中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (07): 506-509.doi: 10.3969/j.issn.1671-4091.2014.07.006

• 临床研究 • 上一篇    下一篇

维持性血液透析患者血清甲状旁腺激素(iPTH)水平与心功能评价的相关性研究

张晓玲,白久旭,郝峻烽,崔汉民,任凯明,曹宁   

  1. 沈阳军区总医院血液净化科
  • 收稿日期:2013-11-18 修回日期:2014-04-10 出版日期:2014-07-12 发布日期:2014-07-12
  • 通讯作者: 曹宁 cn88860068@sohu.com E-mail:cn88860068@sohu.com
  • 基金资助:

    辽宁省科技攻关课题（2010225036）

The association between parathyroid hormone and cardiac function in patients under maintenance hemodialysis

  • Received:2013-11-18 Revised:2014-04-10 Online:2014-07-12 Published:2014-07-12

RichHTML

0

PDF

255

摘要： 目的探讨维持性血液透析(MHD)患者全段甲状旁腺激素(iPTH)水平的变化与左心室结构和功能的相关性，评估iPTH 对MHD 合并心力衰竭早期诊断、治疗及判定预后的临床价值。方法随机选取沈阳军区总医院血液净化科186 名MHD 患者。入选标准为：血液透析3 次/周，每次4h；年龄在18～75 岁；透析年限6 个月以上10 年以下；无急性心血管事件。利用放免法检测患者透析前iPTH 水平、电化学发光免疫分析法检测透析血浆B 型钠尿肽前体(pro-BNP)水平。左心室肥厚(LVH)可由心脏超声检查判断。超声心动图检测患者左心房内径(LAD)、左心室舒张末内径(LVDd)、室间隔厚度(IVST)、左心室后壁厚度(LVPwT)、左心室射血分数(LVEF)等，计算左心室重量(LVM)，左心室心肌重量指数(LVMI)。根据2009 年KDIGO 指南iPTH 水平的目标范围，按iPTH 正常参考值上限水平2～9 倍为界将患者分为3 组，探讨iPTH 与MHD 患者左心功能的关系。结果iPTH ≥549.9pg/ml 组患者的LAD 、LVMI、LVDd、IVST、LVPwT 显著高于iPTH≤122.2pg/ml，122.2-549.9 pg/ml 组(P＜0.05)。随着iPTH 的增长，患者pro-BNP 水平升高，有统计学差异(P＜0.05)。随着iPTH 的增长，iPTH 与NYHA 心功能分级呈正相关，血清iPTH 水平与LAD 、LVMI、LVDd、LVDs、IVST、LVPwT、左心室收缩功能、pro-BNP 呈正相关(P＜0.05)，与LVEF 呈负相关(P＜0.05)。结论MHD 患者iPTH 水平与左心室功能密切相关，可能成为诊断及评估患者心功能的一个重要标志物。
【关键词】维持性血液透析、甲状旁腺激素、NYHA 心功能分级

关键词: 维持性血液透析, 甲状旁腺激素, NYHA心功能分级

Abstract: Objective To investigate the relationship between intact parathyroid hormone (iPTH) and left ventricular structure and function, and to evaluate the clinical value of iPTH for the early diagnosis, treatment and prognosis of heart failure. Methods A total of 186 maintenance hemodialysis (MHD) patients treated in Hospital of Shenyang Military Area Command were recruited in this study. They were treated with maintenance hemodialysis (MHD) 3 times a week and 4 h a session with the dialysis age of 6 months to 10 years, and were 18-75 years old without acute cardiovascular events. Serum iPTH was determined by radioimmunoasssy, and pro- BNP by electro- chemiluminescence. Echocadiography was used to measure left atrial size (LAD), ventricular diastolic diameter (LVDd), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPwT), left ventricular ejection fraction (LVEF), left ventricular mass (LVM) and LVM index (LVMI) for the assay of left ventricular hypertrophy. According to the 2009 KDIGO guidance and 2～9 times of iPTH upper limits (normal range 11.7～61.1 pg/ml), the patients were stratified into three groups, iPTH ≥549.9 pg/ml group, iPTH ≤122.2 pg/ml group and 122.2～549.9 pg/ml group to investigate the relationship between iPTH and left ventricular structure and function. Result LAD, LVMI, LVDd, VST and LVPwT were significantly higher in the iPTH ≥549.9 pg/ml group than those in the iPTH ≤122.2 pg/ml and 122.2～549.9 pg/ml groups (P＜0.05). Serum iPTH was positively correlated with pro-BNP levels (P＜0.05). Serum iPTH increased along with the increase of NYHA class. iPTH level was positively correlated with LAD, LVMI, LVDd, LVDs, IVST, LVPwT, left ventricular systolic function and pro-BNP (P＜0.05), and was negatively correlated with LVEF (P＜0.05). Conclusion In MHD patients, serum iPTH is closely related to left ventricular function. iPTH may become an important factor for the evaluation of heart function.

Key words: maintenance hemodialysis, parathyroid hormone, NYHA functional class