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透析患者的容量评估:脑钠肽测量值与生物电阻抗值的一致性

Volume estimation in dialysis patients: the concordance of brain-type natriuretic peptide measurements and bioimpedance values.

作者信息

Tapolyai Mihály, Faludi Mária, Réti Virág, Lengvárszky Zsolt, Szarvas Tibor, Fülöp Tibor, Bekő Gabriella, Berta Klára

机构信息

Fresenius Medical Care, Semmelweis University, Budapest, Hungary.

出版信息

Hemodial Int. 2013 Jul;17(3):406-12. doi: 10.1111/hdi.12023. Epub 2013 Jan 30.

Abstract

Correct estimation of the dialysis patients' hydration status remains an important clinical challenge. Bioimpedance measurements have been validated by various physiological tests, and the use of brain-type natriuretic peptide (BNP) has been validated by inferior vena cava diameter measurements. This is an observational cohort study that evaluated the correspondence between bioimpedance-measured overhydration percentage (OH%) and BNP. We measured predialysis OH% by bioimpedance apparatus (Body Composition Monitor) and BNP by microparticle enzyme-linked immunoassay in 41 prevalent stable hemodialysis patients, 19 (46%) women, aged 58.9 ± 14.5 years. The cohort's average BNP was 2694 ± 3278 pg/mL and 10 (24.4%) of these 41 patients had BNP < 500 pg/mL (average 260.7 ± 108.5). The OH% was 8.5 ± 7.0% among those with a BNP < 500 pg/mL, while the rest of the population had an OH% of 21.4 ± 8.0%, corresponding to excess volumes of 1.6 ± 1.3 and 4.4 ± 3.8 L, respectively. The OH% vs. BNP relationship was best described by the exponential regression of y = 216.4e(0.097x) , predicting a BNP of 216.4 pg/mL at 0% overhydration status (r 0.61). Receiver-operating curves revealed an area under the curve of 0.885 for BNP when the OH% was set ≥15% of overhydration and an area under the curve of 0.918 for OH% when the BNP was set ≥500 pg/mL for being abnormal. We conclude that in our cohort there was a high degree of correspondence between these two tests with an exponential relationship between the measurements.

摘要

准确评估透析患者的水合状态仍然是一项重要的临床挑战。生物阻抗测量已通过各种生理测试得到验证,而脑钠肽(BNP)的使用已通过下腔静脉直径测量得到验证。这是一项观察性队列研究,评估了生物阻抗测量的水过多百分比(OH%)与BNP之间的相关性。我们使用生物阻抗仪(人体成分监测仪)测量透析前的OH%,并通过微粒酶联免疫分析法测量41例稳定的维持性血液透析患者的BNP,其中19例(46%)为女性,年龄为58.9±14.5岁。该队列的平均BNP为2694±3278 pg/mL,这41例患者中有10例(24.4%)的BNP<500 pg/mL(平均260.7±108.5)。BNP<500 pg/mL的患者OH%为8.5±7.0%,而其余患者的OH%为21.4±8.0%,分别对应过量液体量为1.6±1.3 L和4.4±3.8 L。OH%与BNP的关系最好用y = 216.4e(0.097x)的指数回归来描述,预测在水过多状态为0%时BNP为216.4 pg/mL(r = 0.61)。当OH%设定为≥15%的水过多时,受试者工作曲线显示BNP的曲线下面积为0.885;当BNP设定为≥500 pg/mL为异常时,OH%的曲线下面积为0.918。我们得出结论,在我们的队列中,这两种测试之间存在高度相关性,测量值之间呈指数关系。

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