氨基末端脑钠肽前体在慢性肾功能衰竭合并心力衰竭的诊断价值.docVIP

氨基末端脑钠肽前体在慢性肾功能衰竭合并心力衰竭的诊断价值 　　作者：赵爱国　郭小云　夏天　苏如松 作者单位：300211　天津医科大学第二医院肾内科 　　【摘要】 目的　通过观察人血清估算肾小球滤过率(eGFR)与氨基末端脑钠肽(BNP)前体(NT-pro-BNP)之间的关系，比较慢性肾功能衰竭(CRF)合并心力衰竭患者不同eGFR水平NT-pro-BNP的诊断临床界值，研究肾功能对NT-pro-BNP应用于心力衰竭诊断的影响。方法　对老年CRF合并心力衰竭未透析患者52例及无心力衰竭29例和老年健康体检者30例(正常对照组)采用酶联免疫吸附法测定血清NT-pro-BNP浓度，根据eGFR分组进行对比。结果　eGFR30 ml?min-1?(1.73 m2)-1、30～60 ml?min-1?(1.73 m2)-1心力衰竭组NT-pro-BNP水平均高于eGFR30 ml?min-1?(1.73 m2)-1、30～60 ml?min-1?(1.73 m2)-1无心力衰竭对照组和eGFR60 ml?min-1?(1.73 m2)-1正常组(P0.05)，eGFR30 ml?min-1?(1.73 m2)-1、30～60 ml?min-1?(1.73 m2)-1无心力衰竭对照组NT-pro-BNP水平较eGFR60 ml?min-1?(1.73 m2)-1正常组显著升高(P0.05)。eGFR30 ml?min-1?(1.73 m2)-1心力衰竭组与无心力衰竭对照组NT-pro-BNP水平较eGFR 30～60 ml?min-1?(1.73 m2)-1心力衰竭组与无心力衰竭对照组高(t=2.530，P0.05; t=2.158，P0.05)。心力衰竭组和无心力衰竭对照组eGFR与NT-pro-BNP水平呈负相关(心力衰竭组r=-0354，P0.05，对照组r=-0.520，P0.01)。eGFR 30～60 ml?min-1?(1.73 m2)-1心力衰竭组ROC曲线下面积(AUC)为0.926，NT-pro-BNP 410 pmol/L 作为临界值的敏感度为75.0%，特异度为92.9%;eGFR30 ml ?min-1?(1.73 m2)-1心力衰竭组AUC为0.950，NT-pro-BNP 520 pmol/L作为临界值的敏感度为82.1%，特异度为100.0%。结论　NT-pro-BNP水平与肾功能损害严重性微弱相关，在考虑肾功能的前提下可作为判断CRF患者是否合并心力衰竭的诊断指标。 　　【关键词】 利钠肽，脑;　肾小球滤过率;　心力衰竭;　肾功能衰竭;　老年人 　　【Abstract】　Objective　To investigate the influence of renal function on serum NT-pro-BNP in the diagnosis of chronic renal failure (CRF) with heart failure by observing the relationship between eGFR and NT-pro-BNP in serum and comparing cut-off values of NT-pro-BNP in different eGFR levels.Methods　131 elderly participants were enrolled in the study，including 52 patients with heart failure and 29 patients without heart failure as well as 30 healthy controls.Serum NT-pro-BNP levels were measured using ELISA.Results　The levels of serum NT-pro-BNP were increased significantly in subjects with heart failure compared with those with renal dysfunction for no-heart failure patients (P0.05) as well as healthy controls.NT-pro-BNP level was significantly higher in ESRD no-heart failure patients than in control subjects.eGFR showed negative correlation with NT-pro-BNP in ESRD heart