N末端B型钠尿肽前体在血液透析隐性浮肿患者中临床应用.docVIP

N末端B型钠尿肽前体在血液透析隐性浮肿患者中的临床应用 廖爱能 陈爱萍 金哲 吴文胜 王小华 王新珠 福建中医药大学第五临床医学院 三明市第二医院肾脏风湿科 福建永安 366000 【摘要】 目的：探讨血N末端B型钠尿肽前体（NT-proBNP）在维持性血液透析隐性浮肿患者中的应用价值；方法：检测32例临床无明显浮肿、心力衰竭表现的维持性血液透析终末期肾脏病患者血NT-proBNP水平，同时监测患者体重（BW）、动态血压监测（ABPM）24小时平均收缩压/平均舒张压（24hMSBP/24hMDBP）、血红蛋白（HGB）、血白蛋白水平（ALB）、评估的肾小球滤过率（eGFR）、24小时尿量（24hUV）；心脏超声指标：室间隔厚度（IVST）、左室后壁舒张末厚度（LVPWT）、左室舒张末内径（LVEDd)，并计算左室质量指数（LVMI）；达到干体重时复查上述指标并进行比较分析； 结果：1）隐性浮肿容易被患者忽视；2）达到干体重前后比较，患者血NT-proBNP水平、BW、24hMSBP/24hMDBP均下降，且治疗前后血NT-proBNP水平均高于健康对照组，有显著差异（p＜0.05或p＜0.01），而HGB、ALB、eGFR、24hUV、LVMI无明显变化（p＞0.05）；3）NT-proBNP降幅与体重的下降值之间呈正相关（p=0.025），与24hMSBP、24hMDBP及LVMI的下降值无明显相关（p＞0.05）。结论：要重视对血液透析隐性浮肿患者干体重的定期评估，血NT-proBNP水平动态检测有助于判断患者体重变化。 【关键词】 N末端B型钠尿肽前体；隐性浮肿；血液透析 Application of N-terminal pro-B-type natriuretic peptide for maintenance hemodialysis patients with recessive edema. LIAO Ai-neng, CHEN Ai-ping, JIN zhe, et al. Department of Nephropathy Rheumatology, The second hospital of Sanming, The fifth clinical medical college of Fujian University of Traditional Chinese Medicine. Yongan, 366000, China. 【Abstract】 Object To evaluate the application of N-terminal pro-B-type natriuretic peptide(NT-proBNP)for maintenance hemodialysis(MHD)patients with recessive edema. Methods The level of blood NT-proBNP was tested pre- and post-dialysis until obtaining dry weight(DW)in 32 MHD patients with recessive edema and without clinical manifestation of heart failure, clinical data include body weight(BW),24-hour mean systolic/diastolic blood pressure (24hMSBP/24hMDBP), hemoglobin(HGB),albumin(ALB), estimated glomerular filtration rate(eGFR),24hours urine volume(24hUV) were collected and analyzed as well, ultrasonic cardiography (UCG) examination was performed to determine interventricular septal thickness (IVST）、left ventricular posterior wall thickness（LVPWT）、left ventricular end-diastolic diameter（LVEDd) and left ventricular mass index (LVMI). Results 1）Recessive edema was easily ignored. 2)The level of blood NT-proBNP, BW and 24hMSBP/24hMDBP we