Association between N-terminal pro-brain natriuretic peptide and acute ischemic stroke in patients on chronic hemodialysis

Background

Plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) has been reported as a predictor for ischemic stroke in general population. However, predictive value of plasma NT-proBNP for acute ischemic stroke in patients on chronic hemodialysis has not been well established. The aim of this study was to determine whether NT-proBNP could predict acute ischemic stroke in patients on chronic hemodialysis.

Methods

This study was designed prospectively. Clinical, laboratory, and echocardiographic variables were assessed in 72 patients on chronic hemodialysis. The plasma levels of NT-proBNP were measured by immunoassay.

Results

During the follow-up period of 45 months, 11 patients had an acute ischemic stroke. The Kaplan–Meier plot showed an increased frequency of acute ischemic stroke in patients with plasma levels of NT-proBNP above the median values compared to patients with lower concentrations (P = 0.028). The multivariate Cox proportional hazard models showed that the NT-proBNP was a significant independent predictor of acute ischemic stroke after adjustment for age, sex, mean blood pressure, diabetes, serum cholesterol levels, left ventricular mass index, and left ventricular fractional shortening (HR 6.66, 95% CI, 1.22–36.48, P = 0.029).

Conclusions

Our data suggest that plasma NT-proBNP levels predict the risk of acute ischemic stroke in patients on chronic hemodialysis.     

N-terminal pro brain natriuretic peptide predicts hospitalization of hemodialysis patients for cardiovascular disease

We investigated whether or not N-terminal pro brain natriuretic peptide (NT-proBNP) could predict hospitalization for cardiovascular disease (CVD) among Japanese hemodialysis patients. A total of 104 patients on maintenance dialysis 3 times per week were enrolled. We followed the patients for 23.9 +/- 4.2 months and 19 hospitalizations for CVD occurring during this period. The area under the curve (AUC) for the risk of CVD hospitalization was calculated after drawing a receiver operating characteristic curve. Predialysis NT-proBNP showed a larger AUC value than both postdialysis NT-proBNP and brain natriuretic peptide. The optimal cut-off value of predialysis NT-proBNP for predicting CVD hospitalization was 5,894 pg/mL, (sensitivity of 60 % and specificity of 76 %). Diabetes mellitus, a history of CVD, and the predialysis NT-proBNP level were significant determinants of CVD hospitalization according to Cox proportional hazards analysis. In conclusion, predialysis NT-proBNP is useful for predicting CVD hospitalization in hemodialysis patients.     

Correlation analysis of N-terminal pro-brain natriuretic peptide in maintenance hemodialysis patients

Objective To analysis the distribution and influence factors of N-terminal pro-brain natriuretic peptide (NT-pro BNP), and also its clinical significance though a cross-sectional survey of NT-pro BNP in maintenance hemodialysis patients in Zhongshan Hospital, Fudan University. Methods A total of 207 stable hemodialysis patients were enrolled. The clinical parameters, plasma NT-proBNP levels and echocardiographic parameters were analyzed. Results Level of plasma NT-proBNP in patients with left ventricular hypertrophy (LVH) were significantly higher than those without LVH[M(1/4, 3/4): 3 104(1 626, 7 843) ng/L vs 1 291(772, 1 845) ng/L, P﹤0.01]. After logarithmic transformation for skewed variables NT-proBNP, log[NT-proBNP] was negatively correlated with hemoglobin (r=-0.212, P=0.004) and left ventricular ejection fraction (LVEF)(r=-0.202, P=0.003), and was positively correlated with left ventricular mass index (LVMI)(r=0.370, P=0.001), interdialysic weight gain (IDWG) rate (r=0.233, P=0.001), predialysis systolic blood pressure (r=0.345, P=0.001), predialysis diastolic blood pressure (r=0.152, P=0.032). The areas under curve(AUC) of NT-proBNP for diagnosing LVH and IDWG﹥4% were 0.786(95%CI 0.689-0.883, P﹤0.01) and 0.738(95%CI 0.667-0.810, P﹤0.01). When the threshold of NT-proBNP was set at 1 917 ng/L to diagnosis LVH, the sensitivity and specificity were 0.676 and 0.824. When the threshold of NT-proBNP was set at 2 872 ng/L to diagnosis IDWG﹥4%, the sensitivity and specificity were 0.704 and 0.758. Conclusions NT-proBNP levels are significantly abnormality in hemodialysis patients, mainly related with LVH, the high rate of IDWG, and the poorly controlled predialysis blood pressure. Proper dry weight assessment and strict control of IDWG may be effective way to intervene NT-proBNP.     

