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目的:探讨血浆脑型钠利尿肽(BNP)在维持性血透(MHD)患者左心室舒张功能障碍(LVDD)中的诊断价值。方法:MHD患者59例,透析前行心脏多普勒组织成像检测,按不同舒张早期峰值速度(Ve)与舒张晚期峰值速度(Va)的比值分为LVDD组(Ve/Va<1)和左心室舒张功能正常组(Ve/Va≥1)两组。同时检测透析前血浆BNP、血常规及生化指标、超敏C反应蛋白(hs-CRP)、甲状旁腺激素(PTH)等。结果:LVDD组与左心室舒张功能正常组相比,BNP、hs-CRP、收缩压显著性升高,血红蛋白(Hb)显著性降低(P<0.05)。MHD患者的BNP水平与hs-CRP、收缩压、舒张压等显著正相关,与Hb显著负相关。BNP诊断MHD患者LVDD的曲线下面积(AUC)为0.86(95%C:I 0.76~0.96),353.6 pg.ml-1作为界值的灵敏度为80%,特异度为85%。结论:BNP水平升高对MHD患者合并LVDD可能具有重要的诊断价值。
Objective: To investigate the diagnostic value of plasma brain natriuretic peptide (BNP) in left ventricular diastolic dysfunction (LVDD) in patients with maintenance hemodialysis (MHD). Methods: Fifty-nine patients with MHD were examined by Doppler echocardiography before hemodialysis. According to the ratio of peak early diastolic velocity (Ve) and peak late diastolic velocity (Va), we divided the LVDD group (Ve / Va <1) Ventricular diastolic function was normal group (Ve / Va≥1) two groups. Simultaneously, plasma BNP, blood routine and biochemical indexes, hs-CRP, PTH and so on were measured before dialysis. Results: The levels of BNP, hs-CRP, systolic blood pressure and hemoglobin in LVDD group were significantly lower than those in normal left ventricular diastolic function group (P <0.05). BNP levels in MHD patients were significantly and positively correlated with hs-CRP, systolic blood pressure and diastolic blood pressure, but negatively correlated with Hb. The area under the curve (AUC) for LVDD in BNP-diagnosed MHD patients was 0.86 (95% CI: 0.76 to 0.96), with a sensitivity of 80% and specificity of 353.6 pg.ml-1 as a cutoff. Conclusion: Elevated BNP level may have important diagnostic value for patients with MHD complicated with LVDD.