连续静脉血液滤过治疗对血浆NT-proBNP水平的影响及其意义

目的:研究连续静脉血液滤过(CVVH)对N端脑钠尿肽原(NT-proBNP)的影响，以及此类患者CVVH治疗前后NT-proBNP的水平和心功能的相关性。方法: 对50例接受CVVH治疗患者的临床资料进行回顾性分析，收集CVVH治疗前后的血样，采用电化学发光免疫技术检测血浆NT-proBNP的水平，并比较NT-proBNP水平在血液净化治疗前后的变化及其与左室射血分数(LVEF)的相关性。结果: 血浆NT-proBNP的水平在CVVH治疗前明显高于治疗后（P<0.01）。CVVH治疗前NT-proBNP的水平与LVEF呈负相关性（Pearson系数为-0.783），治疗结束后此种相关性消失。CVVH治疗前，死亡组患者NT-proBNP的水平高于存活组患者（P<0.01）。治疗结束后，两组患者血浆NT-proBNP的水平无统计学差异。结论: CVVH治疗可以使血浆NT-proBNP的水平显著下降，且NT-proBNP水平下降的程度与CVVH治疗的时间及脱水量呈正相关。对于接受CVVH治疗及肾功能不全的患者，需慎重以NT-proBNP的水平作为评价心功能的血清学指标。

Changes and significance of plasma NT-proBNP level in patients treated with continuous veno-venous hemofiltration

AIM: To explore the influence and significance of serum NT-proBNP level in patients treated with continuous veno-venous hemofiltration(CVVH) and to investigate the relationship of NT-proBNP and heart function before and after CVVH therapy.METHODS: Clinical data of 50 patients treated with CVVH therapy were retrospectively analyzed.The level of NT-proBNP was measured by electrochemiluminescence immunoassay and the changes of NT-proBNP with LVEF were compared before and after CVVH therapy.RESULTS: The NT-proBNP level before CVVH therapy was significant higher than that after CVVH therapy(P<0.01).Before CVVH therapy,NT-proBNP was closely related to LVEF(Pearson correlation is-0.783),whereas after CVVH the correlation of NT-proBNP and LVEF disappeared.Before CVVH therapy,the NT-proBNP level of nonsurvivors was higher than that of survivors,whereas after CVVH no statistically difference was observed between nonsurvivors and survivors.CONCLUSION: CVVH therapy significantly decreases plasma NT-proBNP level and the descent is closely related to the amount of dehydration and time of CVVH therapy.As a biochemical marker to evaluate the heart function of patient,NT-proBNP should be cautiously used in patients with renal insufficiency and patients treated with CVVH.