Association between brain natriuretic peptide and extracellular water in hemodialysis patients
Association between brain natriuretic peptide and extracellular water in hemodialysis patients
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DOI：
10.1159/000073669
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发表时间：
2003-10-01
影响因子：
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通讯作者：
Palumbo, R
中科院分区：
文献类型：
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作者：
Fagugli, RM;Palumbo, B;Palumbo, R
背景：脑钠肽（BNP）是左心室在压力或容量负荷下释放的一种激素。BNP在左心室肥厚（LVH）、左心室功能不全时升高，它还可以预测普通人群以及接受血液透析（HD）的人群的心血管死亡率。我们研究了血液透析患者BNP与容量负荷之间的关系。方法：我们研究了32例HD患者（60+/-17.1岁），每周治疗3次，至少6个月。排除标准：左室功能障碍、心房颤动、营养不良。在周中HD日测定血液化学和BNP。通过24小时动态血压监测和超声心动图，在周中HD间期测定血压（BP）和心脏直径。血液透析后进行生物阻抗测定，细胞外水（ECW%），计算为总身体水分的百分比，被认为是容量负荷的指标。结果如下：根据BNP值，将患者分为四分位数，每组8例：第1个qtl BNP小于或等于45.5 pg/ml（28.4+/-10.9 pg/ml），第二qtl BNP>45.5 pg/ml且小于或等于99.1 pg/ml（60.9+/-15.8 pg/ml），第三qtlBNP>99.1 pg/ml且小于或等于231.8 pg/ml（160.5+/-51.8 pg/ml），第四qtlBNP>231.8 pg/ml（664.8+/-576.6 pg/ml）。未报告年龄、HD年龄、体重指数spKt/V或血生化的四分位数间差异。正如预期的那样，BNP第4四分位数的患者显示出24小时脉压（PP）和LV质量指数（LVMi）的最高值。身体成分的研究显示，ECW%存在显著差异，第四四个四分位数的ECW %高于其他四分位数（第四个四分位数：50+/-9.6%，1st q. 40.1+/-2.4%，第二个q。41.9+/-5%，第3个q。42.8+/-6.9%）。采用多元逐步线性回归，其中BNP为因变量，PP和ECW%为自变量，只有ECW%作为BNP水平的预测因子保持统计学显著性（PP：Beta=0.86，p=0.58; ECW%：Beta=0.64，p
Background: Brain natriuretic peptide (BNP) is a hormone released by the left ventricle (LV) as a consequence of pressure or volume load. BNP increases in left ventricle hypertrophy (LVH), LV dysfunction, and it can also predict cardiovascular mortality in the general population as well as those undergoing hemodialysis (HD). We investigated the association between BNP and volume load in HD patients. Methods: We studied 32 HD patients (60+/-17.1 years) treated thrice-weekly for at least 6 months. Exclusion criteria were: LV dysfunction, atrial fibrillation, malnutrition. Blood chemistries and BNP were determined on mid-week HD day. Blood pressure (BP) and cardiac diameters were determined on mid-week inter-HD day by using 24-hour ambulatory blood pressure monitoring and echocardiography. Bioimpedance was performed after HD and extracellular water (ECW%), calculated as a percentage of total body water, was considered as the index of volume load. Results: Patients were divided into quartiles of 8 patients depending on the BNP value: 1st qtl BNP less than or equal to45.5 pg/ml (28.4+/-10.9 pg/ml), 2nd qtl BNP>45.5 pg/ml and less than or equal to99.1 pg/ml (60.9+/-15.8 pg/ml), 3rd qtl BNP>99.1 pg/ml and less than or equal to231.8 pg/ml (160.5+/-51.8 pg/ml), 4th qtl BNP>231.8 pg/ml (664.8+/-576.6 pg/ml). No inter-quartile differences were reported in age, HD age, body mass index spKt/V, or blood chemistries. As expected patients in the 4th BNP quartile showed the highest values of 24-hour pulse pressure (PP) and LV mass index (LVMi). The study of body composition revealed significant differences in ECW%, which was higher in the 4th quartile when compared to the others (4th q: 50+/-9.6%, vs 1st q. 40.1+/-2.4%, 2nd q. 41.9+/-5%, 3rd q. 42.8+/-6.9%). Using multiple stepwise linear regression where BNP was the dependent variable, and PP and ECW% the independent variables, only ECW% maintained statistical significance as a predictor of BNP levels (PP: Beta=0.86, p=0.58; ECW%: Beta=0.64, p