Mark Patrick B, Stewart Graham A, Gansevoort Ron T, Petrie Colin J, McDonagh Theresa A, Dargie Henry J, Rodger R Stuart C, Jardine Alan G
Renal Unit, University of Glasgow, Division of Cardiovascular and Medical Sciences, Western Infirmary, Glasgow, UK.
Nephrol Dial Transplant. 2006 Feb;21(2):402-10. doi: 10.1093/ndt/gfi187. Epub 2005 Oct 12.
Measurement of natriuretic peptides, particularly brain natriuretic peptide (BNP) is an established method for the diagnosis of cardiovascular disorders, chiefly left ventricular (LV) dysfunction. The influence of renal function on the diagnostic utility of natriuretic peptides is unclear.
We performed a cross-sectional study of 296 patients with renal disease but no history of cardiac disease using echocardiography to assess LV mass and function. Circulating levels of atrial natriuretic peptide (ANP) and BNP were also measured.
The incidence of LV hypertrophy increased with progressive renal dysfunction; from 39% in patients with near-normal renal function, to 80% in renal transplant patients. There was a negative correlation between both ANP and BNP, and glomerular filtration rate (GFR) (ANP: r = -0.28, P<0.001; BNP: r = -0.40, P<0.001). Serum ANP and BNP had sensitivity and specificity for LV hypertrophy of 39.9%, 87.4% (ANP) and 61.4%, 67.6% (BNP) respectively. Sensitivity and specificity for LV dysfunction was 77.2%, 32.4% (ANP) and 71.8%, 40.0% (BNP). Significant confounders in determining serum ANP were haemoglobin, beta blockade and albumin, while serum BNP levels were significantly confounded by GFR, albumin, haemoglobin, beta blockade and age.
Across a spectrum of renal dysfunction, GFR is a more important determinant of serum BNP than ventricular function, and several factors are predictors of natriuretic peptide levels. In chronic kidney disease, the use of natriuretic peptides to diagnose LV hypertrophy must be interpreted in light of these other factors. The use of these peptides in renal dysfunction to diagnose LV dysfunction may be of limited value.
利钠肽的检测，尤其是脑利钠肽（BNP），是诊断心血管疾病，主要是左心室（LV）功能障碍的一种既定方法。肾功能对利钠肽诊断效用的影响尚不清楚。
我们对296例无心脏病史的肾病患者进行了一项横断面研究，采用超声心动图评估左心室质量和功能。同时检测了循环中的心房利钠肽（ANP）和BNP水平。
左心室肥厚的发生率随肾功能进行性减退而增加；从肾功能接近正常的患者中的39%，增加到肾移植患者中的80%。ANP和BNP与肾小球滤过率（GFR）均呈负相关（ANP：r = -0.28，P<0.001；BNP：r = -0.40，P<0.001）。血清ANP和BNP对左心室肥厚的敏感性和特异性分别为39.9%、87.4%（ANP）和61.4%、67.6%（BNP）。对左心室功能障碍的敏感性和特异性分别为77.2%、32.4%（ANP）和71.8%、40.0%（BNP）。影响血清ANP的显著混杂因素有血红蛋白、β受体阻滞剂和白蛋白，而血清BNP水平则受GFR、白蛋白、血红蛋白、β受体阻滞剂和年龄的显著影响。
在一系列肾功能障碍中，GFR比心室功能更重要地决定血清BNP水平，并且有几个因素是利钠肽水平的预测指标。在慢性肾病中，使用利钠肽诊断左心室肥厚时必须结合这些其他因素进行解读。在肾功能障碍中使用这些肽诊断左心室功能障碍可能价值有限。
