Goto Takatoshi, Takase Hiroyuki, Toriyama Takayuki, Sugiura Tomonori, Kurita Yutaka, Tsuru Nobuo, Masuda Hiroaki, Hayashi Kunihiko, Ueda Ryuzo, Dohi Yasuki
Department of Internal Medicine, Enshu General Hospital, Hamamatsu, Japan.
Nephron. 2002;92(3):610-5. doi: 10.1159/000064100.
BACKGROUND/AIMS: Cardiovascular events are the major determinant of the prognosis in patients with chronic hemodialysis. The present study was designed to investigate whether increased plasma levels of atrial or brain natriuretic peptides (ANP or BNP) predict future cardiac events in such patients.
Fifty-three patients undergoing chronic hemodialysis without clinical symptoms suggestive of cardiac disorders were enrolled and their blood was sampled for ANP and BNP measurements. Electrocardiograms demonstrated left ventricular hypertrophy in 28 patients but no other abnormal findings. We followed them up for 11.3 +/- 0.2 months. The endpoint was cardiac events.
Cardiac events occurred in 13 patients (CE group). Both ANP and BNP levels were higher in CE group than in patients without cardiac events (ANP: 118 +/- 21 vs. 56 +/- 5 pg/ml, BNP: 769 +/- 204 vs. 193 +/- 25 pg/ml, respectively). Receiver operating characteristics curve revealed that the cut-off levels of ANP and BNP were 58 and 390 pg/ml, respectively. Using the Kaplan-Meier method, the incidence of cardiac events was significantly greater in patients with higher levels of ANP (50.0 vs. 0.0%) or BNP (72.7 vs. 11.9%) than in those with lower levels of the peptides.
Elevated levels of ANP or BNP indicate an increased risk of cardiac events and these peptides are clinically useful to predict cardiac events in patients with hemodialysis.
背景/目的：心血管事件是慢性血液透析患者预后的主要决定因素。本研究旨在调查血浆心房钠尿肽或脑钠尿肽（ANP或BNP）水平升高是否可预测此类患者未来的心脏事件。
纳入53例无心脏疾病临床症状的慢性血液透析患者，采集其血液样本检测ANP和BNP水平。心电图显示28例患者有左心室肥厚，但无其他异常发现。对他们进行了11.3±0.2个月的随访。终点为心脏事件。
13例患者发生心脏事件（CE组）。CE组的ANP和BNP水平均高于无心脏事件的患者（ANP分别为118±21 vs. 56±5 pg/ml，BNP分别为769±204 vs. 193±25 pg/ml）。受试者工作特征曲线显示，ANP和BNP的截断水平分别为58和390 pg/ml。采用Kaplan-Meier法，ANP（50.0% vs. 0.0%）或BNP（72.7% vs. 11.9%）水平较高的患者心脏事件发生率显著高于肽水平较低的患者。
ANP或BNP水平升高表明心脏事件风险增加，这些肽在临床上可用于预测血液透析患者的心脏事件。
