혈액투석 환자에서 체내 수분 상태와 혈중 BNP 농도 변화의 연관성 = The association between volume status and plasma brain natriuretic peptide in hemodialysis patients

다국어 초록 (Multilingual Abstract)

Background : Brain natriuretic peptide (BNP, b- type natriuretic peptide) is released into circulation in response to ventricular dilatation and pressure overload. In the general population, the plasma concentration of BNP are useful to predict left ventricular hypertrophy (LVH) and LV systolic dysfunction. Whether these cardiac hormone have correlation with hydration state in hemodialysis (HD) patients is unclear.
Methods : We measured the pre-HD and post- HD plasma BNP level in 36 HD patients and evaluated their cardiac state with echocardiography and their fluid overload state with chest X-ray. We checked intradialytic HD weight gain and ultrafiltration volume, as a marker of hydration status.
Results : Mean pre-HD BNP level of 36 HD patients was 545.79 pg/mL and mean post-HD BNP level was 503.64 pg/mL. And mean BNP level of 10 healthy adults was 13.46 pg/mL. In 29 patients, BNP level was decreased after HD. But BNP levels of 7 patients were paradoxically increased after HD. Ultrafiltration volume was smaller in these patients (p= 0.03) and post-HD blood pressure was higher (p= 0.048). Plasma BNP level was significantly increased in 17 patients with pulmonary congestion or cadiomegaly (p=0.005). But pre-HD BNP level did not correlated with pre-HD blood pressure. BNP reduction ratio was higher in larger ultrafiltration (UF) volume (>3 L) group than in smaller UF volume group (p=0.02). There were no difference in BNP levels between DM and non-DM group.
Conclusion : Plasma BNP level seems to be a limited but useful, marker of volume status in HD patients. (Korean J Nephrol 2006;25(2):273-281)

국문 초록 (Abstract)

배 경 : Brain natriuretic peptide (BNP)는 심실의 확장과 심실 압력의 과부하에 반응하여 혈중으로 분비된다. 일반적으로 BNP는 좌심실 비대와 좌심실 수축 부전을 예측하는 유용한 인자로 알려져 있다. 그러나 말기신부전으로 혈액투석 치료를 받고 있는 환자에게서, BNP 농도와 체내 수분 상태의 연관성에 대하여는 아직 명확히 밝혀져 있지 않다.방 법 : 말기신부전으로 순천향대학교 부천병원의 인공신장실에서 주 3회 혈액투석 중인 36명의 환자를 대상으로 하였다. 환자들의 투석 전후의 BNP 농도를 측정하였으며, 심초음파로 심장의 상태를 평가하였고 말초부종과 투석간 체중 증가 및 폐울혈 등으로 수분 과부하 상태를 평가하였다.결 과 : 36명 투석 환자의 평균 투석 전 BNP 농도는 545.8 pg/mL이었고, 평균 투석 후 BNP 농도는 503.6 pg/mL였다. 10명의 건강 대조군의 평균 BNP 농도는 13.5 pg/mL였다. 36명 중 29명에서 투석 후에 BNP 농도가 감소하였고, 7명에서는 투석 후에 오히려 증가하였다. 흉부방사선에서 폐 수분 저류나 심장 비대 소견을 보이는 17명의 BNP 농도는 유의하게 증가해 있었다 (p=0.005). 심부전이나 좌심실 비대 없이, 말초부종이나 폐 수분 저류 소견을 보이는 환자들의 BNP 농도가 증가되어 있었으나 유의하지 않았다. 투석 후 수축기 혈압과 투석 전후의 BNP 농도는 유의한 관련이 있었고 (p=0.017, p=0.026), 투석 후 BNP 농도가 증가한 군에의 평균 혈압도 BNP가 감소한 군에 비해 유의하게 높았다 (p=0.048). 수분과 초여과량에 따른 BNP 변화를 관찰할 때 초여과를 3 L 이상 시행한 군에서 BNP 농도의 감소율이 높았다 (p=0.02).

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