【摘要】：目的 研究維持性血液透析患者不同心力衰竭分級中血漿中NT-proBNP水平的變化,并聯(lián)合超聲心臟檢查患者的心室結(jié)構(gòu)、血流動力學(xué)及功能變化,為維持性血液透析患者并發(fā)心力衰竭臨床分期診斷提供臨床依據(jù),制定相應(yīng)診療方案。 資料與方法 所有診斷及檢查操作均獲得受試者的知情同意,嚴格納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)。研究對象為2012年9月至2013年10月期間在棗莊市立醫(yī)院行血液透析并資料完整的患者,共110例。所有患者每周透析2-3次,每次透析時間為4h,每人維持血液透析的時間超過4個月。110例患者均行常規(guī)血液相關(guān)指標(biāo)檢查,同步進行NT-proBNP、心臟彩超檢查。 血液學(xué)檢測：NT-ProBNP、尿素氮、血肌酐、血鈣、血紅蛋白、紅細胞比容等。血透前的標(biāo)本采集：均為血透開始前,尚未連接體外循環(huán)裝置、尚未應(yīng)用肝素抗凝,從患者上肢前臂靜脈抽取。血透結(jié)束時的血標(biāo)本采集：均為血透結(jié)束、回血前,從透析器靜脈端采集。所有血液標(biāo)本采血后立即送檢,應(yīng)用自動化分析儀進行檢測。透析前血液學(xué)結(jié)果作為本研究的觀察指標(biāo),根據(jù)透析前后血生化計算Kt/V。 MHD患者靜坐10min,在血液透析前抽取外周靜脈血2m1,經(jīng)2000r/min后取血漿,采用電化學(xué)發(fā)光免疫熒光法測定患者血清中NT-proBNP水平。 所有患者均采用美國GE公式V70智維星心臟彩超機檢測心臟,其探頭頻率為2.0～4.3赫茲。常規(guī)超聲切面下LAD、LVEDd、LVESD、IVST、LVPWT、LVEP、根據(jù)Devereux和Reichek公式計算LVMI。 結(jié)果 1、三組MHD患者分別兩兩相比,在年齡、性別、體重、體重指數(shù)、透析齡、收縮壓、舒張壓、血肌酐、尿素氮、血紅蛋白、血清白蛋白及Kt/V等相關(guān)理化數(shù)據(jù)上比較,P值0.05,差異無統(tǒng)計學(xué)意義。 2、MHD患者HF與NT-proBNP、LVEF、LVEDd、透析間期體重增長率具有正相關(guān),其中NT-proBNP的相關(guān)系數(shù)0.571,P值為0.008, LVEF的相關(guān)系數(shù)為0.472,P值為0.005,說明NT-proBNP與LVEF兩者具有顯著相關(guān)性。MHD患者HF與LVESD、LEMI、Kt/V成負相關(guān)。有臨床癥狀心衰與年齡、血壓、HGB、透析齡、尿素氮、血肌酐、血清白蛋白無相關(guān),其相關(guān)數(shù)據(jù)不具統(tǒng)計學(xué)相關(guān)性。 3、MHD心功能D級與C級、C級與B級、B級與A級在NT-proBNP水平方面相比P值0.05,差異有統(tǒng)計學(xué)意義。且隨著維持性血液透析患者HF程度的加重,NT-ProBNP水平呈明顯增高趨勢。 4、NT-proBNP水平與LVEDd、LVMI、SBP呈正相關(guān),與血色素、紅細胞壓積、LVEF呈負相關(guān),而與透析齡和LVPWT無相關(guān)性(P0.05)。 5、LVEF、LVEDd的統(tǒng)計數(shù)值在心功能D級與C級、C級與B級、B級與A級相比P值0.05,差異有統(tǒng)計學(xué)意義；詳見表6。隨HF程度加重,LVEF呈逐漸下降趨勢,LVEDd逐漸增加。 6、MHD心衰應(yīng)用NT-proBNP檢查的敏感性為84.6%、特異性為57.2%；應(yīng)用心臟超聲檢查則分別為67.4%、68.9%；聯(lián)合診斷則分別為92.3%、73.3%。 結(jié)論 1、MHD患者心功能衰竭與NT-proBNP顯著正相關(guān),NT-proBNP與LVEF呈顯著負相關(guān)。HF可導(dǎo)致LVEF的降低,且衰竭程度越高,LVEF越低, NT-proBNP升高越為顯著,LVEF逐漸降低,而LVEDd則逐漸增加。 2、NT-proBNP水平升高與左心室舒張功能減退、心室重構(gòu)及高血壓有關(guān),而與患者透析齡無關(guān),可有效提示MDH患者HF病變及衰竭程度。 3、NT-proBNP聯(lián)合心臟超聲檢查指標(biāo),如LVEDd、LVMI、SBP,可顯著提高對MHD患者發(fā)生心功能衰竭診斷的敏感性及特異性,對MDH患者HF的診斷意義重大。
[Abstract]:objective
To study the changes of plasma NT-proBNP level in the patients with different heart failure in the maintenance hemodialysis patients, and to combine the ventricular structure, hemodynamics and function changes of the patients with the echocardiography to provide the basis for the diagnosis and treatment of the patients with heart failure in the maintenance hemodialysis patients.