Assessment of N-terminal pro-brain natriuretic peptide in volume status in maintenance hemodialysis patients with non dominant edema

objective To investigate the value of NT-proBNP in assessing the volume status in maintenance hemodialysis patients with non-dominant edema. Methods One hundred and forty-five patients were recruited. Bioimpedance measurements were performed for overhydration (OH). NT-proBNP was detected by colloidal gold method. Patients were divided into three groups by levels of OH variability (△OH, equal to OH minus weight increase) as group H (hypervolemia, n=90); group N (normovolemia, n=36) and group L (hypovolemia, n=19). Hemoglobin，albumin，blood urea nitrogen and serum creatinine were assayed, blood pressure and body mass increase were recorded. Dry weight of patients in Group H were adjusted in 3 months，the relationship between NT-proBNP and volume change were assessed. Results (1) At baseline, overall plasma NT-proBNP levels were higher than normal range. The median NT-proBNP levels in group H and group N were [1318.50(IQR 717.00, 3154.25) pg/ml] and [703.50 (IQR 873.00, 450.50) pg/ml], respectively. NT-proBNP was positively correlated with △OH value (r=0.801, P＜0.001). (2) After 3 months, NT-proBNP levels in group H was significantly lower than baseline. Forty-one patients reached normal volume range (group H1), 49 patients were resistant hypervolemia (group H2). The median NT-proBNP levels in group H1 and group H2 were [685.00 (IQR 422.50, 988.50) pg/ml] and [1569.00 (IQR 982.50, 2500.50) pg/ml], △OH in group H1 and group H2 were [(0.63±0.23)L] and [(1.75±0.71)L], respectively. NT-proBNP and △OH value in two groups had significant difference (P＜0.05). NT-proBNP was positively correlated with △OH value (r=0.684, P＜0.001). (3) The area under ROC curve for NT-proBNP was 0.818，95%CI(0.733～0.904)，P＜0.001, since the absolute value of normovolemia was defined as ≤1. The cut off value of plasma NT-proBNP was set at 962.50 pg/ml in MHD patients with non-dominant edema, the diagnostic specificity and sensitivity were 79.6% and 73.2%. Conclusion NT-proBNP could be used to assess volume status in MHD patients with non dominant edema.     

N-terminal pro brain natriuretic peptide predicts mortality in patients with end-stage renal disease in hemodialysis

Concentrations of N-terminal pro brain natriuretic peptide (NT-proBNP) increase in patients with heart failure and other cardiovascular (CV) diseases and are strong prognostic markers. In patients with end-stage renal disease (ESRD) in hemodialysis (HD), levels of NT-proBNP are almost always raised. In ESRD patients undergoing HD, we aimed at (i) identifying the factors that affect levels of NT-proBNP, (ii) determining the effect of HD on NT-proBNP, and (iii) determining the prognostic impact of NT-proBNP. A total of 109 patients underwent physical examination, electrocardiogram, and echocardiography. Serum NT-proBNP was measured before and after HD (Elecsys 2010). NT-proBNP levels were markedly elevated (pre-HD 4079 pg/ml, post-HD 2759 pg/ml, P<0.001). There was a strong inverse correlation between NT-proBNP and left ventricular ejection fraction (LVEF) (P=0.043), 24-h urine production (P=0.006), and K(t)/V (efficacy of dialysis) (P=0.016) and a positive correlation with left ventricular hypertrophy (LVH) (P=0.014). Patients with higher concentrations, both pre- and post-HD had an increased mortality rate compared to those with lower concentrations (P=0.007, P=0.002). We found age (P=0.009) and NT-proBNP (pre-HD P=0.007, post-HD P=0.001) predictive of death. Our findings demonstrate that CV disease in terms of LVH and reduced LVEF in addition to 24-h urine production and K(t)/V determine NT-proBNP levels. Post-HD levels of NT-proBNP were lower than pre-HD levels; both predictive of mortality.     

