中文摘要：

目的 探讨N端脑钠肽前体（NT-proBNP）在评估维持性血液透析患者容量状态中的临床应用价值.方法 选择非临床显性水肿的维持性血液透析患者145例为研究对象.采用生物电阻抗方法检测患者多余细胞外液（Overhydration,OH值）,胶体金法检测血浆NT-proBNP水平.按△OH水平（△OH=OH值-体重增加量）将患者分为容量超负荷组（H组,90例）、干体重达标组（N组,36例）和低干体重组（L组,19例）.同期检测患者透析前血压、体质量增加值、Hb、Alb、BUN、Scr等指标.调整H组患者干体重,观察3月内患者容量负荷变化对血浆NT-proBNP水平的影响.结果 （1）126例患者NT-proBNP基线水平均高于正常范围.H组NT-proBNP中位数[M（1/4,3/4）]为1318.50 （717.00,3154.25） pg/ml;N组为703.50（873.00,450.50） pg/ml.基线NT-proBNP水平与△OH值呈正相关（r=0.801,P＜ 0.001）.（2）3月后H组患者OH值及NT-proBNP均较调整前明显下降.其中41例患者干体重达标（H1组）,NT-proBNP中位值为685.00 （422.50,988.50） pg/ml,△OH（0.63±0.23）L;49例患者持续未达标（H2组）,NT-proBNP中位值为1569.00 （982.50,2500.50） pg/ml,△OH （1.75±0.71）L.两组间△OH和NT-proBNP的比较差异有统计学意义（均P＜0.05）.△OH和NT-proBNP呈正相关（r=0.684,P＜ 0.001）.（3）当以△OH绝对值≤1定义干体重达标时,NT-proBNP在判断患者容量状态的受试者工作曲线（ROC）下面积（AUC）为0.818,95％可信区间0.733～0.904 （P＜ 0.001）.NT-proBNP判断维持性血液透析患者容量状态的最佳临界值为962.50pg/ml,诊断的灵敏度为79.6％,特异度为73.2％.结论 维持性血液透析患者NT-proBNP水平升高.临床非显性水肿患者血NT-proBNP水平升高提示容量增加,可作为早期干体重调整的临床指标.

英文摘要：

objective To investigate the value of NT-proBNP in assessing the volume status in maintenance hemodialysis patients with non-dominant edema.Methods One hundred and forty-five patients were recruited.Bioimpedance measurements were performed for overhydration （OH）.NT-proBNP was detected by colloidal gold method.Patients were divided into three groups by levels of OH variability （△ OH,equal to OH minus weight increase） as group H （hypervolemia,n=90）; group N （normovolemia,n=36） and group L （hypovolemia,n=19）.Hemoglobin,albumin,blood urea nitrogen and serum creatinine were assayed,blood pressure and body mass increase were recorded.Dry weight of patients in Group H were adjusted in 3 months,the relationship between NT-proBNP and volume change were assessed.Results （1） At baseline,overall plasma NT-proBNP levels were higher than normal range.The median NT-proBNP levels in group H and group N were [1318.50（IQR 717.00,3154.25） pg/ml] and [703.50 （IQR 873.00,450.50） pg/ml],respectively.NT-proBNP was positively correlated with △OH value （r=0.801,P ＜ 0.001）.（2） After 3 months,NT-proBNP levels in group H was significantly lower than baseline.Forty-one patients reached normal volume range （group H1）,49 patients were resistant hypervolemia （group H2）.The median NT-proBNP levels in group H1 and group H2 were [685.00 （IQR 422.50,988.50） pg/ml] and [1569.00 （IQR 982.50,2500.50） pg/ml],△ OH in group H1 and group H2 were [（0.63±0.23）L] and [（1.75±0.71）L],respectively.NT-proBNP and △ OH value in two groups had significant difference （P ＜ 0.05）.NT-proBNP was positively correlated with △ OH value （r=0.684,P ＜ 0.001）.（3） The area under ROC curve for NT-proBNP was 0.818,95％CI （0.733～ 0.904）,P ＜ 0.001,since the absolute value of normovolemia was defined as ≤ 1.The cut off value of plasma NT-proBNP was set at 962.50 pg/ml in MHD patients with non-dominant edema,the diagnostic specificity and sensitivity were 79.6％ and 73.2％.Concl