中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (11): 816-820.doi: 10.3969/j.issn.1671-4091.2023.11.004

• 临床研究 • 上一篇    下一篇

不同NYHA分级维持性血液透析患者的临床特征及其心脏结构功能的变化

李转欢   练 游   

  1. 528000 佛山，1 广东医科大学附属佛山复星禅诚医院血液净化中心
  • 收稿日期:2023-07-13 修回日期:2023-08-26 出版日期:2023-11-22 发布日期:2023-11-12
  • 通讯作者: 李转欢 E-mail:lizhuanhuan11@126.com

Clinical features and changes of cardiac structure and function in maintenance hemodialysis patients with different NYHA grades

LI Zhuan-huan, LIAN You   

  1. Blood Purification Center, Foshan Fosun Chancheng Hospital of Guangdong Medical University, Foshan 528000, China
  • Received:2023-07-13 Revised:2023-08-26 Online:2023-11-22 Published:2023-11-12
  • Contact: 528000 佛山，1广东医科大学附属佛山复星禅诚医院血液净化中心 E-mail:lizhuanhuan11@126.com

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摘要： 目的 研究不同纽约心脏协会心功能分级(NYHA分级)的维持性血液透析(maintenance hemodialysis，MHD)患者的临床特征及其心脏结构功能的变化。 方法 收集佛山复星禅诚医院148例MHD患者，根据NYHA分级将其分为NYHA I级组、 NYHA II级组、NYHA III级组、NYHA IV级组。收集其临床资料、实验室指标及心脏彩超结果，比较不同NYHA分级MHD患者上述指标的变化。 结果  NYHA III级组患者透析间期体质量增长、收缩压与NYHA I级组相比差异有统计学意义(t=2.057,P=0.049；t=2.415, P=0.017)。随着NYHA分级逐渐增高，射血分数保留型心力衰竭(heart failure with preserve ejection fraction，HFpEF)患者占比逐渐减少，射血分数降低型心力衰竭(heart failure with reduced ejection fraction，HFrEF)患者占比逐渐增加(χ2=8.517，P=0.046)；氨基末端脑钠肽(NT-proBNP)、C-反应蛋白(CRP)逐渐增高，白蛋白(ALB)、血红蛋白(Hb)逐渐下降，以NYHA IV级组明显，4组间差异有统计学意义(χ2=9.465，P=0.009；F=6.745，P=0.048；F=6.235，P=0.037；F=6.812，P=0.042)。随着NYHA分级的增加，左心房内径(left atrial diameter，LA)、左心室舒张末期直径(left ventricular end-diastolic diameter，LVEDd)、二尖瓣舒张晚期峰值流速(the late diastolic peak flow velocity，VA)逐渐增加，以NYHA IV级组明显，组间比较差异有统计学意义(F=6.701，P=0.032；F=6.278，P=0.037；F=6.485，    P=0.042)；随着NYHA分级增高，左心室射血分数(left ventricular ejection fraction，LVEF)降低，组间比较差异有显著性(χ2=58.216，P＜0.001)。 结论  NYHA III、IV级的MHD患者多合并透析间期体质量增长多、血压控制欠佳。随着NYHA分级增加，微炎症状态、营养不良、贫血逐渐加重，心脏房室内径增大，以舒张功能减退为主，早期识别其舒张功能减退不能局限于二尖瓣舒张早期与舒张晚期峰值流速之比值，需结合二尖瓣舒张早期峰值流速(early diastolic peak velocity，VE)、VA及其动态变化综合判断。

关键词: NYHA分级, 维持性血液透析, 心脏结构

Abstract: Objective  To analyze the clinical characteristics and changes of cardiac structure and function in maintenance hemodialysis (MHD) patients with different New York Heart Association cardiac function grade (NYHA grade).  Methods  A total of 148 MHD patients were divided into NYHA I group, NYHA II group, NYHA III group and NYHA IV group according to the NYHA classification of their heart function. Clinical data, laboratory indicators and Echocardiography results were collected. Changes of the above indicators were compared in the MHD patients with different NYHA grades.  Results   There were significant differences in weight gain in the hemodialysis period (t=2.057, P=0.049) and systolic blood pressure (t=2.415,       P=0.017) between NYHA III group and NYHA I group. With the increase of NYHA grade, the proportion of heart failure with preserve ejection fraction (HFpEF) patients reduced gradually, and the proportion of patients with heart failure and reduced ejection fraction (HFrEF) increased gradually (χ2=8.517, P=0.046); NT-proBNP and CRP increased gradually, and ALB and Hb decreased gradually, especially in NYHA IV group, with statistical significances among the four groups (χ2=9.465, P=0.009; F=6.745, P=0.048; F=6.235, P=0.037;             F=6.812, P=0.042); left atrial diameter (LA), left ventricular end-diastolic diameter (LVEDd) and the late diastolic peak flow velocity (VA) increased gradually, especially in NYHA IV group, and the differences were statistically significant among the groups (F=6.701, P=0.032; F=6.278, P=0.037; F=6.485, P=0.042); left ventricular ejection fraction (LVEF) decreased gradually, with significant differences among the groups (χ2=58.216, ＜0.000).  Conclusion  MHD patients with NYHA III or IV grade usually show more weight gain and poor blood pressure control during the dialysis period. With the increase of NYHA grade, microinflammatory state, malnutrition and anemia increased gradually, atrial and ventricular diameters increased mainly due to the decrease of diastolic function. Early identification of the decreased diastolic function should combine the values of early diastolic peak velocity (VE) and VA and their dynamic changes rather than limited to the E/A ratio.

Key words: NYHA grade, Maintenance hemodialysis, Cardiac structure

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