N-terminal pro-brain natriuretic peptide identifies patients at high risk for adverse cardiac outcome after vascular surgery

BACKGROUND: Preoperative N-terminal pro-BNP (NT-proBNP) is independently associated with adverse cardiac outcome but does not anticipate the dynamic consequences of anesthesia and surgery. The authors hypothesized that a single postoperative NT-proBNP level provides additional prognostic information for in-hospital and late cardiac events. METHODS: Two hundred eighteen patients scheduled to undergo vascular surgery were enrolled and followed up for 24-30 months. Logistic regression and Cox proportional hazards model were performed to evaluate predictors of in-hospital and long-term cardiac outcome. The optimal discriminatory level of preoperative and postoperative NT-proBNP was determined by receiver operating characteristic analysis. RESULTS: During a median follow-up of 826 days, 44 patients (20%) experienced 51 cardiac events. Perioperatively, median NT-proBNP increased from 215 to 557 pg/ml (interquartile range, 83/457 to 221/1178 pg/ml; P<0.001). The optimum discriminate threshold for preoperative and postoperative NT-proBNP was 280 pg/ml (95% confidence interval, 123-400) and 860 pg/ml (95% confidence interval, 556-1,054), respectively. Adjusted for age, previous myocardial infarction, preoperative fibrinogen, creatinine, high-sensitivity C-reactive protein, type, duration, and surgical complications, only postoperative NT-proBNP remained significantly associated with in-hospital (adjusted hazard ratio, 19.8; 95% confidence interval, 3.4-115) and long-term cardiac outcome (adjusted hazard ratio, 4.88; 95% confidence interval, 2.43-9.81). CONCLUSION: A single postoperative NT-proBNP determination provides important additional prognostic information to preoperative levels and may support therapeutic decisions to prevent subsequent structural myocardial damage.     

Troponin T and N-terminal pro-brain natriuretic peptide changes in patients undergoing transurethral resection of the prostate

PURPOSE: We investigated whether transurethral resection of the prostate (TURP) caused subclinical myocardial damage or cardiac dysfunction by measuring troponin T (Trop T) and N-terminal pro-brain natriuretic peptide (pro-BNP). MATERIALS AND METHODS: A total of 52 consenting patients took part in this study. All had a detailed medical history including cardiac history taken. On the day of the operation all patients had troponin T, pro-BNP, full blood count and urea, electrolytes and creatinine measured preoperatively. A preoperative and postoperative electrocardiogram was performed. Patients in renal failure were excluded from analysis. During the operations factors such as blood loss, operative time, tissue resected and fluid absorption were monitored. On postoperative day 1 all the previously mentioned tests were repeated. RESULTS: Mean patient age was 71 years (range 52 to 85). Eight patients had a history of associated cardiac problems. Mean preoperative and postoperative hemoglobin were 14.1 gm/dl (range 10.5 to 17) and 13.3 gm/dl (range 9.9 to 16.2), respectively. None of the patients had significant (greater than 1,000 ml) fluid absorption during TURP, which was calculated using ethanol tagged glycine. Mean blood loss measured with a photometer was 129.7 ml (range 0 to 1,800). Mean operative time was 28.4 minutes (range 5 to 50) and mean weight of prostatic tissue resected was 15.2 gm (range 1 to 47). Preoperative Trop T was less than 0.01 mcg/ml in all patients and mean pro-BNP was 39.2 pg/ml (range 0.5 to 866). Postoperative Trop T was less than 0.01 mcg/ml in all but 1 patient who experienced chest pain after TURP and had an increased Trop T (0.28 mcg/ml). Mean postoperative pro-BNP was 54.57 pg/ml (range 1 to 679). A total of 37 patients had an increase in pro-BNP which was still within the reference range for the age group. There were no significant electrocardiogram changes postoperatively. The Trop T changes were not statistically significant (Wilcoxon sign ranked test p = 0.31) although they may be clinically significant. CONCLUSIONS: Our study indicates that in patients with no prior cardiac history TURP does not cause myocardial damage indicated by nonincrease of Trop T. There are slight increases in pro-BNP after TURP in some patients although the exact clinical significance is uncertain.     

