N末端脑钠肽前体联合在线血容量监测在维持性血液透析中的应用

何景芳; 罗姗; 李海涛

doi:10.7619/jcmp.20201409

N末端脑钠肽前体联合在线血容量监测在维持性血液透析中的应用

1.
北京市普仁医院肾内科, 北京, 100062
2.
北京市普仁医院内科, 北京, 100062

详细信息

通讯作者:
李海涛, E-mail: lht1020@sina.com

中图分类号: R459.5;R446
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出版历程
- 收稿日期: 2020-11-09
- 网络出版日期: 2021-03-22
- 发布日期: 2021-03-14

Application of serum N-terminal pro-B type natriureticpeptide combined with online blood volume monitor in treatment of patients with maintenance hemodialysis

1.
Department of Nephrology, Beijing Puren Hospital, Beijing, 100062
2.
Department of Internal Medicine, Beijing Puren Hospital, Beijing, 100062

摘要

摘要:
目的观察血浆N末端脑钠肽前体（NT-proBNP）水平联合在线血容量监测（BVM）对维持性血液透析（MHD）患者容量负荷和并发症发生情况的评估效果。
方法选取MHD患者140例作为研究对象，以透析期间体质量增长率（PIBWG）为标准评估容量负荷，检测患者透析前和透析2、4 h时的血浆NT-proBNP水平，应用BVM系统监测在线相对血容量（RBV）水平，采用Pearson相关性分析法分析血浆NT-proBNP、RBV水平与PIBWG、左室舒张末期容积（LVEDV）的相关性，并观察透析并发症（低血压和心律失常）发生情况。
结果 140例患者平均PIBWG为（4.33±1.26）%，按照PIBWG的不同将患者分为低容量组（PIBWG < 4.33%，50例）与高容量组（PIBWG≥4.33%，90例）。高容量组透析2、4 h时的血浆NT-proBNP、RBV水平高于低容量组，变化差值小于低容量组，差异有统计学意义（P < 0.05）。Pearson相关分析显示，PIBWG、LVEDV分别与血浆NT-proBNP、RBV的变化差值呈正相关（P < 0.05或P < 0.01）。高容量组透析并发症发生率低于低容量组，差异有统计学意义（P < 0.05）。
结论血浆NT-proBNP水平联合BVM可用于MHD患者容量负荷和并发症发生情况的评估，与PIBWG、LVEDV水平有较好的一致性。分析血浆NT-proBNP或RBV水平透析2、4 h时与透析前的变化差值，可为准确评估透析效率和安全性提供更多信息。
- N末端脑钠肽前体 /
- 在线血容量监测 /
- 维持性血液透析 /
- 容量负荷 /
- 透析期间体质量增长率
Abstract:
Objective To observe the effect of serum N-terminal pro-B type natriuretic peptide (NT-proBNP) combined with online blood volume monitor (BVM) in the assessment of volume overload and complications in patients with maintenance hemodialysis (MHD).
Methods A total of 140 MHD patients were selected as objectives, and percentage of interdialysis body weight gain (PIBWG) was used as a standard to evaluate volume overload. Plasma NT-proBNP levels were measured before dialysis and 2, 4 hours after dialysis. Online relative blood volume (RBV) was monitored by BVM system. Pearson correlation analysis was used to analyze the correlations between plasma NT-proBNP, RBV levels and PIBWG, left ventricular end diastolic volume (LVEDV). The incidence of dialysis complications such as hypotension and arrhythmia was observed.
Results The average PIBWG of 140 patients was (4.33±1.26)%. According to the value of PIBWG, the patients were divided into low volume group (PIBWG < 4.33%, n=50) and high volume group (PIBWG≥4.33%, n=90). The plasma levels of NT-proBNP and RBV at 2 and 4 h after dialysis in the high volume group were significantly higher than those in the low volume group, and the variation value was significantly smaller than that in the low volume group (P < 0.05). Pearson correlation analysis showed that PIBWG and LVEDV were respectively positively correlated with variation values of plasma NT-proBNP and RBV (P < 0.05 or P < 0.01). The incidence of dialysis complications in the high volume group was significantly lower than that in the low volume group (P < 0.05).
Conclusion Plasma NT-proBNP level combined with BVM can be used to evaluate the volume overload and incidence of complications in MHD patients, which is consistent with PIBWG and LVEDV levels. Analysis in variation values of plasma NT-proBNP or RBV levels between 2, 4 h after dialysis and before dialysis can provide more information for accurate evaluation of dialysis efficiency and safety.
- N-terminal pro-B type natriuretic peptide /
- online blood volume monitoring /
- maintenance hemodialysis /
- volume overload /
- percentage of interdialysis body weight gain

