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目的研究慢性肾脏疾病(CKD)非透析患者脑钠素与肾功能及左室肥厚的关系。方法采用双抗夹心免疫荧光法检测203例 CKD 非透析患者与16例对照组全血脑钠素(BNP)水平,分析其与肾功能及左室心肌重量指数(LVMI)的关系。结果 BNP 水平随着肾小球滤过率(eGFR)的下降逐渐递增[9.35(7.35-15.00)v8 54.40(15.10-173.00)ng/L,P<0.01],Spearman 相关分析提示 CKD 患者 BNP 水平和 eGFR 呈负相关(r=-0.417,P<0.01)。多重回归分析显示 eGFR是影响 BNP 水平的独立危险因素(β=-0.293,P<0.01),lgGFR 每降低1 ml·min~(-1)·(1.73m~2)~(-1),lgBNP 水平就上升0.293 ng/L。CKD 非透析患者与对照组相比左室肥厚发生率明显上升(53.2%vs 10.0%,P<0.05),存在左室肥厚的患者血 BNP 水平显著升高[93.05(37.70-272.00)vs17.30(7.20-63.70)ng/L,P<0.01],LVMI 也是影响 BNP 水平高低的主要原因之一(B=0.266,P<0.01),lgLVMI 每升高1g/m~2,lgBNP 水平就上升0.266 ng/L。结论在 CKD 非透析患者中,eGFR 下降可上调 BNP 水平,虽然肾功能不全可部分干扰 BNP 浓度,但是左室肥厚仍可作为一项影响 BNP 水平升高的独立危险因素。
Objective To investigate the relationship between brain natriuretic peptide and renal function and left ventricular hypertrophy in non-dialysis patients with chronic kidney disease (CKD). Methods The levels of whole blood brain natriuretic peptide (BNP) in 203 non-dialysis CKD patients and 16 healthy controls were measured by double-antibody sandwich immuno-fluorescence. The relationship between BNP and renal function and LVMI were analyzed. Results BNP levels gradually increased with the decrease of glomerular filtration rate (eGFR) [9.35 (7.35-15.00) v8 54.40 (15.10-173.00) ng / L, P <0.01]. Spearman correlation analysis showed that BNP levels and eGFR was negatively correlated (r = -0.417, P <0.01). Multiple regression analysis showed that eGFR was an independent risk factor for BNP (β = -0.293, P <0.01), and lgBNP decreased by 1 ml · min -1 · 1.73m -2 · l -1 The level rose 0.293 ng / L. Compared with the control group, the incidence of left ventricular hypertrophy was significantly increased in CKD non-dialysis patients (53.2% vs 10.0%, P <0.05), and BNP levels were significantly higher in patients with left ventricular hypertrophy [93.05 (37.70-272.00 vs 17.30 (7.20-63.70) ng / L, P <0.01]. LVMI was also one of the major factors affecting the level of BNP (B = 0.266, P <0.01). The level of lgBNP increased by 0.266 ng / L. Conclusions Decreased eGFR may up-regulate BNP levels in CKD non-dialysis patients. Although renal insufficiency may partially interfere with BNP concentration, left ventricular hypertrophy may still be an independent risk factor for the elevation of BNP.