Investigation of optimum N-terminal probrain natriuretic peptide level in patients on maintained hemodialysis

Background: Serum N-terminal probrain natriuretic peptide (NT-proBNP) level is known to be strongly associated with fluid overload, and serves as a guide for fluid management in patients on hemodialysis (HD). This study aimed at investigating the relationship between NT-proBNP level and blood pressure (BP), ultrafiltration/dry weight ratio as well as hemoglobin, and to explore the optimal cutoff point of NT-proBNP level in Chinese patients on HD.

Methods: A total of 306 patients on maintained HD for stage 5 chronic kidney disease (CKD) were included in this prospective study. Their average ultrafiltration/dry weight ratio and BP before dialysis were recorded. The serum NT-proBNP, hemoglobin, serum calcium, and phosphorus were detected. The cutoff value for NT-proBNP level was calculated using receiver operating characteristic (ROC) analysis.

Results: The high NT-proBNP level was associated with high BP and ultrafiltration/dry weight ratio, and low hemoglobin level. The optimal cutoff point of NT-proBNP level for patients on maintained HD was 5666?pg/mL, with a sensitivity of 78.5%, specificity of 43.9%, and area under the curve (AUC) of 0.703 (<0.001).

Conclusions: NT-proBNP level ≤5666?pg/mL was recommended to achieve the target BP, hemoglobin level, and ultrafiltration/dry weight ratio in patients on maintained HD with an ejection fraction (EF) >50%.     

运用N-末端脑钠肽评估维持性血液透析患者干体质量

目的观察N-末端脑钠肽(N-terminal brain natriuretie peptide,NT-proBNP)运用于维持性血液透析患者干体质量的评估并分析临床意义。方法 48例行维持血液透析患者分为干体质量组(Ⅰ组,24例),容量超负荷组(Ⅱ组,24例)。治疗前比较两组年龄、平均动脉压、心胸比例、左室射血分数、左室容积、NT-proBNP、血肌酐、尿素氮、估算肾小球滤过率。两组常规透析前后检测NTproBNP、血肌酐、尿素氮,计算尿素清除指数(the urea clearance index,Kt/V)值,并于下次透析前检测NT-proBNP、血肌酐、尿素氮。结果Ⅰ、Ⅱ两组患者间性别、年龄、左室射血分数、左室容积、透析之前血肌酐、尿素氮及估算肾小球滤过率比较,差异均无统计学意义(均P0.05);平均动脉压[(88.10±10.16)mm Hg、(93.92±8.03)mm Hg]、心胸比例[(48.80±6.11)%、(53.25 4-2.72)%]及NT-proBNP[(3 827.67±712.12)ng/L、(5 793.58±945.20)ng/L],Ⅰ组小于Ⅱ组,差异有统计学意义(P0.05或P0.01);透析后两组间NT-proBNP[(1847.77 4-802.54)ng/L、(3 023.58±876.56)ng/L]、血肌酐[(287.26±62.86)μmol/L、(298.86±74.57)μmol/L]比较,差异有统计学意义(P0.01)。下次透析前测NT-proBNP、血肌酐值,与上次透析前比较,差异均无统计学意义(均P0.05)。Ⅰ、Ⅱ两组NT-proBNP值远高于正常值范围。结论在非显性水肿的维持性血液透析的患者中,NT-proBNP增高提示容量超负荷普遍存在。NT-proBNP可用来评估非显性水肿的维持性血液透析的容量负荷,但具有局限性,可辅助调节干体质量。维持性血液透析干体质量的确定需要查体及多项检测综合判断。     

