文章摘要
张英姿,刘 宏,刘金洪,胡 宏.MHD患者血浆BNP水平与左心室功能异常和结构重塑的关系及其危险因素分析[J].南京医科大学学报,2015,(10):1409~1414
MHD患者血浆BNP水平与左心室功能异常和结构重塑的关系及其危险因素分析
Association of plasma brain natriuretic peptide level and left ventricular remodeling in patients with maintenance haemodialysis
投稿时间:2014-07-17  
DOI:10.7655/NYDXBNS20151016
中文关键词: 脑型钠利尿肽  血液透析  左心室舒张功能障碍  左室构型
英文关键词: brain natriuretic peptide  maintenance haemodialysis  left ventricular diastolic
基金项目:江苏省自然科学基金(BK2011061)
作者单位
张英姿 东南大学医学院附属江阴医院肾脏科, 江苏 江阴 214400 
刘 宏 东南大学临床医学院肾脏病研究所, 江苏 南京 210009 
刘金洪 东南大学医学院附属江阴医院肾脏科, 江苏 江阴 214400 
胡 宏 东南大学医学院附属江阴医院肾脏科, 江苏 江阴 214400 
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中文摘要:
      目的:评价血浆脑型钠利尿肽(BNP)水平与维持性血液透析(MHD)患者左心室重构和舒张功能障碍的关系,并分析影响MHD患者血浆BNP水平的危险因素。方法:MHD患者85例,于透析前行心脏多普勒组织成像检测,按舒张早期峰值速度(Ve)与舒张晚期峰值速度(Va)的比值(Ve/Va)分为左心室舒张功能障碍组(Ve/Va < 1,n=36)和舒张功能正常组(Ve/Va ≥1,n=49)。同时测定透析前血常规?生化?超敏C-反应蛋白(hs-CRP)?甲状旁腺激素(PTH)?血浆BNP等。结果:左室舒张功能障碍组与左室舒张功能正常组相比,BNP水平显著升高(P < 0.01),且BNP诊断MHD患者左心室舒张功能障碍的曲线下面积(AUC)为0.724 (95%CI:0.606~0.842,P < 0.001)。进一步依据左心室舒张末内径(LVDD)?室间隔厚度(IVST)?左室后壁厚度(PWT)评估患者左室构型,将其分为正常构型组?向心性肥厚组和离心性肥厚组。向心性肥厚组与正常构型组相比血浆BNP水平显著升高(P = 0.007)。单因素相关分析结果提示,MHD患者血浆BNP水平与收缩压(SBP)?脉压?IVST?PWT显著正相关。多元线性回归分析显示,SBP?IVST?PWT是BNP水平升高的独立危险因素(F=3.217,P=0.028)。结论:SBP?IVST?PWT增加是MHD患者BNP水平的独立危险因素,且BNP水平升高是该患者群左室舒张功能障碍及左室向心性肥厚的生物标志物。
英文摘要:
      Objective:To determine the association of plasma brain natriuretic peptide (BNP) level and left ventricular remodeling in patients with maintenance haemodialysis (MHD) and to evaluate the risk factors for increased BNP levels in this population. Methods: We measured the left ventricular diastolic dimension (LVDD), interventricular septal thickness (IVST), left ventricular posterior wall thickness (PWT), according to ratio of early to late left ventricular filling velocity (Ve/Va) by tissue Doppler imaging in 85 patients with MHD. The patients were divided into two groups: left ventricular diastolic dysfunction (Ve/Va<1,n=36) and without left ventricular diastolic dysfunction (Ve/Va≥1, n=49). Plasma high sensitivity C-reactive protein (hs-CRP), parathyroid hormone (PTH) and BNP levels were determined from medical records. Results: Plasma BNP levels were significantly higher in patients with left ventricular diastolic dysfunction than in those without left ventricular diastolic dysfunction (P < 0.01). The area under the receiver-operating characteristic curve for BNP to detect left ventricular diastolic dysfunction was 0.724 (95% CI: 0.606-0.842, P < 0.001). According to LVDD, LVST and PWT, patients were further divided into three groups: the left ventricle with normal structure group, left ventricle with concentric hypertrophy group, and the left ventricle with eccentric hypertrophy group. Plasma BNP levels had significantly positive correlation with systolic blood pressure, pulse pressure, IVST, and PWT. Stepwise multiple regression analysis further revealed that SBP, IVST and PWT were independent risk factors for increased BNP levels (F=3.217, P=0.028). Conclusion: Plasma BNP level is significantly higher in MHD patients with left ventricular concentric hypertrophy and may be a biomarker for assessing left ventricular function. SBP, IVST and PWT are independent risk factors for increased BNP level.
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