维持性血透患者营养状况与血浆BNP水平的关系

Relationship between nutritional status and plasma B-type natriuretic peptides level in patients receiving maintenance hemodialysis

关键词:  维持性血透  血浆B型利钠肽  体质量指数  血清总胆固醇

Key words:  maintenance hemodialysis  plasma B-type natriuretic peptide  body mass index  serum total cholesterol

摘要:

目的 了解终末期肾病维持性血透(maintained hemodialysis, MHD)患者血浆B型利钠肽(B-type natriuretic peptide, BNP)水平以及营养状况与BNP水平的关系。 方法 采用横断面研究，纳入符合观察条件的MHD患者116例。测量身高、体质量、上臂围、小腿围、握力等，免疫发光法检测血浆BNP水平，生物电阻抗分析法测量骨骼肌质量指数(skeletal muscle mass index, SMI)，多元线性回归分析血浆BNP水平的影响因素。 结果 MHD患者中位血浆BNP水平为250.5(107.3,491.5) pg/mL。血浆BNP水平与年龄呈正相关(P<0.05)；与细胞内水分、体质量指数(body mass index, BMI)、上臂围、小腿围、握力、骨骼肌质量指数、血红蛋白、血清总胆固醇呈负相关(P<0.05)。多元线性回归分析显示，BMI、血红蛋白、年龄、血清总胆固醇水平是MHD患者血浆BNP水平的独立影响因素(β=-0.299,P<0.001;β=-0.283,P=0.001;β=0.242,P=0.005;β=-0.187,P=0.030)。 结论 MHD患者血浆BNP水平高于普通人群，较低的BMI、血红蛋白和血清总胆固醇水平与较高的血浆BNP水平有关。

Abstract:

Objective To investigate the plasma level of B-type natriuretic peptide(BNP) and its relationship with nutritional status in patients with end-stage renal disease receiving maintenance hemodialysis(MHD). Methods A cross-sectional survey was conducted. A total of 116 MHD patients who met the observation criteria were included. The height, weight, upper arm circumference, calf circumference and grip strength in the patients were measured. The plasma BNP level was detected by immunoluminescence method, while skeletal muscle mass index(SMI) was measured by bioelectrical impedance analysis. Multiple linear regression analysis was performed to identify the influencing factors of plasma BNP level. Results The median plasma BNP level in MHD patients was 250.5(107.3,491.5) pg/mL. Plasma BNP level was positively correlated with age(P<0.05), and was negatively correlated with intracellular water content, body mass index, upper arm circumference, calf circumference, grip strength, SMI, hemoglobin and serum total cholesterol(all P<0.05). Multiple linear regression analysis showed that body mass index, hemoglobin, age and serum total cholesterol level were independent influencing factors for plasma BNP level in MHD patients(β=-0.299, P<0.001; β=-0.283, P=0.001; β=0.242, P=0.005; β=-0.187, P=0.030). Conclusion The plasma BNP level in MHD patients is higher than that in the general population, and lower body mass index, hemoglobin and serum total cholesterol levels are associated with higher plasma BNP levels.