NT-proBNP联合心脏超声在维持性血液透析（MHD）心力衰竭诊断价值
发布时间：2018-08-07 07:19
【摘要】：目的 研究维持性血液透析患者不同心力衰竭分级中血浆中NT-proBNP水平的变化,并联合超声心脏检查患者的心室结构、血流动力学及功能变化,为维持性血液透析患者并发心力衰竭临床分期诊断提供临床依据,制定相应诊疗方案。 资料与方法 所有诊断及检查操作均获得受试者的知情同意,严格纳入标准及排除标准。研究对象为2012年9月至2013年10月期间在枣庄市立医院行血液透析并资料完整的患者,共110例。所有患者每周透析2-3次,每次透析时间为4h,每人维持血液透析的时间超过4个月。110例患者均行常规血液相关指标检查,同步进行NT-proBNP、心脏彩超检查。 血液学检测：NT-ProBNP、尿素氮、血肌酐、血钙、血红蛋白、红细胞比容等。血透前的标本采集：均为血透开始前,尚未连接体外循环装置、尚未应用肝素抗凝,从患者上肢前臂静脉抽取。血透结束时的血标本采集：均为血透结束、回血前,从透析器静脉端采集。所有血液标本采血后立即送检,应用自动化分析仪进行检测。透析前血液学结果作为本研究的观察指标,根据透析前后血生化计算Kt/V。 MHD患者静坐10min,在血液透析前抽取外周静脉血2m1,经2000r/min后取血浆,采用电化学发光免疫荧光法测定患者血清中NT-proBNP水平。 所有患者均采用美国GE公式V70智维星心脏彩超机检测心脏,其探头频率为2.0～4.3赫兹。常规超声切面下LAD、LVEDd、LVESD、IVST、LVPWT、LVEP、根据Devereux和Reichek公式计算LVMI。 结果 1、三组MHD患者分别两两相比,在年龄、性别、体重、体重指数、透析龄、收缩压、舒张压、血肌酐、尿素氮、血红蛋白、血清白蛋白及Kt/V等相关理化数据上比较,P值0.05,差异无统计学意义。 2、MHD患者HF与NT-proBNP、LVEF、LVEDd、透析间期体重增长率具有正相关,其中NT-proBNP的相关系数0.571,P值为0.008, LVEF的相关系数为0.472,P值为0.005,说明NT-proBNP与LVEF两者具有显著相关性。MHD患者HF与LVESD、LEMI、Kt/V成负相关。有临床症状心衰与年龄、血压、HGB、透析龄、尿素氮、血肌酐、血清白蛋白无相关,其相关数据不具统计学相关性。 3、MHD心功能D级与C级、C级与B级、B级与A级在NT-proBNP水平方面相比P值0.05,差异有统计学意义。且随着维持性血液透析患者HF程度的加重,NT-ProBNP水平呈明显增高趋势。 4、NT-proBNP水平与LVEDd、LVMI、SBP呈正相关,与血色素、红细胞压积、LVEF呈负相关,而与透析龄和LVPWT无相关性(P0.05)。 5、LVEF、LVEDd的统计数值在心功能D级与C级、C级与B级、B级与A级相比P值0.05,差异有统计学意义；详见表6。随HF程度加重,LVEF呈逐渐下降趋势,LVEDd逐渐增加。 6、MHD心衰应用NT-proBNP检查的敏感性为84.6%、特异性为57.2%；应用心脏超声检查则分别为67.4%、68.9%；联合诊断则分别为92.3%、73.3%。 结论 1、MHD患者心功能衰竭与NT-proBNP显著正相关,NT-proBNP与LVEF呈显著负相关。HF可导致LVEF的降低,且衰竭程度越高,LVEF越低, NT-proBNP升高越为显著,LVEF逐渐降低,而LVEDd则逐渐增加。 2、NT-proBNP水平升高与左心室舒张功能减退、心室重构及高血压有关,而与患者透析龄无关,可有效提示MDH患者HF病变及衰竭程度。 3、NT-proBNP联合心脏超声检查指标,如LVEDd、LVMI、SBP,可显著提高对MHD患者发生心功能衰竭诊断的敏感性及特异性,对MDH患者HF的诊断意义重大。
[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.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R692.5
本文编号：2169281
[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.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R692.5
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