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表 1 2组患者一般临床资料比较(x ±s)[n(%)]

指标		高容量组(n=90)	低容量组(n=50)	χ²/t	P
性别	男	50(55.6)	30(60.0)	0.259	0.611
	女	40(44.4)	20(40.0)
年龄/岁		63.5±7.4	63.6±7.7	0.356	0.641
病程/月		10.5±3.4	11.6±3.7	0.458	0.562
体质量/kg		68.7±4.2	69.9±4.5	0.539	0.508
BMI/(kg/m²)		24.3±2.3	24.6±2.5	0.329	0.621
血肌酐/(μmol/L)		896.5±142.3	899.6±155.2	0.562	0.452
原发疾病	慢性肾小球肾炎	35(38.9)	25(50.0)	3.654	0.301
	糖尿病肾病	30(33.3)	13(26.0)
	高血压肾病	15(16.7)	7(14.0)
	肾病综合征	10(11.1)	5(10.0)
BMI: 体质量指数。

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表 2 2组血浆NT-proBNP水平比较(x ±s) ng/mL

组别	n	透析前	透析2 h时	透析4 h时	变化差值1	变化差值2
低容量组	50	864.5±123.2	547.6±55.4	302.8±36.7	317.6±74.9	560.7±112.4
高容量组	90	869.5±132.4	665.3±65.7^*	423.5±42.6^*	208.5±76.3^*	445.8±92.7^*
NT-proBNP: N末端脑钠肽前体; 变化差值1: 透析前与透析2 h时的NT-proBNP差值; 变化差值2: 透析前与透析4 h时的NT-proBNP差值。与低容量组比较, *P < 0.05。

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表 3 2组RBV水平比较(x ±s) %

组别	n	透析前	透析2 h时	透析4 h时	变化差值1	变化差值2
低容量组	50	138.5±33.2	91.6±28.4	83.5±15.6	45.6±6.9	56.3±13.3
高容量组	90	139.5±32.4	102.3±25.7^*	88.6±12.3^*	38.5±8.3^*	51.2±10.2^*
RBV: 在线相对血容量; 变化差值1: 透析前与透析2 h时的RBV差值; 变化差值2: 透析前与透析4 h时的RBV差值。与低容量组比较, *P < 0.05。

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表 4 2组透析前后LVEDV比较(x ±s) mL

组别	n	透析前	透析后	变化差值
低容量组	50	174.9±35.8	155.2±39.9	16.8±6.3
高容量组	90	176.5±42.3	159.8±35.2^*	15.5±4.4
LVEDV: 左室舒张末期容积。与低容量组比较, *P < 0.05。

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表 5 相关性分析

指标		PIBWG		LVEDV
指标		r	P	r	P
NT-proBNP	变化差值1	0.765	0.008	0.689	0.013
	变化差值2	0.863	0.004	0.745	0.009
RBV	变化差值1	0.752	0.010	0.648	0.016
	变化差值2	0.862	0.006	0.713	0.011
NT-proBNP: N末端脑钠肽前体; RBV: 在线相对血容量; PIBWG: 体质增长率; LVEDV: 左室舒张末期容积; 变化差值1: 透析前与透析2 h时的差值; 变化差值2: 透析前与透析4 h时的差值。

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