N-terminal fragments of the proatrial natriuretic peptide in patients before and after hemodialysis treatment

BACKGROUND: Fragments derived from the prohormone of alpha-human atrial natriuretic peptide (alpha-ANP) in patients with cardiac failure are more closely related to the disease state than intact alpha-ANP. METHODS: Specific immunoassays have been developed to detect proANP 1-30, proANP 31-67, and proANP 1-98. Plasma concentrations of these fragments were determined in 122 hemodialysis patients with and without cardiac dysfunction, with and without hypertension, as well as with and without dialysis-associated hypotensive episodes either before or after a regularly scheduled hemodialysis session. The effects of different dialyzer membranes were also evaluated. The results of these assays along with other markers of volume regulation such as alpha-ANP and cyclic 3',5' guanosine monophosphate (cGMP) were compared with those of healthy controls. RESULTS: Predialytic and postdialytic plasma concentrations of the proANP fragments were markedly higher in uremic patients than in controls (98-fold for proANP 1-98, 56-fold for proANP 31-67, and 35-fold for proANP 1-30). All proANP fragments, alpha-ANP, and cGMP decreased during hemodialysis. A strong linear correlation was found between predialytic and postdialytic plasma levels. There was no correlation, however, with the amount of fluid removed during hemodialysis. Patients with altered left ventricular hemodynamics displayed significantly higher plasma concentrations of all proANP fragments and alpha-ANP, but not cGMP, than patients with normal cardiac function. Hemodialysis patients with moderate or severe hypertension had higher concentrations of proANP fragments, alpha-ANP, and cGMP than patients with normal blood pressure or patients with only mild hypertension. There was no significant difference in circulating levels of proANP peptides, alpha-ANP, and cGMP between patients with and without frequent dialysis-associated hypotensive episodes. Cellulose-triacetate dialyzers reduced plasma levels of proANP 1-30, proANP 31-67, and proANP 1-98 significantly more than polysulfone dialyzers, but alpha-ANP and cGMP levels were not different. CONCLUSIONS: Circulating alpha-ANP and proANP fragments are influenced by a variety of factors such as end-stage renal disease, hemodialysis treatment, dialyzer membrane material, cardiac dysfunction, and hypertension. Therefore, these are not useful markers to accurately estimate volume status in hemodialysis patients.     

Analysis of impact factors of serum N-terminal pro-brain natriuretic peptide in patients with renal failure in non-dialysis phase

Objective To analyze the impac factors of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with renal failure in non-dialysis phase, and to determine the cut-off point of as a diagnostic values in these patients with heart failure (HF). Methods Cross-sectional study was applied. Clinical data of 145 patients (37 cases of CKD4, 89 cases of CKD5, and 19 cases of acute renal injury (AKI) with renal failure in non-dialysis phase were collected. Comparison between groups and lineal regression analysis were utilized to investigate the impact factors of NT-proBNP, and the receiver operating characteristic curve (ROC curve) to select a better cut-off point of diagnosis in these patients with HF. Results (1) Compared with patients without HF, patients with HF had significantly higher edema, cardiac troponin I, serum phosphorus concentration, and left atrial diameter (LA), while ALB and left ventricular ejection fraction (LVEF) were decreased (P＜0.05). (2) The NT-proBNP was divided into 4 groups with four points: First groups of 36 cases, NT-proBNP 1 -862 ng/L, second groups 37 cases, 866-2670 ng/L, third groups 37 cases, 2790-20 000 ng/L, fourth groups 35 cases, 20 900-35 000 ng/L. With the increase of NT-proBNP levels, the occurrence of AKI and CKD4 decreased gradually while the occurrence of CKD and edema were significantly increased (P＜0.01). Systolic blood pressure, troponin I, uric acid, serum phosphorus, parathyroid hormone, 24 hours urine protein, LA, interventricular septum thickness (IVS), left ventricular posterior wall thickness (LVPW) level gradually increased. Hb, ALB, calcium, CO2, eGFR, LVEF significantly decreased (P＜0.01). The serum NT-proBNP of patients with HF was significantly higher than that of patients without HF (19 150 ng/L vs 1530 ng/L, P＜0.01). The serum NT-proBNP of patients with edema was significantly higher than that in patients without edema (5460 ng/L vs 1630 ng/L, P＜0.01). (3) Single factor linear regression analysis indicated that higher NT-proBNP was positive correlated with HF, edema, cardiac troponin I, uric acid, serum phosphorus, LA, IVS and LVPW (P＜0.05), while negative correlated with Hb, eGFR, ALB, serum calcium, CO2, LVEF (P＜0.05), and not correlated with eGFR, uric acid, serum calcium (P＞0.05). (4) The best cut-off point of NT-proBNP predicting HF in patients with renal failure in non-dialysis phase was 3805 ng/L, AUC=0.848, 95%CI 0.786-0.910. Sensitivity was 82.4%, specificity 74.5%, positive predictive value 62.1%, negative predictive value 87.3%, positive likelihood ratio 3.2, negative likelihood ratio 0.24. Conclusions The level of NT-proBNP＞20 000 ng/L is mainly found in end-stage renal disease patients with HF. HF is a main factor for the increase of NT-proBNP in patients with renal failure in non-dialysis phase. High phosphorus viremia, anemia, and hypoalbuminemia are closely related to NT-proBNP. Therefore NT-proBNP predicting HF should take into account the effects of these confounding factors in these patients.     

