Codognotto Marta, Piccoli Antonio, Zaninotto Martina, Mion Monica, Plebani Mario, Vertolli Ugo, Tona Francesco, Ruzza Luisa, Barchita Agata, Boffa Giovanni M
Division of Nephrology, University Hospital, University of Padova, Italy.
Clin Chem. 2007 Dec;53(12):2097-104. doi: 10.1373/clinchem.2007.089656. Epub 2007 Oct 12.
The diagnostic value of natriuretic peptides in uremic cardiomyopathy has not been defined, nor has the effect of a hemodialysis (HD) session on peptides.
We performed an observational study of 100 white adult outpatients in New York Heart Association class I-II, with neither diabetes nor ischemic heart disease, 50 of whom had idiopathic dilated cardiomyopathy (DCM) and 50 of whom had uremic cardiomyopathy and were undergoing HD. We measured plasma N-terminal proB-type natriuretic peptide (NT-proBNP), BNP, and atrial natriuretic peptide (ANP) both before and after a dialysis session. Doppler echocardiograms were evaluated. We performed multiple regression analysis on the logarithm of peptide concentrations using clinical, laboratory, and echocardio-Doppler data as explanatory variables.
Mean peptide concentrations were higher in the HD group, with an HD:DCM ratio of 25 for NT-proBNP and 5 for BNP and ANP. Peptides were correlated with each other (r > 0.85). After HD, NT-proBNP significantly increased by 14%, BNP decreased by 17%, and ANP decreased by 56%. Predialysis concentrations correlated with postdialysis values (r > 0.85). A multiple regression equation significantly fitted the observed peptide concentrations, both pre- and postdialysis, using the same set of 4 variables: disease group (DCM or HD), diastolic pattern, left atrial volume, and body mass index.
Renal dysfunction was a confounder for natriuretic peptides, which were present in higher concentrations in the uremic patients with milder cardiac dysfunction than in those with idiopathic DCM without renal dysfunction. Left diastolic function pattern and atrial volume were cardiac determinants of peptide concentrations in DCM and HD.
利钠肽在尿毒症性心肌病中的诊断价值尚未明确，血液透析（HD）治疗对利钠肽的影响也未明确。
我们对100名纽约心脏协会心功能I-II级的成年白人门诊患者进行了一项观察性研究，这些患者既无糖尿病也无缺血性心脏病，其中50人患有特发性扩张型心肌病（DCM），50人患有尿毒症性心肌病且正在接受血液透析。我们在透析治疗前后测量了血浆N末端B型利钠肽原（NT-proBNP）、脑钠肽（BNP）和心房利钠肽（ANP）。对多普勒超声心动图进行了评估。我们使用临床、实验室和超声心动图-多普勒数据作为解释变量，对肽浓度的对数进行了多元回归分析。
HD组的平均肽浓度较高，NT-proBNP的HD:DCM比值为25，BNP和ANP的比值为5。肽之间相互关联（r>0.85）。HD治疗后，NT-proBNP显著增加14%，BNP下降17%，ANP下降56%。透析前浓度与透析后值相关（r>0.85）。使用相同的4个变量集：疾病组（DCM或HD）、舒张模式、左心房容积和体重指数，一个多元回归方程显著拟合了透析前后观察到的肽浓度。
肾功能不全是利钠肽的一个混杂因素，与无肾功能不全的特发性DCM患者相比，轻度心功能不全的尿毒症患者中利钠肽浓度更高。左室舒张功能模式和心房容积是DCM和HD中肽浓度的心脏决定因素。
