维持性血液透析患者血浆ANP和BNP动态变化的意义

目的：探讨ANP、BNP评估维持性血液透析患者水平衡及干体重的价值。方法：40例血液透析龄≥1年的稳定的MHD患者为MHD组，40名健康志愿者为正常对照组。应用放免法检测稳定的MHD患者血液透析前后和透析间期ANP、BNP动态的变化；观察平均每日尿量对MHD患者血液透析前后和透析间期血浆ANP、BNP动态变化影响。结果：MHD患者血浆ANPOh、24h、48h高于-4h（Oh、24hP〈0．01，48hP〈0．05），24h、48h低于Oh（P〈0．01）；48h低于24h（P〈0．05）；血浆BNP血液透析前后和透析间期无差异；MHD患者血浆ANP-4h、24h、48h均低于正常对照组（P〈0．01），0h高于正常对照组（P〈0．05）；MHD患者血浆BNP-4h、0h、24h和48h均明显高于正常对照组（P〈0．01）。0h达干体重和未达干体重的MHD患者血浆ANP、BNP无差异；少无尿的MHD患者血浆ANP、BNP和有尿的MHD患者相比无统计学差异。结论：血浆ANP、BNP可以反映MHD患者的容量状况，BNP水平随容量的增加而增高，且对于容量的评价作用优于ANP，但二者评估干体重不敏感。提示严格控制血压，控制透析间期容量负荷增长，是预防MHD患者心脑血管事件发生的重要措施。

Significance of Dynamic Change of Plasma ANP and BNP Levels in Patients on Maintenance Hemodialysis

Objective To explore the usefulness of determination of plasma ANP,BNP contents for assessment of the volume balance and dry weight in patients on maintenance hemodialysis(MHD).Methods Plasma ANP and BNP contents were determined dynamically with RIA at-4h, on before dralysis and 24h,48h after dialysis in 40 patients on MHD over one year as well as determinedonce in 40 controls.Results Plasma level of ANP in patients at 0,24,48h were higher than those at-4 hour(0h,24h P<0.01,48h P<0.05),level of ANP were lower at 24,48 hour(P<0.01) than those at 0 hour,level of ANP were lower at 48 hour(P<(0.05)) than those at 24 hour,level of ANP were lower in MHD group at-4,24,48 hour(P<0.01) than those in control group,level of ANP were higher in MHD group at 0 hour than those in control group(P<0.05);level of BNP were higher in MHD group at-4,0,24,48 hour than those in control group(P all <0.01).Conclusion The body fluid volume is well reflected by ANP and BNP in MHD patients,but both ANP and BNP are not sensitive parameters to evaluate the dry weight.Strict control of blood pressure and restriction of fluid increase during hemodialysis are beneficial to lessen the incidence and mortality of cardiovascular and cerebrovascular disease in MHD patients.