Preoperative plasma N-terminal pro-brain natriuretic peptide as a marker of cardiac risk in patients undergoing elective non-cardiac surgery

BACKGROUND: Plasma N-terminal pro-brain natriuretic peptide (NTproBNP) is a sensitive marker for heart failure. This study tested whether the preoperative plasma level of NTproBNP could predict cardiac complications in patients undergoing non-cardiac surgery. METHODS: A total of 190 consecutive patients who underwent elective non-cardiac surgery that required general anaesthesia were studied. In addition to routine preoperative evaluation, a blood sample was taken for estimation of plasma NTproBNP concentration. Postoperative cardiac complications were defined as cardiac death, acute coronary syndrome, heart failure and haemodynamic compromise from cardiac arrhythmias. RESULTS: Fifteen of the 190 patients had a cardiac complication: four had acute coronary syndrome and 13 had congestive heart failure. NTproBNP concentration was significantly higher in patients with a cardiac complication; a level greater than 450 ng/l was predictive of cardiac complications with a sensitivity of 100 per cent and a specificity of 82.9 per cent. Other factors associated with cardiac complications were a higher American Society of Anesthesiologists grade, age and clinical cardiac impairment, but in a multivariate analysis NTproBNP level was the only independent factor. CONCLUSION: Preoperative plasma NTproBNP concentration may be an independent predictor of cardiac complications in patients undergoing non-cardiac surgery.     

N端前体脑钠肽对主动脉缩窄术后早期结果的预测价值

目的探讨N端前体脑钠肽(NT-proBNP)作为主动脉缩窄(CoA)术后预测性生物标志物的价值。方法回顾性分析2014年9月至2017年10月我院收治的344例CoA患儿的临床资料,其中男206例(59.9%)、女138例(40.1%),年龄0.2~60.0(7.1±10.6)个月。收集并分析患儿的NT-proBNP水平、临床特点、影像学资料和早期随访结果。结果NT-proBNP正常组与NT-proBNP异常组患儿在年龄、先天性心脏病危险程度分级–1≥3的占比、伴有主动脉弓发育不良的占比、术前肺炎占比、术前左心室收缩功能不全、左室壁厚度、左心室扩张、住院时间、住ICU时间、呼吸机辅助时间、血管活性药物使用时间、延迟关胸、经鼻持续气道正压通气(nCPAP)、术后心功能不全方面差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,NT-proBNP≥3000 pg/mL是住ICU时间延长[OR=3.17,95%CI(1.61,6.23)]、呼吸机辅助时间延长[OR=5.84,95%CI(2.86,11.95)]、血管活性药物使用时间延长[OR=2.22,95%CI(1.22,4.02)]、术后心功能不全[OR=3.10,95%CI(1.64,5.85)]的独立危险因素;NT-proBNP≥5000 pg/mL是延迟关胸[OR=3.55,95%CI(1.48,8.50)]的独立危险因素。结论CoA患儿NT-proBNP水平受多种因素影响,包括年龄、先天性心脏病的复杂程度、术前心功能不全等。NT-proBNP水平对术后早期结果有预测价值。     

