminal pro-brain natriuretic peptide value in maintenance hemodialysis patients and peritoneal dialysis patients and exploration the influencing factors

Objective To compare the level of serum N-terminal pro-brain natriuretic peptide （NT-proBNP） in maintenance hemodialysis （MHD） patients and maintenance peritoneal dialysis （MPD） patients and to explore the factors that affect the variation of NT-proBNP.MethodsA total of 68 patients in our hemodialysis unit from January 1, 2011 to April 30, 2014 were enrolled in the two groups （MHD group and MPD group） and the clinical data were confirmed retrospectively. The serum NT-proBNP value, the results of echocardiography and other clinical parameters in MHD and MPD patients were compared and theinfluencing factors were analyzed.ResultsThere were observed statistically significance between the two groups of the NT-proBNP value, right atrium diameter （RA）, 24-hour urine volume and C reactive protein value （P〈0.05）. Pearson linear correlation analysis showed that NT-proBNP value was significant negative correlation with left ventricular ejection fraction （LVEF） and urine volume （r values were-0.380 and-0.417, respectively,P〈0.01）. And NT-proBNP value was significant positive correlation with the duration of dialysis, RA, left atrium diameter （LA） and left ventricular end-systolic diameter （LVDS） （r values were 0.343, 0.247, 0.288 and 0.341, respectively,P〈0.05）. Moreover NT-proBNP value was positive correlation with CRP value but no statistically difference （P=0.059）. Generalized linear model multiple factors regression analysis showed that NT-proBNP was independently related to LVEF （regression coefficient was-640.641,P〈0.01） and was not related to the other factors significantly. ConclusionsCompared with MPD patients, the level of NT-proBNP was significantly higher in MHD patients, which may be due to larger RA, fewer residual urine volume and more serious micro-inflammation status of MHD patients. And the NT-proBNP value was independently related to LVEF in maintenance dialysis patients. NT-proBNP may be an effective assessment index of left ventricular systolic