长期维持性血液透析患者并发的肺动脉高压  

Pulmonary hypertension in patients on long-term maintenance hemodialysis

作　　者：叶文玲[1] 马杰[1] 石涛[1] 孙威[1] 张抒扬[2] 方理刚[2] 李雪梅[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院肾内科,北京100710 [2]中国医学科学院北京协和医学院北京协和医院心内科,北京100710

出　　处：《中华肾脏病杂志》2012年第1期31-35,共5页Chinese Journal of Nephrology

基　　金：北京协和医院面上青年基金（2009155）

摘　　要：目的研究长期维持性血液透析（MHD）患者肺动脉高压（PHT）的特征及相关因素。方法参照2010年美国心脏超声协会右心检测指南，肺动脉收缩压（PASP）〉35mmHg诊为PHT。超声心动图和脉搏波传导速度（baPWV）于透析后次日集中检测。自体动静脉内瘘（AVF）流量采用超声稀释法检测。收集及评估患者的透析相关信息，取血检测血常规、钙、磷、甲状旁腺激素（iPTH）、肝肾功能等指标。结果我院透析中心进行MHD6个月以上，采用自体AVF并除外其他疾病引起并发PHT者，共111例，其中男性45例，女性66例，平均年龄（57．32±12．49）岁，平均透析龄为（70．51士44．98）个月。28例诊为PHT，占25．23％，平均PASP为（45．68±10．83）mmHg。PHT组的左室舒张功能不全明显较非PHT组常见（53．60％比6．02％，P〈0．01）。PHT组左室射血分数（EF）值（62．06％±14．90％比69．72％±8．60％）、左室内径缩短分数（36．46％±10．04％比40．20％±7．86％）均低于非PHT组（均P〈0．01）。EF〈50％者在PHT组和非PHT组分别占21．43％和3．61％。但PHT组和非PHT组在年龄、性别、透析龄、身高、体质量指数（BMI）、透析间期平均每日体质量增长、透析前血压、血红蛋白、血白蛋白、前白蛋白、血钙、血磷、iPTH、标准化蛋白分解率（nPCR）、Kt／V、baPWV以及AVF流量等差异均无统计学意义。结论PHT是维持性血液透析常见的并发症，其发生与左室收缩和舒张功能下降密切相关；与钙磷代谢、AVF流量、血红蛋白、透析充分性及营养状态等无明显相关性。vascular access. The patients with any possible diseases causing PHT were excluded. The mean MHD period was （70.51±44.98） months. Twenty-eight patients （25.32%） were diagnosed as PHT with mean PASP （45.68 ±10.83） mm Hg. Left ventricular diastolic dysfunction was severer in patients with PHT than that in patients without PHT. The prevalence of moderate to severe diastolic dysfunction was statistically higher in PHT group compared to non-PHT group （53.60% vs 6.02%, P〈0.01）. Ejection fraction （EF）, fractional shortening of left ventricular diameter in PHT group were also significantly lower than those in non-PHT patients （62.06%±14.90% vs 69.72%±8.60%, 36.46%±10.04% vs 40.20%±7.86%, P〈0.01）. The patients with EF less than 50% were 21.43% and 3.61% in PHT and non-PHT group respectively. However, there were no significant differences in age, sex, MHD periods, body mass index （BMI）, interval dialysis weight growth, blood pressure before dialysis, hemoglobin, albumin, pre-albumin, serum calcium and phosphorus, iPTH, nPCR, Kt/V, baPWV and AVF flow between the two groups. Conclusions PHT is a common complication of patients on long-term MHD. There is close relationship between PHT and left ventricular insufficiency. PHT is not significantly relevant to mineral metabolic disturbance, AVF flow, hemoglobin, dialysis adequacy and nutrition status.

关 键 词：肾透析 高血压 肺性 脉搏波传导速度 动静脉内瘘 钙磷代谢 

分 类 号：R459.5[医药卫生—治疗学]