Brain Natriuretic Peptide in Hemodialysis Patients: Predictive Value for Hemodynamic Change during Hemodialysis and Cardiac Function
Brain Natriuretic Peptide in Hemodialysis Patients: Predictive Value for Hemodynamic Change during Hemodialysis and Cardiac Function
复制标题
血液透析患者脑钠肽：对血液透析期间血流动力学变化和心脏功能的预测价值
DOI：
10.1159/000109969
复制
发表时间：
2007
影响因子：
4.2
通讯作者：
Y. Kawano
中科院分区：
文献类型：
--
作者：
T. Matayoshi;T. Kato;H. Nakahama;Hiroto Nakata;F. Yoshihara;K. Kamide;T. Horio;Satoko Nakamura;Y. Kawano
背景：虽然脑利钠肽(BNP)被广泛用作心功能的临床标志物，但在血液透析(HD)患者中，对其价值的解释仍存在相当大的混乱，这些患者的BNPS经常升高，而不是心脏疾病。本研究的目的是检验BNP对HD期间血压下降和心功能下降的预测价值。方法：选择2001-2004年收治的需要维持性血液透析的尿毒症患者205例，男160例，女45例，年龄66.5±10.5岁。111例有缺血性心脏病病史。测定所有病例的BNP，并收集年龄、性别、HD持续时间、血常规和超声心动图等临床资料。结果：205例患者的BNP范围为6~16097pg/ml(中位数831)。HD期间平均血压变化为-24.5±20.5 mm Hg，111例患者出现收缩压下降和收缩压下降20 mm Hg。BNP不能预测BP下降的程度。调整混杂因素后，缺血性心脏病、超滤率、透析前收缩压和血钠浓度与血压变化呈显著正相关(t=-2.84、-2.76、-4.68和2.9；p=0.005、t=0.01、p=0.0001和p=0.005)。在超声心动图指标方面，BNP>；785pg/ml可预测左心功能不全(左室短轴缩短率30%，敏感性73%，特异性65%)。结论：BNP水平不能预测血液透析时血压下降。然而，即使在尿毒症患者中，BNP也是一个很好的心功能指标。
Background: Though brain natriuretic peptide (BNP) is widely used as a clinical marker of cardiac function, there is considerable confusion in the interpretation of its value in hemodialysis (HD) patients whose BNPs are often elevated without cardiac diseases. The aim of the present study is to examine the predictive value of BNP for blood pressure (BP) fall during HD and cardiac function. Methods: Subjects consisted of 205 (160 males, 45 females; age 66.5 ± 10.5 years) consecutive uremic patients requiring maintenance HD who were admitted to our hospital during 2001–2004. One hundred and eleven cases had a history of ischemic heart disease. We measured BNP in all cases and collected clinical data including age, sex, duration of HD, blood examination and echocardiography. Results: BNP of all 205 cases ranged from 6 to 16,097 pg/ml (median 831). During HD, the average BP change was –24.5 ± 20.5 mm Hg, and 111 cases showed a systolic BP reduction >20 mm Hg. BNP did not predict the degree of BP fall. After adjusting confounding factors, the presence of ischemic heart disease, ultrafiltration rate, systolic BP before HD and serum sodium concentration showed a significant correlation with BP change (t = –2.84, –2.76, –4.68 and 2.90; p = 0.005, <0.01, <0.0001 and <0.005, respectively). In relation to echocardiographic indices, BNP >785 pg/ml could predict left ventricular dysfunction (fractional shortening of the left ventricle <30%, sensitivity 73%, specificity 65%). Conclusion: The level of BNP could not predict BP fall during HD. However, BNP is a good indicator of cardiac function even in uremic patients.