中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (09): 465-469.doi: 10.3969/j.issn.1671-4091.2013.09.00

• 临床研究 •    下一篇

维持性血液透析患者的心脏结构改变及预后分析

毛永辉1,王海涛1,陈献广2   

  1. 1. 卫生部北京医院肾脏内科
    2. 卫生部北京医院肾内科
  • 收稿日期:2013-04-28 修回日期:2013-06-18 出版日期:2013-09-12 发布日期:2013-09-12
  • 通讯作者: 王海涛 wanghaitaoj@yahoo.com.cn E-mail:wanghaitaoj@aliyun.com

The Cardiac structural abnormalities and its effct on the prognosis of maintenance hemodialysis patients

  • Received:2013-04-28 Revised:2013-06-18 Online:2013-09-12 Published:2013-09-12

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摘要： 目的 观察维持性血液透析(MHD)患者心脏结构与功能改变的状况，进行心脏病变危险因素筛查，并进一步探讨其与心脑血管事件的关系。 方法 横断面及前瞻性随访研究。选取2008年1月至8月北京医院肾内科115例维持性血液透析患者，收集其临床资料、进行超声心动图(UCG)检查，分析心脏病变的相关因素；随访2年，记录随访期间发生的心脑血管事件，并分析心脑血管事件的相关危险因素。 结果 横断面研究显示，115例MHD患者中瓣膜钙化92例(80%)，为最常见的心脏病变；左室肥厚80例(69.6%)；左房扩大75例(65.2%)；左室舒张功能障碍98例(85.6%)，左室收缩功能障碍9例(7.83%)；肺动脉高压13例(11.3%)。多因素logestic分析示年龄增加、三酰甘油下降与心脏瓣膜钙化相关；收缩压升高是左室肥厚的危险因素；舒张压和尿素清除率(URR)下降与左房扩大独立相关。随访研究显示，2年期间有23例(20%)发生心脑血管事件，各种原因的死亡18例(15.7%)，其中12例(66.7%)死于心脑血管疾病。事件组患者CRP阳性率(43.5% 比 17.4%，P=0.007)、低白蛋白血症(＜35g/L)比例(17.4% 比 3.3%，P=0.041)、左房内径[(46.7±5.4 )比(41.0±6.2)mm，P=0.000]、左室重量指数[(179.5±65.0)比(149.7±50.2)g/m2，P=0.018]高于非事件组。COX多因素分析显示，血浆ALB＜35g/L(P=0.004)、CRP阳性(P=0.004)、左房扩大(P=0.014)是发生心脑血管事件的独立危险因素。 结论 MHD患者普遍存在心脏结构及功能异常，这也是患者不良心血管预后的危险因素。定期对患者进行UCG检查，有助于早期发现心脏结构和功能的改变，从而有针对性地采取干预措施，改善患者的远期预后。 目的 观察维持性血液透析（MHD）患者心脏结构与功能改变的状况，进行心脏病变危险因素筛查，并进一步探讨其与心脑血管事件的关系。方法 横断面及前瞻性随访研究。选取2008年1月至8月北京医院肾内科115例维持性血液透析患者，进行超声心动图（UCG）检查，分析心脏病变的相关因素；随访2年，记录随访期间发生的心脑血管事件，并分析其相关危险因素。结果 横断面研究显示，115例MHD患者中瓣膜钙化92例（80%）；左室肥厚80例（69.6%）；左房扩大75例（65.2%）；左室舒张功能障碍98例（85.6%），左室收缩功能障碍9例（7.83%）；肺动脉高压13例（11.3%）。多因素logestic分析示年龄增加、三酰甘油下降与心脏瓣膜钙化相关；收缩压升高是左室肥厚的危险因素；舒张压和尿素清除率（URR）下降与左房扩大独立相关。随访研究显示，2年期间有23例（20%）发生心脑血管事件，各种原因的死亡18例（15.7%），其中12例（66.7%）死于心脑血管疾病。事件组患者CRP阳性率（43.5% 比 17.4%，P=0.007）、低白蛋白血症（<35g/L）比例（17.4% 比 3.3%，P=0.041）、左房内径[(46.7±5.4 )比（41.0±6.2）mm，P=0.000]、左室重量指数[（179.5±65.0）比（149.7±50.2）g/m2，P=0.018]高于非事件组。COX多因素分析显示，血浆ALB<35g/L（P=0.004）、CRP阳性（P=0.004）、左房扩大（P=0.014）是发生心脑血管事件的独立危险因素。 结论 MHD患者普遍存在心脏结构及功能异常，这也是患者不良心血管预后的危险因素。定期对患者进行UCG检查，有助于早期发现心脏结构和功能的改变，从而有针对性地采取干预措施，改善患者的远期预后。

关键词: 血液透析, 心血管病变, 超声心动描记术

Abstract: Objective To investigate the changes of cardiac structure and function in maintenance hemodialysis（MHD） patients, as well as to explore the relationship between the changes and cardiocerebrovascular events. Methods The study included two parts:Cross-sessional study and prospective cohort study. 115 MHD patients were enrolled.Baseline anthropometric and laboratory parameters were measured and echocardiography was performed to assess the cardiac structure and function.The cardiocerebrovascular events during the 2 year follow-up period were documented. Results In all patients, valve calcification were observed in 92 (80%) patients, left ventricular hypertrophy in 80 (69.6%) patients, left atrial enlargement in 75 (65.2%) patients, pulmonary hypertension in 13(11.3%) patients.98 (85.6%) patients had cardiac diastolic dysfunction while only 9 (7.83%) patients had cardiac systolic dysfunction.Multivariate logistic regression analysis revealed that the independent associations of the different echocardiographic abnormalities were: valve calcification – increased age and lower serum triglyceride; left ventricular hypertrophy – higer systolic blood pressure; left atrial enlargement – lower blood diastolic pressure and urea reduction ratio. During the follow-up period ,there were 23(20.0%) cardiocerebrovascular events,18（15.7%） deaths, of which 12 were attributable to cardiovascular disease.In event group , the incidence of hypoalbuminemia and C- reactive protein (CRP) positive , left atrial size and LVMI were significantly higher than those of in control group(P <0.05).The independent risk factors for cardiocerebrovascular event were decreased serum albumin, positive CRP and left atrial enlargement. Conclusions Echocardiographic cardiovascular disease are already present in a very high proportion of MHD patients and are independent risk factor for adverse outcomes. Echocardiography should be performed periodically to detect early structural and functional changes in MHD patients .

Key words: Hemodialysis, Cardiovascular disorder, Echocardiography