中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (07): 400-403.doi: 10.3969/j.issn.1671-4091.2015.07.005

• 临床研究 • 上一篇    下一篇

腹膜透析患者心脏结构功能与透析充分性相关性研究

张威,纪天蓉,孔凡武,鲍运霞,任野平   

  1. 哈尔滨医科大学附属第二医院肾内科一病房
  • 收稿日期:2015-02-13 修回日期:2015-05-08 出版日期:2015-07-12 发布日期:2015-07-12
  • 通讯作者: 任野平 hayidazhangwei@163.com E-mail:renyeping123@126.com

Effect of peritoneal dialysis adequacy on cardiac structure and function in peritoneal dialysis patients

  • Received:2015-02-13 Revised:2015-05-08 Online:2015-07-12 Published:2015-07-12

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摘要： 【摘要】目的探讨腹膜透析充分性对慢性肾脏病(chronic kidney disease，CKD)5 期患者心脏结构与功能的影响。方法选择哈尔滨医科大学附属二院肾内科随访的CKD5 期并持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis，CAPD)＞3 月的患者86 例，根据透析充分与否分为A,B两组。其中A 组44 例[尿素清除指数(Kt/V)≥1.7 且肌酐清除指数(总Ccr)≥50L/(周•1.73m2)]；B 组42 例[Kt/V＜1.7 且总Ccr＜50L/(周·1.73m2)]并与44 例健康体检者(C 组)对照。分别采集病史、检测相关生化指标、检查心脏彩色多普勒超声，同时测量患者血压。根据相关公式计算左室心肌质量指数(LVMI)、残余肾肌酐清除率(rGFR)。分析心脏结构与功能的影响因素。结果①A 组左室心肌质量指数(LVMI)为139.8±29.7ｇ/m2，显著低于B 组178.4±30.5g/m2(F=1.053，P=0.003)；A 组室间隔厚度(IVST)为11.9 ± 2.01mm，显著低于B 组13.5±1.7mm(F=1.396，P=0.012)；A 组左室后壁厚度(LVPWT)为11.3±2.1mm，显著低于B 组13.0±1.8mm(F=1.358，P=0.011)；A 组左房内径(LAD)为34.2±5.6mm，显著低于B 组40.0±6.3mm(F=1.258，P=0.011)。A 组收缩功能(EF)为61.4±5.6%，高于B 组57.8±7.4%(F=1.754，P=0.041)，而2 组舒张功能差异无统计学意义(F=1.778，P=0.821)。②A 组与B 组相比，A 组尿素氮(BUN)、血肌酐(Scr)、甲状旁腺激素(PTH)显著低于B 组(P＜0.01)，收缩压(SPD)、舒张压(DBP)低于B 组(P＜0.05)，而血清白蛋白(Alb)、血红蛋白(Hb)高于B 组(P＜0.05)，残肾Kt/V、rGFR 则显著高于B 组。其中A 组残肾Kt/V 占总Kt/V 的35%，B 组占12%(P＜0.01)。③通过相关性分析显示患者代谢毒素水平、营养不良、贫血、血压及残肾功能对心脏结构与功能均有一定程度的影响。结论充分腹膜透析对改善患者心脏结构与功能有重要意义。适时透析，保护残肾功能，提高透析充分性，可减少患者心血管系统并发症，从而提高患者生存率及生活质量。

关键词: 腹膜透析, 透析充分性, 心脏结构与功能

Abstract: 【Abstract】Objective To investigate the effect of peritoneal dialysis adequacy on cardiac structure and function in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods Eighty-six patients treated with CAPD for at least 3 months in our department were enrolled in this study. Patients were divided into two groups according to the adequacy of peritoneal dialysis: group A (n=44), urea clearance index (Kt/V total) ≥ 1.7 and creatinine clearance weekly (WCcr total) ≥50L/(w•1.73m2), and group B (n=42), urea clearance index (Kt/V total) ＜1.7 and creatinine clearance weekly (WCcr total) ＜50L/(w•1.73m2). Forty-four healthy individuals were recruited as controls (group C). Blood pressure was measured, and blood BUN, Scr, Ca, P, PTH, Hb and Alb were also measured in all patients. IVST, LVPWT, LAD, LVDd, LVDs, EF and E/A were determined by echocardiography. Kt/V total, Kt/V renal, WCcr total and rGFR were calculated. Results ① LVMI, IVST, LVPWT and LAD were significantly lower in group A than in group B (139.8±29.7 g/m2 vs. 178.4±30.5 g/m2, F=1.053, P =0.003 for LVMI; 11.9±2.01 mm vs. 13.5±1.7 mm, F=1.396, P =0.012 for IVST; 11.3±2.1 mm vs. 13.0±1.8 mm, F=1.358, P =0.011 for LVPWT; 34.2±5.6 mm vs. 40.0±6.3 mm, F=1.258, P= 0.011 for LAD). EF was significantly higher in group A than in group B (61.4±5.6% vs. 57.8±7.4% F=1.754, P=0.041). There was no significant difference in diastolic function between the two groups (F=1.778, P=0.821). ② Group A had lower levels of BUN, Scr and PTH (P＜0.01), lower SBP and DBP (P＜0.05), higher Alb and Hb (P＜0.05), higher Kt/V values of residual renal function and rGFR (P＜0.01) as compared with whose in group B. The Kt/v value of residual renal function was 35% of total Kt/V in group A, and was 12% of total Kt/V in group B (P＜0.01). ③ Cardiac structure and function were correlated with uremic toxins, malnutrition, anemia, hypertension and residual renal function. Conclusions There is a close relationship between peritoneal dialysis adequacy and cardiac structure and function. Cardiac structure and function can be improved by maintaining a rational peritoneal dialysis adequacy. Protecting the residual renal function and maintaining the dialysis adequacy can reduce the incidence of cardiovascular disease and the mortality in CAPD patients.

Key words: perioneal dialysis, dialysis adequacy, cardiac structure and function