贫血与慢性肾脏病无症状透析前患者的NT-前脑钠肽水平独立相关。

Anemia is independently associated with NT-proBNP levels in asymptomatic predialysis patients with chronic kidney disease.

作者信息

Tirmenstajn-Jankovic B, Dimkovic N, Perunicic-Pekovic G, Radojicic Z, Bastac D, Zikic S, Zivanovic M

机构信息

Department of Nephrology and Hemodialysis, Medical Center Zajecar, Serbia.

Clinical Department for Renal Disease, Zvezdara University Medical Center, Belgrade, Serbia.

出版信息

Hippokratia. 2013 Oct;17(4):307-12.

PMID:25031507

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4097409/

Abstract

BACKGROUND

Although anemia and renal dysfunction are related to increased natriuretic peptides levels in heart failure patients, less is known about this relationship in asymptomatic predialysis patients with chronic kidney disease (CKD). The aim of this study was to investigate relationship between hemoglobin (Hb) concentration, N-terminal proBNP (NT-proBNP) levels and echocardiographic findings in these patients.

METHODS

The study included 61 patients with CKD stage IV-V (34 male, mean age 62.6 ± 13.6 years) and 22 age- and sex -matched healthy persons as control group. All participants underwent clinical, laboratory and echocardiographic examination, including Tissue Doppler Imaging and colour M-mode Doppler.

RESULTS

Patients with CKD had lower Hb levels (p<0.001), and higher levels of NT-proBNP (p<0.001) than healthy controls. Patients were divided into two groups according to their mean Hb levels: group A, Hb<10.3 g/dL and group B, Hb≥10.3 g/dL. Patients from group A was significantly older (p<0.001), left ventricular mass index was significantly higher (LVMI, p<0.001), LV diastolic function was worse (septal and lateral E'/A' ratio: p<0.05 and p<0.01, respectively), and the level NT-proBNP was higher (p<0.001) compared to patients from group B. The natural logarithm of NT-proBNP (lnNT-proBNP) showed highly significant correlation with Hb (p<0.001) and significant correlation with estimated glomerular filtration rate (p=0.035) in CKD patients. Multiple regression analysis revealed Hb levels (p<0.01), cholesterol (p<0.001), LV ejection fraction (p<0.001) and septal E/E' ratio (p<0.01) as the independent variables predicting as much as 54% variability of lnNTpro-BNP.

CONCLUSIONS

The increased NT-proBNP levels in asymptomatic patients with advanced CKD were independently associated with echocardiographic parameters of LV function, but anemia may represent one of the important confounder of the relationship between NT-proBNP and cardiovascular abnormalities.

摘要

背景

虽然贫血和肾功能不全与心力衰竭患者利钠肽水平升高有关，但对于无症状的慢性肾脏病（CKD）透析前患者的这种关系了解较少。本研究旨在调查这些患者血红蛋白（Hb）浓度、N末端脑钠肽前体（NT-proBNP）水平与超声心动图检查结果之间的关系。

方法

本研究纳入了61例CKD Ⅳ-Ⅴ期患者（34例男性，平均年龄62.6±13.6岁），并选取22例年龄和性别匹配的健康人作为对照组。所有参与者均接受了临床、实验室及超声心动图检查，包括组织多普勒成像和彩色M型多普勒检查。

结果

CKD患者的Hb水平低于健康对照组（p<0.001），NT-proBNP水平高于健康对照组（p<0.001）。根据平均Hb水平将患者分为两组：A组，Hb<10.3 g/dL；B组，Hb≥10.3 g/dL。与B组患者相比，A组患者年龄显著更大（p<0.001），左心室质量指数显著更高（LVMI，p<0.001），左心室舒张功能更差（室间隔和侧壁E'/A'比值：分别为p<0.05和p<0.01），NT-proBNP水平更高（p<0.001）。在CKD患者中，NT-proBNP的自然对数（lnNT-proBNP）与Hb高度显著相关（p<0.001），与估计肾小球滤过率显著相关（p=0.035）。多元回归分析显示，Hb水平（p<0.01）、胆固醇（p<0.001）、左心室射血分数（p<0.001）和室间隔E/E'比值（p<0.01）是预测lnNTpro-BNP高达54%变异性的独立变量。