Analysis of cystatin C combined with amino-terminal pro-brain natriuretic peptide to predict cardiovascular risk in maintenance hemodialysis patients

Objective To research the relationship between the serum level of cystatin C (Cys-C), N-terminal pro brain natriuretic peptide (NT-proBNP) and the cardiovascular (CV) events in maintenance hemodialysis (MHD) patients, looking for a new and effective biological prediction method for cardiovascular disease (CVD). Methods According to the excluded criteria and included criteria, a total of 126 patients [male 67(53.2%), female 59 (46.8%)] were included in this study, screening out of 452 MHD patients from 3 blood purification centre, no secondary hyperparathyroidism, blood pressure controlled, hemoglobin standard, no lipid abnormalities, and without history of coronary heart disease, heart failure and arrhythmia. Participants adopted 3 dialysis treatment, including hemodialysis, hemoperfusion and hemodiafiltration. Every 3 months before the dialysis, the Cys-C, NT-proBNP, serum phosphorus, serum intact parathyroid hormone (iPTH), hemoglobin and electrocardiogram were detected. The heartbeat ultrasound was examined every 6 months, observed for 24 months and followed up for 3 years, recording the incidence and the inspection results. The correlation and the occurrence of CVD were analyzed by conducting a multiple factor logistic regression analysis. The forecast performance of Cys-C, NT-proBNP was evaluated by using receiver operating characteristic (ROC) curves and area under curves (AUC). Results Eighteen episodes of CV events occurred in 126 patients during the experiment and follow-up, including 8 episodes of heart failure, 4 episodes of myocardial infarction, 6 episodes of arrhythmia. Detection indexes had no statistically significant correlation (P＞0.05), and the results of ECG and ultrasound heartbeat graph showed that no significant difference in cardiac structure and function before treatment (P＞0.05). After 24 months duration, the research showed that the level of serum calcemia was lower, and the levels of phosphorus and iPTH were higher in hemodialysis group compared with that in the other 2 groups, and the differences had statistical significance (P＜0.05). Themedian levels of Cys-C and NT-proBNP were 8.59 (9.74, 7.10) mg/L and 7 739 (9 887, 6 736) ng/L in the patients CV events occurred. Non conditional multivariate logistic regression analysis demonstrated that the increasing interdialytic weight, Cys-C, NT-proBNP, iPTH, dialysis hypotension were theindependent risk factors of CV occurrence. AUCs to predict CVD occurrence in MHD patients was 0.64 (95%CI 0.53-0.71, P＜0.05) and 0.79 (95%CI 0.72-0.89, P＜0.01) using Cys-C and NT-proBNP respectively. The cut-off values of serum Cys-C and NT-proBNP for CVD occurrence were 8.59 mg/L and 7 739 ng/L, with a sensitivity of 84.3% and a specificity of 92.7%. Conclusions Cys-C, NT-proBNP can be used to predict the risk of CV events in dialysis patients.     

血浆N-末端脑钠肽前体水平与维持性血液透析患者容量状态无关

目的 测定维持性血液透析患者生物电阻抗与血浆N-末端脑钠肽前体水平透析前后的变化,评价N-末端脑钠肽前体水平在血透患者中血容量评估的应用价值.方法 选取我院血液净化中心30例病情稳定的维持性血液透析患者,留取透析前后血标本测定N-末端脑钠肽前体.应用生物电阻抗(英国BodyStat公司QUADSCAN 4000多频生物电阻抗分析仪)测量透析前后体水量.结果 透析后N-末端脑钠肽前体水平较透析前明显升高[分别为(6 478.93±7 503.48)与(4 692.83±4 290.62) pg/ml,P＜0.01].透析后身体成分监测值较透析前明显降低[(-0.987± 1.451)与(0.964± 1.581),P＜0.01].结论 N-末端脑钠肽前体的血浆水平与维持性血透患者血容量无关.     

