Comparison of the Diagnostic Performance of Three Natriuretic Peptides in Hemodialysis Patients: Which is the Appropriate Biomarker?
Comparison of the Diagnostic Performance of Three Natriuretic Peptides in Hemodialysis Patients: Which is the Appropriate Biomarker?
复制标题
DOI：
10.1159/000343406
复制
发表时间：
2012-01-01
影响因子：
2.8
通讯作者：
Friedrich, Bjoern
中科院分区：
文献类型：
--
作者：
Artunc, Ferruh;Mueller, Christian;Friedrich, Bjoern
背景：慢性血液透析患者血浆利钠肽浓度经常升高，由于蓄积、心脏病高发和容量状态的改变而难以解释。中部地区的pro-ANP是一种新开发的检测方法，而BNP及其片段NT-pro-BNP可用于更长的时间。在这项横断面研究中，我们比较了稳定的门诊血液透析患者（n = 239） MR-pro-ANP、BNP和NT-pro-BNP的血浆浓度，并研究了它们与临床因素（如残余利尿、心脏状态和透析间期体重增加）和死亡率的关系。方法和结果：在所有入组患者中，所有利钠肽的血浆浓度均大幅升高，BNP的中位浓度为337 pg/ml（四分位数范围146-684），NT-proBNP的中位浓度为4435 pg/ml (1687-16228)， MR-pro-ANP的中位浓度为907 pmol/L（650-1298）。所有利钠肽的血浆浓度与年龄、收缩功能障碍程度独立相关，与剩余利尿负相关。MR-pro-ANP和NT-pro-BNP片段对残留肾清除的依赖性最强。所有利钠肽的血浆浓度与随访2年内的死亡率相关。受体操作曲线显示低敏感性（32-45%），但对所有利钠肽具有高特异性（85-93%），导致高阴性预测（82-87%）。NT-pro-BNP的最佳临界值为18 611 pg/ml， BNP为958 pg/ml， MR-pro-ANP为1684 pmol/L。结论：在血液透析患者中，NT-proBNP和MR-pro-ANP片段与BNP相比显著升高，这可能与积累有关。MR-pro-ANP的预后表现与NT-proBNP或BNP相似。版权所有(c) 2012 S. Karger AG，巴塞尔
Background: Plasma concentrations of natriuretic peptides are often elevated in chronic hemodialysis patients and difficult to interpret due to accumulation, high incidence of cardiac disease and changes in volume status. Mid-regional pro-ANP is a newly developed assay whereas BNP and its fragment NT-pro-BNP are available for a longer time. In this cross-sectional study, we compared the plasma concentration of MR-pro-ANP, BNP and NT-pro-BNP in stable ambulatory hemodialysis patients (n = 239) and investigated their associations with clinical factors such as residual diuresis, cardiac status and interdialytic weight gain and with mortality. Methods and Results: In all patients enrolled, the plasma concentration of all natriuretic peptides were largely elevated with a median concentration of 337 pg/ml (interquartile range 146-684) for BNP, 4435 pg/ml (1687-16228) for NT-proBNP and 907 pmol/L (650-1298) for MR-pro-ANP. Plasma concentration of all natriuretic peptides correlated independently with age, degree of systolic dysfunction and negatively with residual diuresis. Dependency on residual renal clearance was strongest for the fragments MR-pro-ANP and NT-pro-BNP. The plasma concentration of all natriuretic peptides was associated with mortality within 2 years of follow-up. Receiver-operated curves revealed a low sensitivity (32-45%), but high specificity for all natriuretic peptides (85-93%) resulting in a high negative predictive (82-87%). Best cut-off values obtained from were 18 611 pg/ml for NT-pro-BNP, 958 pg/ml for BNP and 1684 pmol/L for MR-pro-ANP. Conclusions: In hemodialysis patients, the fragments NT-proBNP and MR-pro-ANP are largely elevated compared to BNP which is explained by accumulation. The prognostic performance of MR-pro-ANP is similar to that of NT-proBNP or BNP. Copyright (c) 2012 S. Karger AG, Basel