慢性肾脏病非透析患者脑钠肽前体异常的危险因素分析

金德伟; 陶敏; 马晓燕; 王奕; 盛丽莉; 刘娜

doi:10.16766/j.cnki.issn.1674-4152.002049

慢性肾脏病非透析患者脑钠肽前体异常的危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002049

同济大学附属东方医院肾内科，上海 200092

基金项目:

国家自然科学基金项目 81670690

国家自然科学基金项目 81470991

国家自然科学基金项目 81200492

上海市自然基金项目 20ZR1445800

浦东新区重点学科附带课题 PWZxk2017-05

详细信息

通讯作者:
刘娜，E-mail：naliubrown@163.com

中图分类号: R692
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- 被引次数: 0
出版历程
- 收稿日期: 2021-02-08
- 网络出版日期: 2022-02-16

Study on risk factors of N-terminal pro-brain natriuretic peptide abnormalities in non-dialysis patients with chronic kidney disease

Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200092, China

摘要

摘要: 目的研究慢性肾脏病(chronic kidney disease, CKD)非透析患者氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide, NT-proBNP)异常的危险因素。方法选取2018年1月1日—2019年12月31日在东方医院肾内科入院治疗的259例CKD非透析患者。根据患者NT-proBNP水平将患者分为NT-proBNP正常组(Ⅰ组：NT-proBNP＜125 ng/L)和NT-proBNP异常组(Ⅱ组：NT-proBNP≥125 ng/L)，其中Ⅰ组患者129例，Ⅱ组患者130例。采用多因素logistic回归、ROC曲线分析患者NT-proBNP异常的影响因素。结果 Logistic回归分析显示高龄(P=0.008)为NT-proBNP异常的独立危险因素，高血红蛋白(P=0.014)、eGFR(P < 0.001)水平为患者NT-proBNP异常的保护因素。ROC分析显示, 当患者年龄>75.5岁(AUC=0.658, P < 0.001), 血红蛋白 < 124.5 g/L(AUC=0.769, P < 0.001), eGFR < 47.53 mL/(min·1.73 m²)(AUC=0.810, P < 0.001)时, 患者发生NT-proBNP增高的风险将显著增加。结论高龄为NT-proBNP异常的独立危险因素，高水平血红蛋白、eGFR是患者NT-proBNP异常的保护因素。
- 慢性肾脏病 /
- 氨基末端脑钠肽前体 /
- 危险因素
Abstract: Objective To investigate the risk factors of N-terminal pro-brain natriuretic peptide (NT-proBNP) abnormalities in non-dialysis patients with chronic kidney disease (CKD). Methods Non-dialysis patients hospitalized in the Department of Nephrology from January 1, 2018 to December 31, 2019 at the Shanghai East Hospital were enrolled. According to the level of NT-proBNP, patients were divided into NT-proBNP normal group (Ⅰ: NT-proBNP < 125 ng/L) and NT-proBNP abnormal group (Ⅱ: NT-proBNP≥125 ng/L). There were 129 patients in group Ⅰ and 130 patients in group Ⅱ. Multivariate Logistic regression and ROC curve were used to analyze the influencing factors of patients' NT-proBNP abnormalities. Results Logistic regression showed that age (P=0.008) was an independent risk factor for NT-proBNP abnormality, and hemoglobin (P=0.014) and eGFR (P < 0.001) were protective factors for patients with NT-proBNP abnormality. ROC analysis showed that when the patient's age was>75.5 years (AUC=0.658, P < 0.001), hemoglobin < 124.5 g/L (AUC=0.769, P < 0.001), eGFR < 47.5 [mL/(min·1.73 m²)] (AUC=0.810, P < 0.001), the risk of NT-proBNP increase will increase significantly. Conclusion Age is an independent risk factor for the increase of NT-proBNP, while hemoglobin and eGFR are protective factors.
- Chronic kidney disease /
- N-terminal pro-brain natriuretic peptide /
- Risk factor

