摘要
目的在围透析期慢性肾脏病(chronic kidney disease,CKD)人群中探索氨基末端利尿钠肽原(N terminal pro B type natriuretic peptide,NT-proBNP)诊断或预测心力衰竭的临床价值。方法该研究为单中心回顾性研究,回顾性收集2021年1~6月于郑州大学第一附属医院肾脏内科就诊的围透析期CKD患者,根据有无心力衰竭及左心室射血分数(left ventricular ejection fraction,LVEF)分为4组,即无心力衰竭组、射血分数降低的心力衰竭(heart failure with reduced ejection fraction,HFrEF)组(LVEF<40%)、射血分数中间值的心力衰竭(heart failure with mid-range ejection fraction,HFmrEF)组(40%≤LVEF<50%)和射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFpEF)组(LVEF≥50%)。比较4组患者的NT-proBNP、超声心动图等指标。通过绘制受试者工作特征曲线(receiver operating characteristic curve,ROC曲线),分别分析血浆NT-proBNP诊断心力衰竭、HFpEF、HFmrEF和HFrEF的价值。使用Logistic回归分析法分析围透析期CKD患者心力衰竭的相关因素。结果共纳入508例患者,其中HFrEF组11例,HFmrEF组29例,HFpEF组152例,无心力衰竭组316例。4组患者的年龄、24 h尿量、血液透析比例、未透析比例、血肌酐、估算肾小球滤过率、血红蛋白、血清白蛋白、C反应蛋白、NT-proBNP、心肌肌钙蛋白I、左心室内径、LVEF、肺动脉收缩压、左心室舒张末期容积、E/A值、室间隔厚度、左室后壁厚度的差异有统计学意义(均P<0.05)。两两比较(P值均为Bonferroni法校正后)发现,无心力衰竭组的24 h尿量分别高于另外三组(均P<0.05),血液透析患者比例、NT-proBNP及C反应蛋白水平分别低于另外三组(均P<0.05);HFpEF组的血红蛋白和血清白蛋白均低于无心力衰竭组(均P<0.001);无心力衰竭组的肌钙蛋白I低于HFpEF组(P<0.001)、HFmrEF组(P=0.001)和HFrEF组(P<0.001),HFpEF组的肌钙蛋白I低于HFrEF组(P=0.008);无心力衰竭组的LVEF分别�
Objective To explore the clinical value of N terminal pro B type natriuretic peptide(NT-proBNP)in diagnosing or predicting heart failure in peridialysis chronic kidney disease(CKD)population.Methods It was a single-center retrospective study.Patients with peridialysis CKD who visited the Department of Nephrology,First Affiliated Hospital of Zhengzhou University from January 2021 to June 2021 were collected and divided into 4 groups according to the presence or absence of heart failure and the level of left ventricular ejection fraction(LVEF),namely the non-heart failure group,heart failure with reduced ejection fraction(HFrEF)group(LVEF<40%),heart failure with mid-range ejection fraction(HFmrEF)group(40%≤LVEF<50%),and heart failure with preserved ejection fraction(HFpEF)group(LVEF≥50%).The NT-proBNP,echocardiography and other indicators of the 4 groups were compared.The value of plasma NT-proBNP in diagnosing heart failure,HFpEF,HFmrEF and HFrEF was analyzed by drawing receiver operating characteristic curve(ROC curve).Logistic regression analysis was used to analyze the related factors of heart failure in peridialysis CKD patients.Results A total of 508 patients were included,including 11 cases in the HFrEF group,29 cases in the HFmrEF group,152 cases in the HFpEF group,and 316 cases without heart failure.The differences in age,24-h urine volume,hemodialysis proportion,non-dialysis proportion,serum creatinine,estimated glomerular filtration rate,hemoglobin,serum albumin,C-reactive protein,NT-proBNP,cardiac troponin I,left ventricular internal diameter,LVEF,pulmonary artery systolic pressure,left ventricular end-diastolic volume,E/A value,septal thickness,and left ventricular posterior wall thickness among the four groups were statistically significant(P<0.05,respectively).A two-pair comparison(all P values corrected by Bonferroni method)revealed that the 24-h urine volume was higher in the non-heart failure group than in the other three groups(corrected P<0.05,respectively),while the proportion of hemodialys
作者
杨发燕
郭艳红
于露
王刘伟
翟子涵
唐琳
Yang Fayan;Guo Yanhong;Yu Lu;Wang Liuwei;Zhai Zihan;Tang Lin(Department of Nephrology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2023年第7期506-514,共9页
Chinese Journal of Nephrology
关键词
心力衰竭
利钠肽
脑
透析
射血分数
围透析期
Heart failure
Natriuretic peptide,brain
Dialysis
Ejection fraction
During peridialysis