Cardiac function and aminoterminal pro-brain natriuretic peptide levels in liver-transplanted cirrhotic patients

Bernal V, Pascual I, Lanas A, Esquivias P, Piazuelo E, Garcia‐Gil FA, Lacambra I, Simon MA. Cardiac function and aminoterminal pro‐brain natriuretic peptide levels in liver‐transplanted cirrhotic patients.
Clin Transplant 2012: 26: 111–116.
© 2011 John Wiley & Sons A/S. Abstract: Background: Cirrhosis is associated with structural and functional abnormalities of the heart. We examined the evolution of these abnormalities after liver transplantation (LT). Methods: Sixty cirrhotic patients, without cardiovascular disease, were included. Clinical data, echocardiography, and aminoterminal pro‐brain natriuretic peptide (NT‐proBNP) levels were analyzed before and after transplantation. Healthy controls (n = 25) were included for reference. Results: Before transplantation, cirrhotic patients had higher left atrium diameter, left ventricular (LV) mass index, and ejection fraction than controls. After transplantation, LV mass index increased (105 ± 31 vs. 119 ± 35 g/m²; p < 0.05), diastolic cardiac function deteriorated, expressed as a reduction in E/A wave ratio (1.105 ± 0.295 vs. 0.798 ± 0.248; p < 0.001), and NT‐proBNP levels decreased significantly in patients compared to pre‐transplantation values (1759 ± 1154 vs. 1117 ± 600 pg/mL; p < 0.001), although they were still above levels found in controls (1117 ± 600 vs. 856 ± 123 pg/mL; p < 0.05). NT‐proBNP levels above 2000 pg/mL before transplantation were significantly associated with risk for cardiovascular events after procedure (37% vs. 9%, p = 0.008). Conclusions: In cirrhotic patients, diastolic function and cardiac structure deteriorate after LT. Compared to controls, NT‐proBNP levels tend to be higher before and after transplantation. The mechanisms and consequences of these results require further study.     

血清N末端前体BNP及肌钙蛋白I与脓毒症关系研究

目的评价N末端前体脑钠肽及肌钙蛋白I对脓毒症预后判断的作用。方法采用回顾性研究,选取住院的脓毒症患者41例,按病情严重程度分为轻度脓毒症组（22例）及严重脓毒症组（19例）,严重脓毒症组根据预后情况分为生存组（11例）及死亡组（8例）,同时选取同期住院的健康体检者20例为非脓毒症对照组,在入院的24h内检测NT-proBNP、CTnI等指标,应用单因素方差分析比较各组间NT—proBNP、CTnI水平,绘制受试者工作特征曲线,并计算曲线下面积,结合专业背景知识得到最优的界值和相应的灵敏度、特异度、约登指数。在校正性别、年龄、血管活性药物应川、肌酐清除率等影响因素的条件下,应用Logistics回归方法分析NT—proBNP对严重脓毒症预后判断的价值。结果严重脓毒症组BNP及CTnI与轻度脓毒症组、非脓毒症组比较均明显升高（P〈0．01）,严重脓毒症患者死亡组BNP及CTnI较生存组明显升高（P〈0．01）。NT—proBNP及CTnl的AUC分别为0．89（95％CI为0．42～0．96）、0．67（95％C1为0．61～0．88）,多元Logistics回归提示在校正性别、年龄、血管活性药物使用、肌酐清除牢等影响后Nrr—proBNP最终进入回归模型（OR=2．914,P〈0．05）,提示NT—proBNP为影响严重脓毒症预后的独立预测凶素,CTnl未进入回归模型。结论NT—proBNP及CTnI对脓毒症患者危险分层及预后都有较好的价值,尤其对于严重脓毒症预后的判断,NT—proBNt,优于CTnI,且NT—proBNP为严重脓毒症预后的独立预测因素。