中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (05): 322-325.doi: 10.3969/j.issn.1671-4091.2017.05.010

• 临床研究 • 上一篇    下一篇

维持性血液透析患者左心室肥厚相关因素分析

商惠萍1,宋晓萍2,李学玲3,李德天1   

  1. 1. 中国医科大学附属盛京医院肾脏内科
    2. 辽河油田总医院 血液净化科
    3. 沈阳市经济技术开发区人民医院内三科
  • 收稿日期:2017-01-12 修回日期:2017-03-28 出版日期:2017-05-12 发布日期:2017-05-19
  • 通讯作者: 李德天 lidetian126@163.com E-mail:lidetian126@163.com

The prevalence of left ventricular hypertrophy in maintenance hemodialysis patients

  • Received:2017-01-12 Revised:2017-03-28 Online:2017-05-12 Published:2017-05-19

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摘要： 目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者左心室肥厚(left ventricular hypertrophy,LVH)的相关影响因素。方法回顾性分析2006 年6 月～2016 年6 月于中国医科大学附属盛京医院第一血液净化中心在透析的MHD 患者81 人(男38 例，女43 例)，年龄23～83 岁，规律血液透析每周2～3 次，每次4h，平均透析龄(56.0±39.1)月。超声心动图诊断左心室肥厚，比较年龄、血压，液体负荷，透析中超滤量，贫血，营养状态以及继发性甲状旁腺功能亢进对患者左心室肥厚的影响。结果有左心室肥厚和无左心室肥厚的MHD 患者比较，在年龄(F=5.697,t=-3.557,P=0.000)、收缩压(F=0.338,t=5.171,P=0.000)、舒张压(F=4.990, t=3.971, P=0.000)、平均动脉压(F=1.110,t=5.119,P=0.000)、脑钠肽(F=35.531,t=0.000,P=0.000)、血红蛋白(F=0.029,t’=-4.696,P=0.000)方面差异有统计学意义,与收缩压、舒张压、平均动脉压、脑钠肽呈正相关，与年龄、血红蛋白呈负相关；相同患者左室重量指数最大时与最小时比较，在收缩压(t=2.528,P=0.015)、超滤量(t=-2.472,P=0.016)、脑钠肽(t=3.059,P=0.006)、血红蛋白(t=-2.889,P=0.006)方面差异有统计学意义，与收缩压、脑钠肽呈正相关，与超滤量、血红蛋白呈负相关；Logistic 回归分析显示收缩压[OR 1.033，95% CI 1.011～1.057 ，P=0.004]和脑钠肽[OR 1.001，95% CI 1.000～1.001，P＜0.001]是左心室肥厚的独立危险因素。另外，在MHD 患者有无合并左心室肥厚的比较中血清钙(F=0.660,t=0.141,P=0.888)，血清磷(F=1.337, t=0.907, P=0.365)、全段甲状旁腺激素(F=0.579, t=-0.149,P=0.881)、血清白蛋白(F=1.419,t=-1.615,P=0.108)以及体质量指数(F=1.806,t=0.043,P=0.966)差异无统计学意义；在左室重量指数最大时与最小时的比较中，血清钙(t=-1.051,P=0.299)，血清磷(t=-1.763,P=0.084)、全段甲状旁腺激素(t=-1.381,P=0.174)、血清白蛋白(t=-1.602,P=0.116)以及体质量指数(t=-1.583, P=0.119)同样差异无统计学意义。结论MHD 患者左心室肥厚与血压、液体负荷、贫血关系密切，降低MHD 患者血压，尤其是收缩压，减轻液体超负荷，改善
贫血有助于改善MHD患者的左心室肥厚。

关键词: 维持性血液透析, 左心室肥厚, 左室重量指数

Abstract: Objective To investigate the prevalence of left ventricular hypertrophy(LVH) in maintenance hemodialysis (MHD) patients. Methods A total of 81 MHD patients (38 males and 43 females; 23-83 years old) treated in the First Blood Purification Center, Shengjing Hospital, Chinese Medical University from June 2006 to June 2016 were retrospectively analyzed. They were treated with regular hemodialysis of 4 hours/time and 2-3 times/week with the average dialysis age of 56± 39.1 months. Echocardiography was used for the diagnosis of LVH. The effects of age, blood pressure, fluid load, ultrafiltration volume, anemia, nutritional status, and secondary hyperparathyroidism on LVH were analyzed. Results Age (F=5.697, t=-3.557, P=0.000), systolic blood pressure (F=0.338, t=5.171, P=0.000), diastolic blood pressure (F=4.990, t=3.971, P=0.000), mean arterial pressure (F=1.110, t=5.119, P=0.000), brain natriuretic peptide (BNP, F=35.531, t=0.000, P=0.000), and hemoglobin (F=0.029, t=-4.696, P=0.000) were statistically different between MHD patients with LVH and those without LVH; systolic blood pressure, diastolic blood pressure, mean arterial pressure and BNP were positively correlated with LVH, and age and hemoglobin were negatively correlated with LVH. When comparison of related factors was made at the maximum value and minimum value of left ventricular mass index for every patient, there were significant differences in systolic blood pressure (t=2.528, P= 0.015), ultrafiltration volume (t=- 2.472, P=0.016), BNP (t=3.059, P=0.006) and hemoglobin (t=- 2.889, P= 0.006); systolic blood pressure and BNP were positively correlated with left ventricular mass index, and ultrafiltration volume and hemoglobin were negatively correlated with left ventricular mass index. Logistic regression analysis showed that systolic blood pressure (OR=1.033, 95% CI 1.011~1.057, P=0.004) and BNP (OR= 1.001, 95% CI 1.000~1.001, P<0.001) were the independent risk factors for LVH. In addition, serum calcium (F=0.660, t=0.141, P=0.888) and phosphorus (F=1.337, t=0.907, P=0.365), intact parathyroid hormone (F=0.579, t=-0.149, P=0.881), serum albumin (F=1.419, t=-1.615, P=0.108) and body mass index (F=1.806, t=0.043, P=0.966) showed no significant differences between MHD patients with LVH and those without LVH. When comparison of related factors was made at the maximum value and minimum value of left ventricular mass index, serum calcium (t=- 1.051, P=0.299), serum phosphorus (t=- 1.763, P=0.084), intact parathyroid hormone (t=-1.381, P=0.174), serum albumin (t=-1.602, P=0.116) and body mass index (t=-1.583, P=0.119)
also showed no statistical significances. Conclusion LVH was closely related to blood pressure, fluid over load and anemia in MHD patients. Therefore, reducing blood presure especial systolic blood pressure and fluid load, and treatment of anemia will be helpful for the improvement of LVH in MHD patients.

Key words: Maintenance hemodialysis, Left ventricular hypertrophy, Left ventricular mass index