目的 探讨氨基末端脑钠肽(N terminal-pro brain nalriuretic peptide,NT-proBNP)水平变化对老年血液透析合并充血性心力衰竭诊断和心功能分级的判断价值。方法 选择尿毒症维持性血液透析(maintenance hemodialysis,MHD)合并心力衰竭患者36例作为血透心衰组,选择非血液透析、CKD3期以上[eGFR＞60 ml/(min·1.73m²)]的心力衰竭患者38例作为对照组,测定两组心力衰竭及治疗好转后心功能不同等级时的NT-proBNP,采用受试者工作特征(receive operating characteristic,ROC)曲线评价NT-proBNP的诊断效能。结果 血透心衰组和对照组治疗后随心功能好转,血清NT-proBNP水平下降, 不同心功能分级间NT-proBNP水平有统计学差异(P＜0.05或P＜0.01)。血透心衰组各心功能分级NT-proBNP水平明显高于对照组,差异有统计学意义(P＜0.05)。血透心衰组心功能Ⅳ级AUC值为0.847,NT-proBNP>11 100 ng/L作为界值(cutoff值)的敏感度为83％,特异度为79％;心功能Ⅲ级AUC值为0.794,NT-proBNP>6465 ng/L作为界值的敏感度为100％,特异度为56.4％,心功能Ⅰ级和Ⅱ级时无统计学差异。结论 老年MHD合并心力衰竭时NT-proBNP可作为判断心力衰竭及心功能Ⅲ级、Ⅳ级的分级指标。

Objective To evaluate the changes level of amino terminal brain natriuretic peptide(NT-proBNP) as well as its relationship between the changes and cardiac function classification in elderly maintenance hemodialysis patients with congestive heart failure. Methods Self-reflection Methods was used to analyze clinical data in 36 maintenance hemodialysis patients with congestive heart failure (hemodialysis heart failure group)aged≥60 years and compared with 38 non-maintenance hemodialysis patients with congestive heart failure (control group)aged≥60 years whose estimated glomerular filtration rate (eGFR) ＞60 ml/(min·1.73 m²) more than 60 years old among the same period in this hospital. The NT-proBNP level of different grades classified by NYHA (New York Heart Association) in the two group’s patients was measured after the treatment to improve cardiac function. ROC curve was used to evaluate diagnosis efficiency of NT–proBNP in different cardiac function classification of hemodialysis heart failure group. Results In hemodialysis heart failure group, compared with control group, NT-proBNP level of various cardiac function classification, median NT-proBNP values of Ⅰ, Ⅱ, Ⅲ, Ⅳ cardiac function classification respectively were significantly higher (P<0.05 or P<0.01). Comparing NT-proBNP level between different heart function classification in hemodialysis heart failure group, adjacent grading levels Ⅱ-Ⅳ also had significant difference (P<0.05 or P<0.01), and levels Ⅰ-Ⅱ have no significant difference (P>0.05). The same comparison in control group, adjacent grading levels Ⅰ-Ⅳ all have significant differences (P<0.05 or P<0.01). AUC value Results in hemodialysis heart failure group: AUC value in grade Ⅳ was 0.847, NT-proBNP>11 100 ng/L as boundary values, sensitivity was 83%, specificity was 79%; AUC value in grade Ⅲ was 0.794, NT-proBNP> 6465 ng/L as boundary values, sensitivity was 100%, specificity was 56.4%; cardiac function classification Ⅰ, Ⅱ were meaningless. Conclusions NT- proBNP can be regarded as diagnostic index and grading index of Ⅲ Ⅳ in elderly hemodialysis patients with congestive heart failure.