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表 1 2组CKD非透析患者基本临床资料比较

组别	例数	性别[例(%)]		年龄(x ±s，岁)	BMI (x ±s)	吸烟[例(%)]	饮酒[例(%)]	收缩压(x ±s，mm Hg)	舒张压(x ±s，mm Hg)	心率(x ±s，次/min)	UACR [M(P₂₅, P₇₅), mg/g]
组别	例数	男性	女性	年龄(x ±s，岁)	BMI (x ±s)	吸烟[例(%)]	饮酒[例(%)]	收缩压(x ±s，mm Hg)	舒张压(x ±s，mm Hg)	心率(x ±s，次/min)	UACR [M(P₂₅, P₇₅), mg/g]
Ⅰ组	129	82(63.6)	47(36.4)	54.8±15.4	25.0±3.4	24(18.6)	16(12.4)	144.5±91.4	84.5±12.8	80.65±14.2	307.5(91.1, 1 277.6)
Ⅱ组	130	72(55.4)	58(44.6)	63.8±14.8	24.5±4.4	27(20.8)	21(16.2)	144.8±23.5	85.3±13.2	80.3±13.2	1 218.8(161.6, 3 560.3)
统计量		1.798^a		-4.829^b	1.062^b	0.192^a	0.744^a	-0.038^b	-0.527^b	0.206^b	10 510.000^c
P值		0.180		< 0.001	0.289	0.661	0.388	0.970	0.599	0.837	< 0.001

组别	例数	24小时尿蛋白定量[M(P₂₅, P₇₅), g]		血红蛋白(x ±s，g/L)	白蛋白[M(P₂₅, P₇₅), g/L]		ALT [M(P₂₅, P₇₅), U/L]	AST [M(P₂₅, P₇₅), U/L]		SUA (x ±s，μmol/L)	eGFR[x ±s，mL/(min·1.73 m²)]
Ⅰ组	129	0.7(0.3, 2.2)		131.3±22.2	40.7(35.5, 44.2)		18.0(13.5, 25.0)	18.0(15.0, 23.0)		378.6±104.5	73.2±26.0
Ⅱ组	130	1.8(0.3, 3.7)		108.3±26.2	36.7(30.6, 40.1)		13.5(10.0, 20.0)	17.0(14.0, 24.0)		410.4±112.5	40.6±26.4
统计量		9 651.500^c		7.632^b	5 764.000^c		5 924.500^c	7 647.500^c		-2.354^b	10.001^b
P值		0.036		< 0.001	< 0.001		< 0.001	0.220		0.019	< 0.001

组别	例数	空腹血糖[M(P₂₅, P₇₅), mmol/L]		糖化血红蛋白[M(P₂₅, P₇₅), %]	疾病史[例(%)]				用药史[例(%)]
组别	例数	空腹血糖[M(P₂₅, P₇₅), mmol/L]		糖化血红蛋白[M(P₂₅, P₇₅), %]	高血压	糖尿病	冠心病		钙离子拮抗剂	ACEI/ARB	降糖药
Ⅰ组	129	5.3(4.9, 6.5)		5.8(5.4, 6.6)	87(67.4)	38(29.5)	10(7.8)		51(39.5)	77(59.7)	33(25.6)
Ⅱ组	130	5.1(4.6, 5.9)		5.8(5.3, 6.5)	108(83.1)	46(35.4)	19(14.6)		75(57.7)	76(58.5)	42(32.3)
统计量		6 632.000^c		8 254.000^c	8.508^a	1.038^a	3.068^a		8.545^a	0.040^a	1.424^a
P值		0.004		0.828	0.004	0.308	0.080		0.003	0.841	0.233
注：^a为χ²值；^b为t值；^c为U值。

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表 2 NT-proBNP异常升高的多因素logistic回归分析

因素	B	SE	Wald χ²	P值	OR(95% CI)
年龄(岁)	0.032	0.012	7.135	0.008	1.033(1.009~1.057)
UACR(mg/g)	< 0.001	< 0.001	0.420	0.517	1.000(1.000~1.000)
24小时尿蛋白定量(g)	0.092	0.080	1.309	0.253	1.096(0.937~1.282)
血红蛋白(g/L)	0.021	0.009	6.005	0.014	0.979(0.963~0.996)
白蛋白(g/L)	0.032	0.027	1.344	0.246	0.969(0.918~1.022)
ALT(U/L)	0.003	0.010	0.072	0.789	1.003(0.983~1.023)
SUA (μmol/L)	0.001	0.002	0.091	0.763	1.001(0.997~1.004)
eGFR[mL/(min·1.73 m²)]	0.034	0.008	19.272	< 0.001	0.966(0.952~0.981)
空腹血糖(mmol/L)	0.131	0.072	3.263	0.071	0.877(0.761~1.011)
高血压	0.218	0.451	0.232	0.630	1.243(0.513~3.011)
钙离子拮抗剂	0.206	0.382	0.289	0.591	1.228(0.581~2.600)

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