中国血液净化

中国血液净化 ›› 2026, Vol. 25 ›› Issue (03): 212-217.doi: 10.3969/j.issn.1671-4091.2026.03.008

• 临床研究 • 上一篇    下一篇

维持性血液透析患者肺动脉高压的发生率及相关危险因素

郭晓慧    王俊霞   

  1. 471000 洛阳，1河南科技大学第一附属医院血液净化中心
  • 收稿日期:2025-08-18 修回日期:2025-12-16 出版日期:2026-03-12 发布日期:2026-03-12
  • 通讯作者: 王俊霞 E-mail:lyyzwjx@126.com

The incidence and related risk factors of pulmonary arterial hypertension in maintenance hemodialysis patients

GUO Xiao-hui,WANG Jun-xia    

  1. Hemodialysis Center, the First Affiliated Hospital of Henan University of Science and Technology, Luoyang 471000, China
  • Received:2025-08-18 Revised:2025-12-16 Online:2026-03-12 Published:2026-03-12
  • Contact: 471000 洛阳，1河南科技大学第一附属医院血液净化中心 E-mail:lyyzwjx@126.com

摘要： 目的  探究维持性血液透析(maintenance hemodialysis，MHD)患者发生肺动脉高压(pulmonary hypertension，PAH)的影响因素，为临床诊疗提出科学建议。 方法  选取2022年1月—2025年4月于河南科技大学第一附属医院接受MHD治疗的终末期肾病(end stage renal disease，ESRD)患者。根据PAH(肺动脉收缩压＞35 mmHg定义为发生PAH)的发生情况将患者分为PAH组和非PAH组。收集、整理并比较2组患者的一般资料、实验室检查指标及超声心动图检查结果，分析其与PAH发生之间的相关性。 结果  共纳入159例研究对象，其中发生PAH的患者66例(41.51%)。PAH组和非PAH组患者血钙(t=2.173，P=0.031)、白蛋白(t=3.526，P=0.001)、血红蛋白(t=4.357，P＜0.001)、血小板计数(Z=-2.866，P=0.004)、D-二聚体(Z=-2.188，P=0.029)、透析龄≥3年(χ2=4.781，P=0.029)、经皮腔内血管成形术(percutaneous transluminal angioplasty，PTA)及导管溶栓≥2次(χ2=5.710，P=0.017)、带CUFF导管留置史(χ2=5.695，P=0.017)、左心房前后径(t=-2.255，P=0.026)、左心室前后径(Z=-2.022，P=0.043)、右心房左右径(t=-2.335，P=0.022)、右心室前后径(Z=-2.496，P=0.013)、肺动脉内径(Z=-2.270，P=0.023)及左心室射血分数(Z=-2.224，P=0.026)比较差异有统计学意义。多因素二元Logistic回归分析结果显示白蛋白降低(OR=0.893，95%CI：0.817～0.976，P=0.013)、血红蛋白降低(OR=0.954，95%CI：0.931～0.978，P＜0.001)、D-二聚体升高(OR=1.156，95%CI：1.057～1.263，P=0.001)、透析龄≥3年(OR=2.861，95%CI：1.174～6.975，P=0.021)、PTA及导管溶栓≥2次(OR=2.572，95%CI：1.120～5.907，P=0.026)、带CUFF导管留置史(OR=4.057，95%CI：1.290～12.755，P=0.017)为发生肺动脉高压的独立危险因素。 结论  MHD患者PAH的发生率为41.51%。血红蛋白、白蛋白降低，D-二聚体升高、透析龄≥3年、PTA及导管溶栓≥2次、带CUFF导管留置史是MHD患者发生PAH的独立危险因素，提示可以通过针对性的治疗，降低PAH的发生率，提高患者的生活质量。

关键词: 维持性血液透析, 肺动脉高压, 危险因素

Abstract: Objective To explore the influencing factors of pulmonary arterial hypertension (PAH) in maintenance hemodialysis patients (MHD) and provide scientific recommendations for clinical diagnosis and treatment. Methods  End-stage renal disease (ESRD) patients receiving MHD treatment at the First Affiliated Hospital of Henan University of Science and Technology from January 2022 to April 2025 were selected. Patients were divided into a PAH group (defined as pulmonary artery systolic pressure > 35 mmHg) and a non-PAH group based on PAH occurrence. Demographic data, laboratory test indicators, and echocardiographic findings of the two groups were collected, organized, and compared to analyze their correlation with PAH occurrence.  Result A total of 159 subjects were included, of which 66 (41.51%) developed PAH. Statistically significant differences were observed between the PAH and non-PAH groups in serum calcium (t=2.173, P=0.031), albumin (t=3.526, P=0.001), hemoglobin (t=4.357, P＜0.001), platelet count (Z=-2.866, P=0.004), D-dimer (Z=-2.188, P=0.029), dialysis vintage ≥3 years (χ²=4.781, P=0.029), percutaneous transluminal angioplasty (PTA) and catheter-directed thrombolysis ≥2 times (χ²=5.710, P=0.017), history of cuffed catheter placement (χ²=5.695, P=0.017), left atrial anterior-posterior diameter (t=-2.255, P=0.026), left ventricular anterior-posterior diameter (Z=-2.022, P=0.043), right atrial transverse diameter (t=-2.335,P=0.022), right ventricular anterior-posterior diameter (Z=-2.496, P=0.013), pulmonary artery diameter (Z=-2.270, P=0.023), and left ventricular ejection fraction (Z=-2.224, P=0.026). Multivariate binary logistic regression analysis revealed that decreased albumin (OR=0.893, 95% CI: 0.817～0.976, P=0.013), decreased hemoglobin (OR=0.954, 95% CI: 0.931～0.978, P＜0.001), elevated D-dimer (OR=1.156, 95% CI: 1.057～1.263, P=0.001), dialysis vintage≥3 years (OR=2.861, 95% CI: 1.174～6.975, P=0.021), PTA and catheter-directed thrombolysis≥2 times (OR=2.572, 95% CI: 1.120～5.907, P=0.026), and history of cuffed catheter placement (OR=4.057, 95% CI: 1.290～12.755, P=0.017) were independent risk factors for PAH.  Conclusion  The incidence of PAH in MHD patients was 41.51%. Decreased hemoglobin and albumin, elevated D-dimer, dialysis vintage≥3 years, PTA and catheter-directed thrombolysis≥2 times, and history of cuffed catheter placement are independent risk factors for PAH in MHD patients, suggesting that targeted treatment may reduce the incidence of PAH and improve patients' quality of life

Key words: Maintenance hemodialysis, Pulmonary hypertension, Risk factors

中图分类号: