维持性血液透析患者血清氨基末端脑钠肽前体的相关因素分析及其对缺血性脑卒中的预测价值
摘要
目的:探讨影响维持性血液透析患者氨基末端脑钠肽前体(NT-pro BNP)的相关因素,并分析NT-pro BNP对缺血性脑卒中的预测价值。方法:将143例规律血液透析患者以NT-pro BNP的中位数分为2组(低NT-pro BNP组,89例;高NT-pro BNP组,54例),并收集患者临床资料,使用多因素线性回归分析血清NT-pro BNP的影响因素;使用K-M生存曲线及Cox回归分析了解NT-pro BNP与缺血性脑卒中发生率的关系。结果:(1)维持性血液透析患者中,所有患者的NT-pro BNP均高于正常的参考范围上限(0～125 pg/ml)。NT-pro BNP的中位数5 021. 2 pg/ml。(2)高NT-pro BNP组的年龄、体质量指数、收缩压、血磷、左心室重量指数(LVMI)均显著高于低NT-pro BNP组,而尿素清除指数kt/V、Alb、左室射血分数(EF%)均低于低NT-pro BNP组,其差异有统计学意义(P <0. 05)。(3)多重线性回归结果提示LVMI(β=0. 180,P=0. 026),收缩压(β=0. 185,P=0. 022)与NT-pro BNP呈正相关,白蛋白(β=-0. 158,P=0. 049)、Kt/V(β=-0. 152,P=0. 048)与NT-pro BNP呈负相关。(4) K-M生存曲线显示,两组的缺血性脑卒中发病率的差别同样有统计学意义(4/775. 2%vs 8/47 17%,P=0. 019);在多因素COX风险回归分析中,经传统的缺血性脑卒中风险因素校正后,NT-pro BNP水平与缺血性脑卒中的发生仍有明显的相关性(HR=3. 622,P=0. 036)。结论:维持性血液透析患者NT-pro BNP水平与LVMI、收缩压、白蛋白、Kt/V均密切相关;在维持性血透患者中,NT-pro BNP与缺血性脑卒中发生有密切的相关性。
引文
1.蒲蕾,洪大情,何强,等.维持性血液透析患者住院及死亡事件分析.中国血液净化,2013,12(2):107-109.
2 .丁丽,王晓琴,陶丹,等.应用ROC曲线评价N末端B型脑钠肽前体(NT-pro BNP)及生化指标在心血管疾病中的诊断价值.山西医科大学学报,2013,44(4):294-297.
3 . Bednarek Skublewska A,Zaluska W,Ksiazek A,et al. The relationship between serum level of N terminal pro B type natriuretic peptide and nutritional status,and inflammation in chronic hemodialysis patients. Clin Nephrol,2010,73(1):14-20.
4 .刘鸣,张苏明,饶明俐,等.中国急性缺血性脑卒中诊治指南2010.中国全科医学,2011,14(12):4013-4017.
5 . Stenvinkel P,Heimbürger O,Paultre F,et al. Strong association between malnutrition,inflammation,and atherosclerosis in chronic renal failure. Kidney Int,1999,55(5):1899-1911.
6 .赵玉清,袁桂莉,张进顺,等.和肽前体素联合N末端B型利钠肽前体原评估慢性心力衰竭患者预后的价值.中国循环杂志,2014,29(4):275-278.
7 . Wahl HG,Graf S,Renz H,et al. Elimination of the cardiac natriuretic peptides B-type natriuretic peptide(BNP)and N terminal pro BNP by hemodialysis. Clin Chem,2004,50(6):1071-1074.
8 .毛永辉,赵班,陈欢,等.腹膜透析患者血清N末端脑钠肽前体水平的变化及影响因素探讨.中国血液净化,2014,13(10):717-721.
9 .张清,王昱,鲍晓荣,等.维持性血液透析患者血清BNP水平变化及其临床意义分析.中国中西医结合肾病杂志,2015,16(7):587-589.
10 .温丽颖,李绍梅,焦素敏,等.肾衰竭非透析患者血清氨基末端脑钠肽前体水平影响因素分析.中华肾脏病杂志,2016,32(10):745-752.
11 . Shantsila A,Shantsila E,Gill PS,et al. Renal dysfunction and diastolic impairment among British ethnic minorities with hypertension:the Ethnic-Echocardiographic Heart of England Screening Study. J Hum Hypertens,2017,31(3):206-211.
12 .郑智华,马祖,张涤华,等.血液透析患者营养状态与生存质量关系研究.中国血液净化,2005,4(4):187-190.
13 . Jacques Ducros,Laurent Larifla,Henri Merault,et al. NTpro BNP,Cardiometabolic Risk Factors,and Nutritional Status in Hemodialysis Patients. International Journal of Nephrology,2017,2017:1-8.
14 . Kirushnan BB,Rao BS,Annigeri R,et al. Impact of Malnutrition,Inflammation,and Atherosclerosis on the Outcome in Hemodialysis Patients. Indian J Nephrol,2017,27(4):277-283.
15 .贺海东,张汝忠.维持性血液透析患者透析充分性与血浆脑钠肽前体水平关系.中华肾脏病杂志,2010,26(6):459-459.
16 . Folsom AR,Nambi V,Bell EJ,et al. Troponin T,N-Terminal Pro-B-Type Natriuretic Peptide,and Incidence of Stroke The Atherosclerosis Risk in Communities Study. Stroke,2013,44(4):961.
17 . Collins AJ,Kasiske B,Herzog C,et al. American Journal of Kidney Diseases,2005,45(1 Suppl 1):A5-A7,S1-S280.
18 . Cheng YJ,Yao FJ,Liu LJ,et al. B-Type Natriuretic Peptide and Prognosis of End-Stage Renal Disease:A Meta-Analysis. Plos One,2013,8(11):e79302.
2 .丁丽,王晓琴,陶丹,等.应用ROC曲线评价N末端B型脑钠肽前体(NT-pro BNP)及生化指标在心血管疾病中的诊断价值.山西医科大学学报,2013,44(4):294-297.
3 . Bednarek Skublewska A,Zaluska W,Ksiazek A,et al. The relationship between serum level of N terminal pro B type natriuretic peptide and nutritional status,and inflammation in chronic hemodialysis patients. Clin Nephrol,2010,73(1):14-20.
4 .刘鸣,张苏明,饶明俐,等.中国急性缺血性脑卒中诊治指南2010.中国全科医学,2011,14(12):4013-4017.
5 . Stenvinkel P,Heimbürger O,Paultre F,et al. Strong association between malnutrition,inflammation,and atherosclerosis in chronic renal failure. Kidney Int,1999,55(5):1899-1911.
6 .赵玉清,袁桂莉,张进顺,等.和肽前体素联合N末端B型利钠肽前体原评估慢性心力衰竭患者预后的价值.中国循环杂志,2014,29(4):275-278.
7 . Wahl HG,Graf S,Renz H,et al. Elimination of the cardiac natriuretic peptides B-type natriuretic peptide(BNP)and N terminal pro BNP by hemodialysis. Clin Chem,2004,50(6):1071-1074.
8 .毛永辉,赵班,陈欢,等.腹膜透析患者血清N末端脑钠肽前体水平的变化及影响因素探讨.中国血液净化,2014,13(10):717-721.
9 .张清,王昱,鲍晓荣,等.维持性血液透析患者血清BNP水平变化及其临床意义分析.中国中西医结合肾病杂志,2015,16(7):587-589.
10 .温丽颖,李绍梅,焦素敏,等.肾衰竭非透析患者血清氨基末端脑钠肽前体水平影响因素分析.中华肾脏病杂志,2016,32(10):745-752.
11 . Shantsila A,Shantsila E,Gill PS,et al. Renal dysfunction and diastolic impairment among British ethnic minorities with hypertension:the Ethnic-Echocardiographic Heart of England Screening Study. J Hum Hypertens,2017,31(3):206-211.
12 .郑智华,马祖,张涤华,等.血液透析患者营养状态与生存质量关系研究.中国血液净化,2005,4(4):187-190.
13 . Jacques Ducros,Laurent Larifla,Henri Merault,et al. NTpro BNP,Cardiometabolic Risk Factors,and Nutritional Status in Hemodialysis Patients. International Journal of Nephrology,2017,2017:1-8.
14 . Kirushnan BB,Rao BS,Annigeri R,et al. Impact of Malnutrition,Inflammation,and Atherosclerosis on the Outcome in Hemodialysis Patients. Indian J Nephrol,2017,27(4):277-283.
15 .贺海东,张汝忠.维持性血液透析患者透析充分性与血浆脑钠肽前体水平关系.中华肾脏病杂志,2010,26(6):459-459.
16 . Folsom AR,Nambi V,Bell EJ,et al. Troponin T,N-Terminal Pro-B-Type Natriuretic Peptide,and Incidence of Stroke The Atherosclerosis Risk in Communities Study. Stroke,2013,44(4):961.
17 . Collins AJ,Kasiske B,Herzog C,et al. American Journal of Kidney Diseases,2005,45(1 Suppl 1):A5-A7,S1-S280.
18 . Cheng YJ,Yao FJ,Liu LJ,et al. B-Type Natriuretic Peptide and Prognosis of End-Stage Renal Disease:A Meta-Analysis. Plos One,2013,8(11):e79302.