慢性肾脏病3期糖尿病肾病患者左心结构与功能改变的多因素分析  

Multiplicity of changes of left ventricular structure and function in patients with stage 3 chronic kidney disease complicated with diabetic nephropathy

作　　者：王顺[1] 桑晓红[1] 

机构地区：[1]新疆医科大学第一附属医院肾内科,830000

出　　处：《实用医学杂志》2009年第12期1966-1969,共4页The Journal of Practical Medicine

摘　　要：目的:分析慢性肾脏病3期(CKD3)2型糖尿病肾病患者超声心动图变化,探讨其变化特点与年龄、血脂、血压、血红蛋白、尿蛋白等因素之间的关系。方法:121例确诊为CKD3期的患者,按照原发病不同分为糖尿病肾病组和非糖尿病肾病组,对其年龄、血脂、血压、血红蛋白、尿蛋白等相关临床资料及超声心动图检查结果进行对比分析和多因素分析。结果:CKD3期糖尿病肾病患者贫血发生率84%,与非糖尿病肾病患者相比,贫血发生率高、程度重,尿蛋白排泄率高。心脏结构改变以左室舒末内径增大,左室肥厚为主。功能改变以舒张功能减退为特点。血红蛋白(Hb)与左室舒张末期内径(LVEDd)、左室心肌质量指数(LVMI)相关;尿蛋白(Pr)与二尖瓣血流心房收缩期最大流速(AV)及其比值E/A相关。结论:CKD3期糖尿病肾病患者心脏病变受多因素影响,贫血、尿蛋白等因素作用不容忽视。提示早期积极纠正贫血,控制血压,减少尿蛋白排泄可能是糖尿病肾病患者减少或延缓心血管并发症的重要措施。Objective To observe the changes of left ventricular structure and function in echocardiogram in patients with stage 3 chronic kidney disease （CKD3） complicated with diabetic nephropathy （DN）, and to research the correlations between the changes and multiple factors. Methods 121 patients with CKD3 [including 43 cases complicated with DN （DN group） and 78 cases without DN （non-DN group）] received echocardiogram detection. Age, blood lipids, blood pressure, hemoglobin, and urine protein were measured. Results Incidence of anemia （84%） and the rate of urinary protein excretion in DN group were higher than those in non-DN group. The structural changes of left ventricle were the enlargement of left ventricular end diastolic diameter （LVEDd） and hypertrophy, and the functional changes were the decrescence of diastolic function. Hemoglobin （Hb） was correlated with LVEDd and left ventricular mass index （LVMI）. Urinary protein （Pr） was related to the peak velocity at late diastole （AV） and the ratio of E/A. Conclusions Anemia and urinary protein play an important role in the occurrence and development of heart disease in patients with CKD3 complicated with DN. To effectively control anemia, blood pressure, and urinary protein excretion may be an important measure to reduced cardiovascular complications.

关 键 词：慢性肾脏病 糖尿病肾病 心脏结构和功能 血红蛋白 尿蛋白 

分 类 号：R692[医药卫生—泌尿科学] R587.2[医药卫生—外科学]