脑钠肽在鉴别肾性与肾前性急性肾损伤的应用价值探讨(1)
【摘要】 目的：探讨脑钠肽对鉴别诊断肾性与肾前性急性肾损伤的价值。方法：按标准纳入86例急性肾损伤患者，根据病理分为肾前性AKI组(42例)和肾性AKI组(44例)，收集患者的一般资料并记录、比较两组患者血清Scr、BUN/Scr、血红蛋白、脑钠肽(BNP)；尿钠量和尿渗透压等指标。结果：两组患者血清Scr、BUN/Scr、血红蛋白、脑钠肽(BNP)；尿钠量和尿渗透压比较差异均有统计学意义(P<0.05)，经受试者工作特征曲线(ROC曲线)分析显示BNP更具有鉴别诊断价值。结论：BNP在鉴别诊断肾前性与肾性AKI方面具有无创与准确的优点，具有鉴别两者的价值。
【关键词】 脑钠肽； 急性肾损伤； 鉴别诊断
中图分类号 R692 文献标识码 A 文章编号 1674-6805(2015)12-0008-03
The Value of Brain Natriuretic Peptide on Differential Diagnosis between Prerenal Acute Renal Injury and Renal Acute Kidney Injury/LIANG Zi-an，XUAN Xiao-yan，MA Chun-cheng，et al.//Chinese and Foreign Medical Research，2015，13(12)：8-10
【Abstract】 Objective：To explore the value of brain natriuretic peptide(BNP) on differential diagnosis between prerenal acute renal injury and renal acute kidney injury.Method：According to the standard，86 cases with acute kidney injury were brought into this study and they were divided into prerenal AKI group(42 cases) and renal AKI group(44 cases) on the basic of pathology，the general data was collected，the serum creatinine(Scr)，blood urea nitrogen(BUN)/Scr，hemoglobin，BNP，urinary sodium content and urine osmotic pressure were recorded and compared.Result：There were obvious differences between two groups of patients on serum creatinine(Scr)，blood urea nitrogen(BUN)/Scr，hemoglobin，BNP，urinary sodium content and urine osmotic pressure(P<0.05)；receiver operator characteristic curve(ROC curve) analysis showed that BNP had more value in differential diagnosis.Conclusion：BNP has differential diagnosis value of prerenal acute renal injury and renal acute kidney injury with advantages of no pain and accurate.
【Key words】 Brain natriuretic peptide； Acute kidney injury； Differential diagnosis
First-author’s address：Wuyi Traditional Chinese Medical Hospital of Jiangmen City，Jiangmen 529000，China
doi：10.14033/j.cnki.cfmr.2015.12.004
根据病变部位和病因不同，急性肾损伤(AKI)可分为肾前性、肾性和肾后性三大类，各有不同的病因和发病机制[1-2]。由于肾前性和肾性AKI的病因和发病机制不同，采取的治疗方法和预后具有明显的差异，因此准确地鉴别两者尤为重要。脑钠肽(BNP)目前广泛应用于临床是由于血浆脑钠肽与左心室功能不全的程度呈正相关，可作为心力衰竭严重程度的判定指标，其不仅反映了患者的心功能状态，而且在一定程度上代表了容量负荷的程度[3]。因此，本研究尝试将BNP应用于AKI患者的诊断，拟探讨BNP在肾性与肾前性AKI鉴别诊断中的临床价值。
1 资料与方法
1.1 一般资料
回顾性收集2010年1月-2014年12月就诊于笔者所在医院的86例AKI患者，AKI诊断标准：根据改善全球肾脏病预后组织(Kidney Disease Improving Global Outcomes，KDIGO)的原则符合以下情况之一即可诊断为AKI：血肌酐(Scr)升高至基线的1.5倍(或推测7 d内发生)，或48 h之内Scr绝对值升高≥26.5 μmol/L(0.3 mg/dl)，或尿量<0.5 ml/(kg·h)且时间持续超过6 h[4]。排除标准：年龄<18岁、心肌炎或心肌病、梗阻性肾病、严重的全身性感染、严重肝病、低白蛋白血症(Alb≤24 g/L)、急性心血管事件及临床资料不全者。, http://www.100md.com(梁子安 禤晓燕 马春成 李杰峰)
【关键词】 脑钠肽； 急性肾损伤； 鉴别诊断
中图分类号 R692 文献标识码 A 文章编号 1674-6805(2015)12-0008-03
The Value of Brain Natriuretic Peptide on Differential Diagnosis between Prerenal Acute Renal Injury and Renal Acute Kidney Injury/LIANG Zi-an，XUAN Xiao-yan，MA Chun-cheng，et al.//Chinese and Foreign Medical Research，2015，13(12)：8-10
【Abstract】 Objective：To explore the value of brain natriuretic peptide(BNP) on differential diagnosis between prerenal acute renal injury and renal acute kidney injury.Method：According to the standard，86 cases with acute kidney injury were brought into this study and they were divided into prerenal AKI group(42 cases) and renal AKI group(44 cases) on the basic of pathology，the general data was collected，the serum creatinine(Scr)，blood urea nitrogen(BUN)/Scr，hemoglobin，BNP，urinary sodium content and urine osmotic pressure were recorded and compared.Result：There were obvious differences between two groups of patients on serum creatinine(Scr)，blood urea nitrogen(BUN)/Scr，hemoglobin，BNP，urinary sodium content and urine osmotic pressure(P<0.05)；receiver operator characteristic curve(ROC curve) analysis showed that BNP had more value in differential diagnosis.Conclusion：BNP has differential diagnosis value of prerenal acute renal injury and renal acute kidney injury with advantages of no pain and accurate.
【Key words】 Brain natriuretic peptide； Acute kidney injury； Differential diagnosis
First-author’s address：Wuyi Traditional Chinese Medical Hospital of Jiangmen City，Jiangmen 529000，China
doi：10.14033/j.cnki.cfmr.2015.12.004
根据病变部位和病因不同，急性肾损伤(AKI)可分为肾前性、肾性和肾后性三大类，各有不同的病因和发病机制[1-2]。由于肾前性和肾性AKI的病因和发病机制不同，采取的治疗方法和预后具有明显的差异，因此准确地鉴别两者尤为重要。脑钠肽(BNP)目前广泛应用于临床是由于血浆脑钠肽与左心室功能不全的程度呈正相关，可作为心力衰竭严重程度的判定指标，其不仅反映了患者的心功能状态，而且在一定程度上代表了容量负荷的程度[3]。因此，本研究尝试将BNP应用于AKI患者的诊断，拟探讨BNP在肾性与肾前性AKI鉴别诊断中的临床价值。
1 资料与方法
1.1 一般资料
回顾性收集2010年1月-2014年12月就诊于笔者所在医院的86例AKI患者，AKI诊断标准：根据改善全球肾脏病预后组织(Kidney Disease Improving Global Outcomes，KDIGO)的原则符合以下情况之一即可诊断为AKI：血肌酐(Scr)升高至基线的1.5倍(或推测7 d内发生)，或48 h之内Scr绝对值升高≥26.5 μmol/L(0.3 mg/dl)，或尿量<0.5 ml/(kg·h)且时间持续超过6 h[4]。排除标准：年龄<18岁、心肌炎或心肌病、梗阻性肾病、严重的全身性感染、严重肝病、低白蛋白血症(Alb≤24 g/L)、急性心血管事件及临床资料不全者。, http://www.100md.com(梁子安 禤晓燕 马春成 李杰峰)