Valociková I, Valocik G, Kristofová B, Druzbacká L, Roland R, Mitro P
I. interná klinika Lekárskej fakulty UPJS a FN L. Pasteura Kosice, Slovenská republika.
Vnitr Lek. 2009 Oct;55(10):934-9.
We assessed the relation between BNP levels and some echocardiographic parameters of systolic and diastolic function of the left ventricle in 49 patients (mean age 69.39 +/- 8.47 years) with chronic kidney disease in different stages of chronic renal failure according to K/DOQI and in 45 subjects (mean age 52.6 +/- 14.85 years) on dialysis. Median for BNP in the group of patients with chronic renal failure was 132 pg/ml, and in dialysis subjects 320 pg/ml. None of our patients had clinical signs of heart failure during the last six months. Using a method of correlation matrix we found the left ventricular mass and its indexed value as a common indicator of increased BNP level in both groups of patients (dialysis patients, p = 0.0003, and p = 0.0005, respectively; patients with chronic renal failure, p = 0.03, and p = 0.04, respectively). Further analysis proved that in the group of dialysis patients the main determinants of increased BNP level were volumes of the left heart side: left ventricular end diastolic volume (p = 0.004), endsystolic volume (p = 0.01), and left atrial volumes (maximal, minimal, and total atrial stroke volume; p = 0.004, p = 0.009 and p = 0.04, respectively). In the group of patients with chronic renal failure the major contributors to increased BNP level were echocardiographic parameters of diastolic filling assessed from transmitral and pulmonary venous flow: E wave (p = 0.001), A wave (p = 0.01), E/A (p < 0.001), IVRT (p = 0.004), E/EDT (p < 0.0001), S wave (p = 0.01), D wave (p = 0.0003), S/D (p = 0.001), Ar duration (p = 0.02), and E/Vp (p = 0.003). No significant relation to left ventricular ejection fraction was found in both groups of patients. Our results suggest that the main determinant of increased BNP level in patients with different stages of chronic renal failure is diastolic dysfunction, whereas in dialysis patients high left heart volumes due to volume overload. The common denominator of high BNP level in both groups of patients is especially the left ventricular mass.
我们评估了49例根据K/DOQI处于慢性肾衰竭不同阶段的慢性肾脏病患者（平均年龄69.39±8.47岁）以及45例透析患者（平均年龄52.6±14.85岁）的脑钠肽（BNP）水平与左心室收缩和舒张功能的一些超声心动图参数之间的关系。慢性肾衰竭患者组中BNP的中位数为132 pg/ml，透析患者组中为320 pg/ml。在过去六个月中，我们的患者均无心力衰竭的临床体征。通过相关矩阵法，我们发现左心室质量及其指数值是两组患者（透析患者，p分别为0.0003和0.0005；慢性肾衰竭患者，p分别为0.03和0.04）BNP水平升高的共同指标。进一步分析证明，在透析患者组中，BNP水平升高的主要决定因素是左心腔容积：左心室舒张末期容积（p = 0.004）、收缩末期容积（p = 0.01）和左心房容积（最大、最小和总心房搏出量；p分别为0.004、0.009和0.04）。在慢性肾衰竭患者组中，BNP水平升高的主要因素是通过二尖瓣和肺静脉血流评估的舒张期充盈的超声心动图参数：E波（p = 0.001）、A波（p = 0.01）、E/A（p < 0.001）、等容舒张时间（IVRT，p = 0.004）、E/舒张早期时间（EDT，p < 0.0001）、S波（p =
