中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (03): 151-155.doi: 10.3969/j.issn.1671-4091.2018.03.002

• 临床研究 • 上一篇    下一篇

残余肾功能对维持性血液透析患者心脏瓣膜钙化的影响

孙杰1.2,尹忠诚3   

  1. 1徐州医科大学教学医院丰县人民医院
    2徐州医科大学研究生学院
    3徐州医科大学附属医院肾脏病科
  • 收稿日期:2017-10-27 修回日期:2018-01-21 出版日期:2018-03-12 发布日期:2018-03-12
  • 通讯作者: 尹忠诚yzcxyfy@126.com E-mail:sunjie198507@126.com

Effects of residual renal function on cardiac valve calcification in maintenance hemodialysis patients

  • Received:2017-10-27 Revised:2018-01-21 Online:2018-03-12 Published:2018-03-12

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摘要： 【摘要】目的探讨维持血液透析(maintenance hemodialysis,MHD)患者，残余肾功能对心脏结构及心脏瓣膜钙化的影响。方法研究共纳入88 例维持性血液透析患者的临床资料，采用经体表面积校正的尿素氮清除率和肌酐清除率的均值作为评价透析患者残余肾功能(residual renal function,RRF)的指标。其中RRF(-)组45 例，RRF(+)组43 例。比较患者一般资料、实验室血液检查、心脏结构及瓣膜钙化等各项指标的差异。结果一般资料中，两组患者的透析年龄及高血压2 级以上例数均有统计学差异。实验室血液检查中血钙、钙磷乘积、甲状旁腺素和C 反应蛋白水平RRF(+)组均高于RRF(-)组，有统计学差异(t 值分别为3.796, 2.739, 2.435, 3.081；P 值分别为0.001，0.006,0.010,0.001)。对于心脏结构，左室短轴缩短率(left ventricular short- axis shortening,FS)2 组之间无显著差异(P 值0.45)，而左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDd)2 组之间(55.78±5.92mm 比51.91±5.31mm，t=3.013，P=0.002)、舒张末期左心室后壁厚度(left ventricular posterior wall thickness,LVPWT)2 组之间(10.98±1.24mm 比10.45±0.78mm，t=2.833，P=0.03)、舒张末期室间隔厚度(interventricular septal thickness,IVST)2 组之间(11.12 ± 1.45mm 比10.58 ± 1.06mm，t=2.395，P=0.024)、左心房内径(left atrial diameter,LA)2 组之间(40.71±5.73mm 比37.95± 6.59mm，t=3.761，P=0.03) 及左心室射血分数(left ventricular ejection fraction,LVEF)2 组之间(54.22 ± 9.62mm 比59.79±7.78mm，t=-2.142，P=0.041)相比，均有统计学差异。除此之外，2 组心脏瓣膜钙化也有统计学差异(χ2=8.340,P=0.020)。结论对于维持血液透析患者，残余肾功能可改善钙磷代谢及微炎症状态，可
以改善心脏结构，减轻瓣膜钙化的发生。

关键词: 残余肾功能, 血液透析, 心脏结构, 瓣膜钙化

Abstract: 【Abstract】Objective To illuminate the effect of residual renal function on valve calcification and cardiac structure in maintenance hemodialysis (MHD) patients. Methodology Clinical data of the 88 patients on MHD were recruited. The mean values of urea nitrogen removal rate and creatinine clearance rate were used to evaluate residual renal function (RRF) in these patients, and then the RRF (-) group (n=45) and the RRF (+) group (n=43) were divided. Clinical information, laboratory blood tests, cardiac structure and valve calcification were compared between the two groups. Results For clinical information, dialysis age and hypertension above stage 2 were statistically different between the two groups. For laboratory tests, serum calcium, calcium phosphorus product, parathyroid hormone and C reactive protein were higher in RRF (+) group than in RRF (- ) group (t=3.796, 2.739, 2.435 and 3.081 respectively; P=0.001, 0.006, 0.10 and 0.001 respectively). For cardiac structure, left ventricular short-axis shortening had no difference between the two groups, but left ventricular end-diastolic diameter (LVEDd), end-diastolic left ventricular posterior wall thickness (LVPWT), end- diastolic ventricular septal thickness (IVST), left atrial diameter (LA), left ventricular ejection fraction (LVEF) and cardiac valve calcification were significantly different between the two groups (55.78±5.92 vs.51.91± 5.31mm, t=3.013, P=0.002 for LVEDd; 10.98±1.24 vs. 10.45±0.78mm, t=2.833, P=0.03 for LVPWT; 11.12±1.45 vs. 10.58±1.06mm, t=2.395, P=0.024 for IVST; 40.71±5.73 vs. 37.95±6.59mm, t=3.761, P=0.030 for LA; 54.22±9.62 vs. 59.79±7.78mm, t=-2.142, P=0.041 for LVEF; χ2=8.340, P=0.020 for valve calcification). Conclusion For maintenance hemodialysis patients, residual renal function can improve calcium and phosphorus metabolism, micro-inflammatory state as well as cardiac structural, and alleviate cardiac valve calcification.

Key words: residual renal function, hemodialysis, cardiac structure, valve calcification