Information and methods
All the patients were enrolled in a total of 110 patients undergoing hemodialysis and complete data during the period from September 2012 to October 2013 in Zaozhuang municipal hospital. All patients were dialysis 2-3 times a week, each time of 4H for each dialysis period. For more than 4 months, all.110 patients underwent routine blood related index examination, NT-proBNP and color Doppler echocardiography simultaneously.
Hematological examination: NT-ProBNP, urea nitrogen, blood creatinine, blood calcium, hemoglobin, erythrocyte specific volume and so on. Pre hemodialysis specimens were collected before the start of hemodialysis. It was not yet connected to the extracorporeal circulation device. The heparin anticoagulant was not used, the forearm vein was extracted from the upper limb of the patient. The blood samples were collected at the end of the hemodialysis. All blood samples were taken immediately after blood sampling and tested by automated analyzer. The hematological results before dialysis were used as the observation index of this study, and Kt/V. was calculated according to the blood biochemistry before and after dialysis.
MHD patients sit in 10min, extract 2M1 from peripheral venous blood before hemodialysis, take 2000r/min after 2000r/min, and determine the level of NT-proBNP in the patient's serum by electrochemiluminescence immunofluorescence.
All patients were using the American GE formula V70 intelligence Star color Doppler echocardiography to detect the heart with a probe frequency of 2 to 4.3 hertz. Under conventional ultrasound, LAD, LVEDd, LVESD, IVST, LVPWT, LVEP, and LVMI. according to Devereux and Reichek formulas
Result
1, three groups of MHD patients, compared with 22, were compared in age, sex, weight, body mass index, dialysate age, systolic pressure, diastolic pressure, blood creatinine, urea nitrogen, hemoglobin, serum albumin and Kt/V, and the value of P was 0.05, the difference was not statistically significant.
2, HF in patients with MHD had positive correlation with NT-proBNP, LVEF, LVEDd, and dialysate weight growth rate, of which the correlation coefficient of NT-proBNP was 0.571, P was 0.008, the correlation coefficient of LVEF was 0.472, and P was 0.005, indicating that NT-proBNP and LVEF were correlated with.MHD patients. There were clinical symptoms of heart failure and age, blood There was no correlation between HGB, dialysis age, urea nitrogen, serum creatinine and serum albumin.
3, MHD heart function D and C, C and B, B and class a P value compared with the level of NT-proBNP, the difference is statistically significant. And with the increase of the degree of HF in maintenance hemodialysis patients, NT-ProBNP level is significantly higher.
4. NT-proBNP levels were positively correlated with LVEDd, LVMI and SBP, negatively correlated with hemoglobin, hematocrit and LVEF, but not with dialysis age and LVPWT (P 0.05).
5, LVEF, LVEDd statistical values in the heart function D and C, C and B, B and a P value compared to 0.05, the difference is statistically significant; the details of table 6. with HF, LVEF is gradually decreasing trend, LVEDd gradually increase.
6, the sensitivity of NT-proBNP for MHD heart failure was 84.6%, the specificity was 57.2%, and the applied echocardiography was 67.4% and 68.9%, and the combined diagnosis was 92.3%, 73.3%., respectively.
conclusion
1, the heart failure of MHD patients was positively correlated with NT-proBNP, and the significant negative correlation between NT-proBNP and LVEF could lead to the decrease of LVEF, the higher the degree of failure, the lower the LVEF, the higher the elevation of NT-proBNP, the gradual decrease of LVEF, and the increase of LVEDd.
2, the elevation of NT-proBNP level is associated with left ventricular diastolic dysfunction, ventricular remodeling and hypertension, but not related to the age of dialysis in patients, which can effectively indicate the degree of HF lesions and failure in MDH patients.
3, NT-proBNP combined with echocardiography, such as LVEDd, LVMI, and SBP, can significantly improve the sensitivity and specificity for the diagnosis of cardiac failure in MHD patients, which is of great significance for the diagnosis of HF in MDH patients.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.1;R692.5

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