Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, PR China.
Eur J Intern Med. 2012 Sep;23(6):539-44. doi: 10.1016/j.ejim.2012.06.001. Epub 2012 Jun 24.
Although brain natriuretic peptide (BNP) concentration has been associated with atherosclerosis and ischemic cardiovascular diseases (CVD) in the general population, less is known about this relationship in pre-dialysis chronic kidney disease (CKD) patients.
We prospectively analyzed 227 pre-dialysis patients with CKD [median estimated glomerular filtration rate (eGFR): 28.82 (11.65-48.20) ml/min/1.73 m(2)]. At enrollment, BNP concentrations, biochemical and echocardiographic parameters were measured, and carotid artery ultrasound was performed. Patients were prospectively followed for a mean 31.8 months (range 0.5-57.0 months). Ischemic CV events and patient outcomes were recorded.
Median BNP concentration at enrollment was significantly higher in the CKD patients than in a control group [53.9 (16.2-181.0) pg/ml vs. 9.4 (7.0-15.3) pg/ml, P<0.01]. BNP concentration was positively related with the carotid intima-media thickness of the common carotid artery (CCA-IMT) and left ventricular mass index (LVMI) and was significantly higher in patients with than without carotid plaques (P<0.01). Logistic regression analysis confirmed that lgBNP concentration was independently correlated with carotid plaques. Thirty-two patients experienced ischemic cardiovascular (ICV) events during follow-up. Kaplan-Meier analysis showed that cumulative survival without new ICV events was better in patients with lower than with higher BNP concentrations (P<0.01). Cox regression analysis showed that BNP was an independent risk factor for ICV events (HR=3.167, 95%CI=1.398-7.171, P<0.01).
Similar to findings in the general population, elevated BNP level is related to atherosclerosis and an increased risk of ICV events in pre-dialytic CKD patients.
尽管脑钠肽（BNP）浓度与一般人群中的动脉粥样硬化和缺血性心血管疾病（CVD）有关，但在透析前慢性肾脏病（CKD）患者中，这种关系知之甚少。
我们前瞻性分析了 227 例透析前 CKD 患者[中位估算肾小球滤过率（eGFR）：28.82（11.65-48.20）ml/min/1.73 m（2）]。在入组时，测量了 BNP 浓度、生化和超声心动图参数，并进行了颈动脉超声检查。患者前瞻性随访平均 31.8 个月（0.5-57.0 个月）。记录缺血性 CV 事件和患者结局。
CKD 患者的 BNP 浓度明显高于对照组[53.9（16.2-181.0）pg/ml 比 9.4（7.0-15.3）pg/ml，P<0.01]。BNP 浓度与颈总动脉内膜中层厚度（CCA-IMT）和左心室质量指数（LVMI）呈正相关，且在有颈动脉斑块的患者中显著高于无颈动脉斑块的患者（P<0.01）。Logistic 回归分析证实，lgBNP 浓度与颈动脉斑块独立相关。32 例患者在随访期间发生缺血性心血管（ICV）事件。Kaplan-Meier 分析显示，BNP 浓度较低的患者无新发 ICV 事件的累积生存率优于 BNP 浓度较高的患者（P<0.01）。Cox 回归分析显示，BNP 是 ICV 事件的独立危险因素（HR=3.167，95%CI=1.398-7.171，P<0.01）。
与一般人群的研究结果相似，在透析前 CKD 患者中，升高的 BNP 水平与动脉粥样硬化和 ICV 事件风险增加有关。
