NT―proBNP联合生物电阻抗法对CKD5期患者呼吸困难鉴别诊断意义.docVIP

NT―proBNP联合生物电阻抗法对CKD5期患者呼吸困难鉴别诊断意义 　　【摘要】 目的：探讨氨基末端B型脑钠肽前体（NT-proBNP）联合生物电阻抗法对CKD5期患者呼吸困难鉴别诊断的意义。方法：选取笔者所在医院2015年1月-2016年10月因呼吸困难就诊的CKD5期住院患者共60例，分为心力衰竭组和非心力衰竭组，测定其血浆NT-proBNP水平，并用人体成分分析仪测定容量负荷（OH值）。另纳入同期无呼吸困难的CKD5期患者30例，设为A对照组，纳入30例健康者设为B对照组，亦测定其血浆NT-proBNP和OH值。分析比较四组人群的上述指标。结果：CKD5期患者心力衰竭组NT-proBNP和OH值均高于非心力衰竭组、A对照组、B对照组，差异有统计学意义（P0.05）。OH值诊断容量过负荷所致的心源性呼吸困难的ROC曲线下面积（AUC）为0.889[95%CI=（0.810，0.968），P0.05）]，最佳截值3.2 L，敏感度86.7%，特异度86.0%。结论：测定血浆NT-proBNP有助于CKD5期患者呼吸困难的鉴别诊断。生物电阻抗法检测CKD5期患者容量负荷，有助于判断是否存在容量过负荷导致的心源性呼吸困难。 　　【关键词】 NT-proBNP； 生物电阻抗； CKD5期； 呼吸困难 　　doi：10.14033/j.cnki.cfmr.2017.13.001 文献标识码 A 文章编号 1674-6805（2017）13-0001-03 　　【Abstract】 Objective：To explore the significance of NT-proBNP combined with bioelectrical impedance method in the differential diagnosis of dyspnea in patients with stage CKD 5.Method：60 cases of CKD 5 hospitalized patients admitted to the author’s hospital from January 2015 to October 2016 were divided into heart failure group and non heart failure group.30 patients with stage CKD 5 who had no dyspnea during the same period were established as control group A.30 cases of normal people were set as control group B.Plasma NT-proBNP levels were measured in four groups.The capacity load（OH value）of the 4 groups was determined by body composi-tion monitor.The values of the above indicators were compared among the four groups.Result：The values of NT-proBNP and OH value in heart failure group were higher than those in non heart failure group，control group A and control group B.The differences were statistically significant（P0.05）.The optimal cut-off of OH value to diagnosis cardiac dyspnea caused by overload was 3.2 L，with a sensitivity of 86.7% and a specificity of 86.0%，area under the curve was 0.889[95%CI=（0.810，0.968），P0.05].Conclusion：The measurement of plasma NT-proBNP is helpful in the differential diagnosis of dyspnea in patients with stage CKD 5.Bioelectrical impedance method can be used to determine the volume load of patients with