Das Sandeep R, Abdullah Shuaib M, Leonard David, Drazner Mark H, Khera Amit, McGuire Darren K, de Lemos James A
Donald W Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Am J Cardiol. 2008 Nov 15;102(10):1394-8. doi: 10.1016/j.amjcard.2008.07.018. Epub 2008 Sep 11.
The relations between renal function and circulating B-type natriuretic peptide (BNP) and the amino-terminal fragment of its prohormone (NT-pro-BNP) in the general population have not been fully elucidated. A total of 2,784 subjects from the Dallas Heart Study, a multiethnic population-based sample of Dallas County, Texas, residents, was studied. Detailed cardiac phenotyping, including magnetic resonance imaging and electron beam computed tomography, as well as measurements of NT-pro-BNP and BNP, were performed. Associations between estimated glomerular filtration rate (eGFR) and both NT-pro-BNP and BNP were evaluated using multivariable statistical analysis techniques. Median eGFR in this young, predominantly healthy population was 97 ml/min/1.73 m(2) (interquartile range 84 to 112). Natriuretic peptide levels were not associated with renal function over the normal range of eGFR. Below a threshold eGFR of 90 ml/min/1.73 m(2), both NT-pro-BNP and BNP increased in an exponential fashion with decreasing eGFR. These associations remained significant after adjustment for multiple potential confounders (p <0.001 for all). For eGFR <90 ml/min/1.73 m(2), the relative increase in NT-pro-BNP was twice as great as that for BNP for a given decrease in eGFR. In conclusion, a threshold effect regarding the association between renal function and natriuretic peptides was shown. With eGFR <90 ml/min/1.73 m(2), both NT-pro-BNP and BNP were inversely and independently associated with renal function, with a greater magnitude of association with renal impairment noted for NT-pro-BNP.
在普通人群中，肾功能与循环中的B型利钠肽（BNP）及其激素原的氨基末端片段（NT-pro-BNP）之间的关系尚未完全阐明。我们对来自达拉斯心脏研究的2784名受试者进行了研究，该研究是基于德克萨斯州达拉斯县居民的多民族人群样本。进行了详细的心脏表型分析，包括磁共振成像和电子束计算机断层扫描，以及NT-pro-BNP和BNP的测量。使用多变量统计分析技术评估估计肾小球滤过率（eGFR）与NT-pro-BNP和BNP之间的关联。在这个年轻的、主要为健康人群中，eGFR的中位数为97 ml/min/1.73 m²（四分位间距为84至112）。在eGFR的正常范围内，利钠肽水平与肾功能无关。在eGFR阈值低于90 ml/min/1.73 m²时，NT-pro-BNP和BNP均随着eGFR的降低呈指数增加。在对多个潜在混杂因素进行校正后，这些关联仍然显著（所有p<0.001）。对于eGFR<90 ml/min/1.73 m²，在eGFR给定的降低幅度下，NT-pro-BNP的相对增加是BNP的两倍。总之，研究显示了肾功能与利钠肽之间关联的阈值效应。当eGFR<90 ml/min/1.73 m²时，NT-pro-BNP和BNP均与肾功能呈负相关且独立相关，其中NT-pro-BNP与肾功能损害的关联程度更大。
