血浆B型利钠肽水平对老年腹膜透析患者心功能的评估价值

目的初步观察不同心功能状态下的老年CAPD患者血浆BNP变化，并判断其对心脏组织结构及功能改变的影响。方法收集2006年1月至2007年3月在我院腹膜透析门诊随访的90例老年腹膜透析患者的血浆标本，采用免疫荧光法检测其BNP的水平，以彩色多普勒超声心动图测定患者的左室射血分数（LVEF）、左心室心肌质量指数（LVMl）等指标。依据NYHA分级方案对心衰患者进行心功能分级。探讨BNP水平与心功能LVEF、LVMI等之间的关系。结果（1）腹膜透析患者C组的BNP巾位数（908pg／ml）高于B组（290pg／ml）和A组（195.5pg／ml），（P〈0.05）。（2）相关性分析提示BNP与LVMI呈正相关（r=0.3153，P〈0.05），BNP与LVEF呈负相关（r=-0.4756，P〈0.05）。（3）ROC曲线分析发现BNP诊断CAPD患者心衰的诊断界值（cutoff值）为224pg／ml，其诊断心衰的灵敏度和特异度分别为84.6％和78.9％。结论老年腹膜透析患者的血浆BNP水平随着心功能的减退逐渐增高，血浆BNP的浓度与心室重塑以及左心室功能密切相关，其心衰诊断的灵敏度和特异度较高，作为初步评价老年腹膜透析患者心功能，客观性预测临床心衰发生的实验室指标有其临床应用价值。

Value of plasma BNP in evaluating cardiac function of elderly patients on peritoneal dialysis

Objective To detect changes of plasma brain natriuretic peptide(BNP)in elderly patients with chronic renal failure(CRF)who were on peritoneal dialysis,and to examine the diagnostic value of BNP for evaluating cardiac function in such patients.Methods Plasma BNP concentration was measured in 90 CRF patients on peritoneal dialysis,in whom echocardiographic examinations were performed to determine the relationship between BNP and New York Heart Association(NYHA)classification including LVEF and LVMI.Results(1)The median plasma BNP level was 908pg/ml in group C,290 pg/ml in group B,and 195.5 pg/ml in group A;the difference was significant between the three groups(P<0.05);(2)Spearsman analysis showed that BNP level was significantly negatively correlated with left ventricular function and positively correlated with LVMI(P<0.05);and(3)When cutoff value was 224 pg/ml for heart failure,sensitivity and specificity were 84.6% and 78.9%,respectively.Conclusions Plasma BNP level in elderly patients with heart failure who were on peritoneal dialysis was significantly higher than that in patients with normal cardiac function,and high Plasma BNP level was significantly correlated with left ventricular function and poor cardiac function.BNP is a valuable biomarker for evaluation of cardiac function and diagnosis of heart failure.