【作者】 李燕；

【导师】 刘大军；

【作者基本信息】 中国医科大学 ， 内科学（专业学位）， 2021， 硕士

【摘要】 目的:通过检测慢性肾脏病患者血清中脑钠肽(brain natriuretic peptide,BNP)与N末端B型利钠胎原(N-terminal pro-brain natriuretic peptide,NT-Pro BNP),血红蛋白,白蛋白水平在不同慢性肾脏病(chronic kidney disease,CKD)分期的变化情况,同时结合心脏彩色多普勒超声的代表收缩功能的射血分数(Ejection Fraction,EF)及代表舒张功能的E/A值探讨BNP、NT-proBNP评价心功能的意义,以及其他因素对于BNP及NT-proBNP指标的影响。方法:研究对象观察组选自2019年9月到2020年10月于中国医科大学附属盛京医院滑翔院区肾脏内科住院治疗的慢性肾病患者共82例。应用按照我国改良的肾脏病膳食改善试验(Modification of Diet in Renal Disease,MDRD)公式计算肾小球滤过率,根据肾小球滤过率将观察组分为CKD1期、CKD2期、CKD3期、CKD4期、CKD5期,然后再分为观察1组即CKD1-2期组(15例),观察2组即CKD3-4期组(22例),观察3组即CKD5期组(未透析)(30例),观察4组即规律透析4周以上组(15例)。对照组选自同期于中国医科大学附属盛京医院滑翔院区心血管内科住院诊断为心脏神经官能症的48例患者。比较不同分组BNP及NT-proBNP的浓度差异、血红蛋白浓度差异,白蛋白浓度差异;针对观察组,按照心脏彩色多普勒超声E/A值>1及E/A值≦1分为心脏舒张功能正常及心脏舒张功能下降两组,比较其BNP及NT-proBNP的浓度差异。按照心脏多普勒彩色超声EF值>55%及EF值≦55%分为心脏收缩功能正常及心脏收缩功能下降的两组比较BNP及NT-proBNP的浓度差异;利用接受者操作特性曲线(receiver operating characteristic curve,ROC),评估慢性肾脏疾病患者BNP及NT-proBNP在心脏彩色多普勒超声EF值≦55%时ROC曲线下方的面积大小(Area Under Curve,AUC)及临界值;比较慢性肾脏病患者BNP及NT-proBNP与EF值的相关性。结果:观察组中NT-proBNP、BNP水平明显高于对照组,观察1、2、3、4组的NT-proBNP、BNP浓度随着肾功能不全的进展逐渐上升;所有观察组的EF值水平均低于对照组EF值的水平,观察1、2、3、4组的EF值水平相近但随着肾功能进展仍有下降趋势;观察组的血清白蛋白水平及血红蛋白水平较对照组低。观察组中BNP与EF值的皮尔逊相关性为-0.557(P<0.01),NT-proBNP与EF值的皮尔逊相关性为-0.483(P<0.01)。ROC曲线下观察组的NT-proBNP的面积为AUC=0.797,BNP的AUC=面积为0.852。BNP对于慢性肾脏病患者EF值≦55%的临界值为237.45pg/ml,NT-proBNP对于慢性肾脏病患者EF值≦55%的临界值为29955pg/ml。结论:BNP及NT-proBNP在慢性肾脏病患者中对于左心室射血分数下降的诊断仍有意义,而慢性肾脏病患者中BNP与EF值的相关程度较NT-proBNP更为密切,而且对于诊断EF值的敏感性、真实性及特异性均较NT-proBNP更强;BNP及NT-proBNP对慢性肾脏病患者心脏舒张功能变化无意义。肾功能不全对BNP及NT-proBNP水平有影响,且随着肾功能不全的进展,BNP及NT-proBNP水平逐渐升高,而CKD1期-CKD4期的肾功能对于EF值无明显影响。更多还原

【Abstract】 Objective : The changes of serum brain natriuretic peptide(BNP)and N-terminal B-type natriuretic placenta(NT-proBNP),hemoglobin and albumin in different CKD stages were detected in patients with chronic renal disease,and the significance of BNP and NT-proBNP in evaluating cardiac function was discussed by combining the ejection fraction((EF))representing systolic function and E / A value representing diastolic function by color Doppler echocardiography.And the influence of other factors on BNP and NT-proBNP index.Methods : A total of 82 patients with chronic kidney disease were selected from September 2019 to October 2020 in the Department of Nephrology,Department of Nephrology,Shengjing Hospital affiliated to China Medical University.The glomerular filtration rate was calculated according to the modified(MDRD)formula of dietary improvement test for kidney disease in China.according to the glomerular filtration rate,the experimental group was divided into CKD1 stage,CKD2 stage,CKD3 stage,CKD4 stage and CKD5 stage,and then divided into experimental group1,CKD1-2 group(n = 15),experimental group 2,CKD3-4 group(n = 22),and experimental group 3,namely CKD5 stage group(n = 30).Experimental group 4:regular dialysis group(n = 15).The control group was selected from 48 patients with cardiac neurosis diagnosed in the Department of Cardiovascular Medicine of Shengjing Hospital affiliated to China Medical University in the same period.The differences of BNP and NT-proBNP concentration,hemoglobin concentration and albumin concentration in different groups were compared.According to the value of E/ A > 1 and E / A > 1,the experimental group was divided into two groups: normal cardiac diastolic function and decreased cardiac diastolic function to compare the concentration difference of BNP and NT-proBNP,and to compare the concentration difference of BNP and NT-proBNP between the two groups according to the EF >55% and the EF > 55% of cardiac Doppler echocardiography,the two groups were divided into two groups: normal cardiac systolic function and decreased cardiac systolic function.The ROC curve was used to evaluate the AUC area and critical value of BNP and NT-proBNP in patients with chronic kidney disease when the EF value of cardiac color Doppler ultrasound was 55%.The correlation between BNP,NT-proBNP and EF in patients with chronic kidney disease was compared.Results : The levels of NT-proBNP and BNP in the experimental group were significantly higher than those in the control group,and the concentrations of NT-proBNP and BNP in the experimental group 1,2,3 and 4 increased gradually with the progress of renal insufficiency,and the EF levels in all experimental groups were lower than those in the control group.The EF levels in experimental groups 1,2,3and 4 were similar,but still decreased slowly with the progress of renal function.The levels of serum albumin and hemoglobin in the experimental group were lower than those in the control group.In the experimental group,the Pearson correlation between BNP and EF was-0.557,and the Pearson correlation between NT-proBNP and EF was-0.483(P < 0.01).Under the ROC curve,the NT-proBNP area of the experimental group was AUC=0.797,BNP,and the AUC= area of the experimental group was 0.852.The critical value of BNP for patients with chronic kidney disease was 237.45 pg for patients with chronic kidney disease and the cut-off value for patients with chronic kidney disease was 29955pg/ml.Conclusions : BNP and NT-proBNP still have significance in the diagnosis of decreased left ventricular ejection fraction in patients with chronic kidney disease,but in patients with chronic kidney disease,the correlation between BNP and EF is closer than that of NT-proBNP,and the sensitivity,authenticity and specificity of EF are stronger than that of NT-proBNP.BNP and NT-proBNP have no significance in the change of cardiac diastolic function in patients with chronic kidney disease.Renal insufficiency affected the levels of BNP and NT-proBNP,and with the development of renal insufficiency,the levels of BNP and NT-proBNP increased gradually,while the renal function from CKD1 to CKD4 had no significant effect on EF.更多还原