中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (10): 763-767.doi: 10.3969/j.issn.1671-4091.2023.10.010

• 临床研究 • 上一篇    下一篇

左心结构变化与维持性血液透析患者肺动脉高压的相关性研究

何 禾    杨沿浪   

  1. 241001 芜湖，1皖南医学院第二附属医院血液净化中心
    241000 芜湖，2皖南医学院第一附属医院肾内科
  • 收稿日期:2023-04-27 修回日期:2023-08-20 出版日期:2023-10-12 发布日期:2023-09-28
  • 通讯作者: 何禾 E-mail:amy_ken@163.com
  • 基金资助:
    芜湖市科技计划项目(2020rkx4-9)

The correlation between changes of left ventricular structure and pulmonary hypertension in maintenance hemodialysis patients

HE He, YANG Yan-lang   

  1. Blood Purification Center, The Second Affiliated Hospital of Wannan Medical College, Wuhu 241001, China; 2Department of Nephrology, The First Affiliated Hospital of Wannan Medical College, Wuhu 241000, China
  • Received:2023-04-27 Revised:2023-08-20 Online:2023-10-12 Published:2023-09-28
  • Contact: 241001 芜湖，1皖南医学院第二附属医院血液净化中心 E-mail:amy_ken@163.com

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摘要： 目的  分析左心结构是否构成维持性血液透析(maintenance hemodialysis,MHD)患者发生肺动脉高压的危险因素；探讨左心结构变化与MHD患者肺动脉收缩压的关系。 方法  选择存在肺动脉高压(pulmonary hypertension,PH)的MHD患者31人纳入PH组，PH判断标准为彩色超声心动图测量后肺动脉收缩压(pulmonary artery systolic pressure,PASP)≥35 mmHg。选择同期未发生PH的MHD患者49人纳入非肺动脉高压(no pulmonary hypertension,N-PH)组(n=49)。收集2组患者的病史资料、实验室相关数据。将数据结果进行统计学分析，了解PASP的相关影响因素以及导致肺动脉高压的危险因素。结果  皮尔逊相关检验显示肺动脉收缩压与患者左心房内径(r=0.464,P＜0.001)、左心室收缩期内径(r=0.267,P=0.019)、透析间期体质量控制率(r=0.452,P＜0.001)、总胆固醇(r=0.469,P＜0.001)、低密度脂蛋白(r=0.270,P＜0.001)、三酰甘油(r=0.402,P=0.016)呈正相关，与左心室射血分数(r=-0.235, P=0.040)、每月透析时间(r=-0.469,P＜0.001)、血红蛋白(r=-0.300,P=0.005)、血清白蛋白(r=-0.792,P＜0.001)、老年营养风险评估指数(r=-0.324,P=0.003)呈负相关；多因素二元Logistics回归分析中左心房内径(OR=1.757,95% CI:1.164～2.653,P=0.007)、体质量控制率(OR=1.296,95% CI:1.074～1.564,P=0.007)是发生肺动脉高压的独立危险因素。 结论  左心结构变化与MHD患者肺动脉高压密切相关。肺动脉收缩压随着左心房结构、老年营养风险评估指数、体质量控制率、4周透析时间、血脂的变化发生改变。而左心房内径增加、体质量控制率上升则是MHD患者发生肺动脉高压的危险因素。

关键词: 维持性血液透析治疗, 肺动脉高压, 危险因素, 左心结构

Abstract: Objective  To explore whether left heart structure constitutes a risk factor for pulmonary hypertension (PH), and the relationship between changes of left heart structure and pulmonary artery systolic pressure (PASP) in maintenance hemodialysis (MHD) patients.  Methods   A total of 80 MHD patients aged 18 to 80 years old and treated in The Second Affiliated Hospital of Wannan Medical College between January 2016 and June 2019 were enrolled in this study. PASP >35mmHg measured by echocardiography was diagnosed as HP. Patients were then divided into two groups: PH group (n=31) and non-PH group (49). They were followed up for 1.5 years for their prognosis. Clinical and laboratory data were analyzed by univariate and multivariate regression tests to understand the influencing factors for PASP and the risk factors for PH in MHD patients.  Results   Pearson correlation test showed that PASP was positively correlated with left atrial diameter (r=0.464, P<0.001), left ventricular systolic diameter (r=0.267, P=0.019), inter-dialysis body mass growth rate (r=0.452, P<0.001), total cholesterol (r=0.469, P<0.001), low-density lipoprotein (r=0.270,          P<0.001), and triacylglycerol (r=0.402, P=0.016), and was negatively correlated with left ventricular ejection fraction (r=-0.235, P=0.040), monthly dialysis time (r=-0.469, P<0.001), hemoglobin (r=-0.300, P=0.005), serum albumin (r=-0.792, P<0.001), and elderly nutritional risk assessment index (r=-0.324, P=0.003). Multivariate logistic regression found that left atrial diameter (OR=1.757, 95% CI:1.164~2.653, P=0.007) and inter-dialysis body mass growth rate (OR=1.296, 95% CI:1.074~1.564, P=0.007) were the independent risk factors for PH.  Conclusion  Changes of left heart structure were closely related to PH in MHD patients. Changes of PASP were associated with the changes of left atrial structure, elderly nutritional risk assessment index, inter-dialysis body mass growth rate, monthly dialysis time, and blood lipids. Enlargement left atrial diameter and increase of inter-dialysis body mass growth rate were the independent risk factors for PH in MHD patients.

Key words: Maintenance hemodialysis, Pulmonary hypertension, Risk factor, Left ventricular structure

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