【摘要】 目的:探讨血浆脑型钠利尿肽(BNP)在维持性血透(MHD)患者左心室舒张功能障碍(LVDD)中的诊断价值。方法:MHD患者59例,透析前行心脏多普勒组织成像检测,按不同舒张早期峰值速度(Ve)与舒张晚期峰值速度(Va)的比值分为LVDD组(Ve/Va<1)和左心室舒张功能正常组(Ve/Va≥1)两组。同时检测透析前血浆BNP、血常规及生化指标、超敏C反应蛋白(hs-CRP)、甲状旁腺激素(PTH)等。结果:LVDD组与左心室舒张功能正常组相比,BNP、hs-CRP、收缩压显著性升高,血红蛋白(Hb)显著性降低(P<0.05)。MHD患者的BNP水平与hs-CRP、收缩压、舒张压等显著正相关,与Hb显著负相关。BNP诊断MHD患者LVDD的曲线下面积(AUC)为0.86(95%C:I 0.76~0.96),353.6 pg.ml-1作为界值的灵敏度为80%,特异度为85%。结论:BNP水平升高对MHD患者合并LVDD可能具有重要的诊断价值。更多还原

【Abstract】 Objective: To evaluate the diagnostic value of B-natriuretic peptide(BNP) in the diagnosis of left ventricular diastolic dysfunction(LVDD) in maintenance hemodialysis(MHD) patients with normal ejection fraction.Methods: The study population comprised 59 MHD patients with normal ejection fraction.The ratio of early to late annular velocity(Ve/Va) was determined as a parameter of diastolic function.Plasma BNP levels and serum high sensitivity C-reactive protein(hs-CRP),parathyroid hormone(PTH) levels were assayed with a commercially available kit.Results: Plasma BNP levels were significantly higher in patients with LVDD than that in persons without LVDD(P<0.01).Plasma BNP levels significantly correlated with hs-CRP(r=0.280,P=0.031),systolic blood pressure(r=0.285,P=0.029),diastolic blood pressure(r=0.259,P=0.048) and hemoglobin(Hb)(r=-0.338,P=0.009).The area under the receiver-operating characteristic curve for BNP to detect LVDD was 0.86(95% CI: 0.76 to 0.96;P<0.001).A BNP value of 353.6 pg·ml-1 had a sensitivity of 80% and a specificity of 85% for detecting diastolic dysfunction.Conclusion: Increased levels of BNP were associated with microinflammation state,anemia and hypertension.BNP may be a discerning marker for the detection and evaluation of LVDD in hemodialysis patients with normal ejection fraction.更多还原