血浆脑钠肽水平预测维持性血液透析患者容量超负荷的价值

张周沧; 苏香彪; 杨清华; 赵慧; 张东亮; 王梅

doi:10.3969/j.issn.1671-4091.2019.08.007

中国血液净化 >

2019 , Vol. 18 >Issue 08: 539 - 542

DOI: https://doi.org/10.3969/j.issn.1671-4091.2019.08.007

临床研究

血浆脑钠肽水平预测维持性血液透析患者容量超负荷的价值

张周沧 ,
苏香彪 ,
杨清华 ,
赵慧 ,
张东亮 ,
王梅

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1. 北京大学国际医院肾内科血液净化中心
2. 北京大学人民医院肾内科

收稿日期: 2019-03-20

修回日期: 2019-06-06

网络出版日期: 2019-08-15

基金资助

北京大学国际医院院内科研基金资助(YN2017QN15)

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The value of plasma brain natriuretic peptide level for the prediction of fluid overload in maintenance hemodialysis patients

ZHANG Zhou-Cang ,
SU Xiang-Biao ,
YANG Qing-Hua ,
ZHAO Hui ,
ZHANG Dong-Liang ,
WANG Mei

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1Blood Purification Center, Department of Nephrology, Peking University International Hospital, Beijing 102206, China
2Department of Nephrology, Peking University People’s Hospital, Beijing 100044, China

Received date: 2019-03-20

Revised date: 2019-06-06

Online published: 2019-08-15

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摘要

【摘要】目的利用生物电阻抗分析(bioimpedance analysis，BIA)测量将患者容量状态定量化，同期检测血浆脑钠肽(brain natriuretic peptide，BNP)，探讨BNP 在评价维持性血液透析(maitaining hemodialysis dialysis，MHD)患者容量超负荷的价值。方法选择北京大学国际医院透析中心MHD 患者共74 人，BIA 测算化验BNP 当日患者的多余水分(overhydration in the day of measuring plasma BNP，OHbnp)，在BIA 测量2 周内进行超声心动图检查；依据OHbnp是否大于2.5L 将患者分为2 组，正常容量负荷组(OHbnp≤ 2.5L)和容量超负荷组(OHbnp＞2.5L)，比较2 组血浆BNP 及相关指标差异；多重线性回归分析BNP 影响因素；ROC 曲线分析血浆BNP 对容量超负荷的诊断价值。结果容量超负荷组的BNP 显著高于正常容量负荷组[209(116，395)pg/ml 比339(172，843)pg/ml, t=-2.197, P=0.028]。多重线性回归分析显示血浆BNP 受OHbnp(β=0.107±0.037, P=0.005)、血红蛋白(β=-0.012±0.004，P= 0.005)、瘦体质量指数(β= -0.046 ± 0.019, P= 0.016)影响；ROC 曲线显示取BNP 为309pg/ml 时，诊断容量超负荷敏感性为0.548，特异性为0.698。结论容量负荷、血红蛋白及瘦体质量指数均影响MHD 患者血浆BNP，血浆BNP大于309pg/ml提示存在容量超负荷。

关键词： 生物电阻抗分析; 脑钠肽; 容量超负荷; 维持性血液透析

本文引用格式

张周沧 , 苏香彪 , 杨清华 , 赵慧 , 张东亮 , 王梅 . 血浆脑钠肽水平预测维持性血液透析患者容量超负荷的价值[J]. 中国血液净化, 2019 , 18(08) : 539 -542 . DOI: 10.3969/j.issn.1671-4091.2019.08.007

Abstract

【Abstract】Objective To assess the value of plasma brain natriuretic peptide (BNP) for the prediction of fluid overload after the measurements of volume load status by bioimpedance analysis (BIA) and plasma brain natriuretic peptide (BNP) level in maintenance hemodialysis (MHD) patients. Methods We enrolled 74 MHD patients treated in the Blood Purification Center of Peking University International Hospital in this study. Overhydration before hemodialysis in the day of plasma BNP assay (OHbnp) was evaluated by BIA.Echocardiography was performed within two weeks after BIA. The patients were then divided into two groups, the normal fluid load group (OHbnp ≤2.5L) and the fluid overload group (OHbnp＞2.5L). Plasma BNP level and other parameters were compared between the two groups. Multivariate linear regression was used to assess the variables related to BNP. Receiver operating characteristic (ROC) curve was used to investigate the BNP level for the diagnosis of fluid overload in MHD patients. Results BNP was significantly higher in the fluid overload group than in the normal fluid load group [209 (116,395) pg/ml vs. 339 (172, 843) pg/ml,t=-2.197, P=0.028]. Multivariate linear regression revealed that plasma BNP was closely related to the levels of OHbnp (β =0.107 ± 0.037, P=0.005), hemoglobin (β =-0.012±0.004, P=0.005) and lean tissue index(β=-0.046±0.019, P=0.016). ROC curve revealed that the sensitivity and specificity for the diagnosis of fluid overload were 0.548 and 0.698 respectively, when the cut-off value of BNP was set at 309 pg/ml. Conclusion Plasma BNP level was affected by the levels of fluid load, hemoglobin and lean tissue index. Plasma BNP >309 pg/ml suggests the presence of fluid overload.

Key words： Bioimpedance analysis; Brain natriuretic peptide; Fluid overload; Maintenance hemodialysis

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