【摘要】 目的探讨血清氨基端脑钠肽前体(NT-pro-BNP)水平与腹膜透析患者营养状况、残余肾功能及透析充分性的关系。方法以横断面研究方式,检测58例病情稳定的持续非卧床腹膜透析(continuous ambulatoryperitoneal dialysis,CAPD)患者,以及心肾功能正常者(对照组A)和尿毒症非透析患者(对照组B)的血清NT-pro-BNP浓度,评估CAPD患者的透析充分性、残余肾功能以及营养状况,检测相应的生化参数,对数据进行相关分析。结果 CAPD患者血清NT-pro-BNP水平较对照组A明显升高(z=-7.653,P<0.001),差异有统计学意义;与对照组B比较,差异无统计学意义(z=-0.731,P=0.465)。患者血清NT-pro-BNP水平与BMI、ALB、TSF和MAMC呈负相关(r=-0.304,P=0.020;r=-0.385,P=0.003;r=-0.308,P=0.028;r=-0.333,P=0.017);与SGA(r=0.361,P=0.007)呈正相关。与尿量、rGFR、残肾Kt/V、总Kt/V、残肾Ccr、总Ccr呈负相关(-0.504,P<0.001;-0.616,P<0.001;-0.573,P<0.001;-0.331,P=0.020;-0.616,P<0.001;-0.598,P<0.001);总Kt/v≥2.0患者的血清NT-pro-BNP水平低于总Kt/v<2.0的患者,差异无统计学意义(z=-1.061,P=0.289);而总Ccr≥60 L/周的患者血清NT-pro-BNP水平明显低于总Ccr<60 L/周的患者(z=-3.248,P=0.001),差异有统计学意义。多元回归分析显示,定量SGA评分和残肾Ccr是影响腹透患者血清NT-pro-BNP水平两个独立因素(β=0.313,P=0.015;β=-0.418,P=0.002)。结论 CAPD患者的血清NT-pro-BNP水平与营养状况、残余肾功能和透析充分性密切相关;营养不良、残余肾功能下降是影响CAPD患者血清NT-pro-BNP水平的风险因素。更多还原

【Abstract】 Objective To investigate the association of serum N-terminal pro-brain natriuretic peptide(NT-pro-BNP)levels with nutritional status,residual kidney function and dialysis adequacy in patients undergoing continuous ambulatory peritoneal dialysis(CAPD).Methods Fifty eight clinically stable patients undergoing CAPD were enrolled in the study;subjects with no heart and renal diseases served as control group A and uremic patients without dialysis as control group B.Serum NT-pro-BNP concentrations were measured in CAPD patients and control groups.The indices of dialysis adequacy,residual renal function and nutritional status were assessed in CAPD patients;and other biochemical parameters were also examined.Results Serum NT-pro-BNP levels in CAPD patients and in control group B were markedly higher than those in control group A(z=-7.653,z=-6.535;P< 0.001),there was no significant difference between CAPD patients and control group B(z=-0.731,P=0.465).Correlation analysis showed that BMI,MAMC,ALB and TSF were negatively correlated with serum NT-pro-BNP levels in all patients(r=-0.304,P=0.020;r=-0.385,P=0.003;r=-0.308,P=0.028;r=-0.333,P=0.017),and SGA was positively correlated with NT-pro-BNP(r=0.361,P=0.007).In CAPD patients urine volume,rGFR,residual renal Kt/V,total Kt/V,residual renal Ccr and total Ccr were negatively correlated with NT-pro-BNP levels(r=-0.504,P< 0.001;r=-0.616,P< 0.001;r=-0.573,P< 0.001;r=-0.331,P=0.020;r=-0.616,P<0.001;r=-0.598,P< 0.001).Patients with Kt/v≥2.0 tended to have lower serum NT-pro-BNP levels than those with Kt/v < 2.0,but the difference was not statistically significant(z=-1.061,P=0.289).Patients with total Ccr≥60 L/week had lower serum NT-pro-BNP level than those with total Ccr < 60 l/week/1.73m2 patients(z=-3.248,P=0.001).Multivariate regression analysis revealed that quantitative SGA score and residual renal Ccr were independent risk factors for serum NT-pro-BNP levels(β=0.313,P=0.015;β=-0.418,P=0.002).Conclusion Our data suggest that nutritional status,residual renal function and dialysis adequacy are closely associated with NT-pro-BNP in CAPD patients.Malnutrition and reduced residual renal function are independent risk factors for serum NT-pro-BNP levles.更多还原