【摘要】 目的通过对维持性血液透析(maintenance hemodialysis,MHD)患者血清N端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-pro BNP)的变化率与血压、体液水分含量和NTpro BNP等指标的分析,探讨NT-pro BNP变化率对MHD患者容量负荷及透析超滤量的诊断价值。方法检测103位患者透析治疗前、后血清NT-pro BNP的水平,计算NT-pro BNP的变化率。根据NT-pro BNP变化率的中位数进行分组,对2组患者各个时段血压、总体水含量(total body water,TBW)、细胞外液(extracellular water,ECW)和细胞内液(intracellular water,ICW)以及透析前NT-pro BNP水平比较。结果①MHD患者透析后NT-pro BNP水平较透析前明显下降(Z=-3.968,P<0.001)。②NT-pro BNP变化率小于等于0的患者占总体数值的32.1%,大于0的患者占67.9%。③NT-pro BNP变化率与透析第2h血压呈明显的负相关(r=-0.198,P=0.045),与透析前血压与透析第2h血压差值呈明显的正相关。(r=0.265,P=0.007)。NT-pro BNP变化率较大组第2小时(t=2.466,P=0.015)和第3h(t=2.113,P=0.037)血压明显低于较小组。④NT-pro BNP变化率较大组TBW(t=2.579,P=0.012)、ECW(t=2.297,P=0.006)ICW(t=2.126,P=0.036)和NT-pro BNP(z=1.829,P=0.002)明显低于较小组。结论血清NT-pro BNP变化率有助于判断MHD患者的容量负荷以及在一定的时间内是否能最大限度的清除体内潴留的水分。更多还原

【Abstract】 Objective To explore the diagnostic value of N-terminal pro-brain natriuretic peptide(NTpro BNP) change rate in the estimation of volume load and ultrafiltration volume in maintenance hemodialysis(MHD) patients through the analyses of the correlation among NT- pro BNP change rate, serum NT- pro BNP concentration, blood pressure and water content in the body. Method The change rate of serum NT-pro BNP concentration before and after a dialysis session was calculated in 103 maintenance hemodialysis(MHD) patients. These patients were then divided into 2 groups based on the median value of the change rate. NT-pro BNP concentration before dialysis, blood pressure, total body water(TWB), extracellular water(ECW), intracellular water(ICW) and serum were compared between the 2 groups. Result ①Serum NT-pro BNP concentration decreased significantly after dialysis as compared with the value before dialysis(P=0.001). ②The decrease rate of serum NT-pro BNP was less than zero in 32.1% patients, and was more than zero in 67.9% patients. ③The change rate of NT-pro BNP was negatively correlated with the blood pressure at the 2nd hour of a dialysis session(r=- 0.198, P=0.045), and was positively correlated with the blood pressure differences between pre- dialysis and at the 2nd hour of a dialysis session(r=0.265, P=0.007). Patients in the group with more NT-pro BNP change rate had lower blood pressure at the 2nd(t=2.466, P=0.015) and 3rd hour(t=2.113,P=0.037) in a dialysis session than those in the group with less NT- pro BNP change rate. ④Patients in the group with more NT-pro BNP change rate had lower TBW(t=2.579, P=0.012), ECW(t=2.297, P=0.006), ICW(t=2.126, P=0.036) and NT-pro BNP(z=1.829, P=0.002) than those in the group with less NT-pro BNP change rate. Conclusion Serum NT- pro BNP change rate is a useful marker for the determination of volume load and the evaluation of water retention clearance in a defined period of time in MHD patients.更多还原