非透析慢性肾脏病患者心律失常的临床研究  

Clinical analysis of arrhythmia in chronic kidney disease patients without renal replacement therapy

作　　者：张海英[1] 薛勤[1] 汪年松[1] 胡伟国[2] 李青[3] 简桂花[1] 高许萍[1] 陈海冰[2] 贾伟平[2] 

机构地区：[1]上海交通大学附属第六人民医院肾脏内科,200233 [2]上海交通大学附属第六人民医院心功能室,200233 [3]上海市糖尿病临床医学中心上海市糖尿病研究所内分泌科

出　　处：《中华肾脏病杂志》2012年第2期106-110,共5页Chinese Journal of Nephrology

基　　金：基金项目：上海市第六人民医院优势特色专业基金;上海市市级医院新兴前沿技术联合攻关课题（SHDC12006101,SHDC12010114）

摘　　要：目的 分析尚未行肾脏替代治疗的慢性肾脏病（CKD）患者心律失常的发生情况及临床特点,并探讨其相关因素.方法 收集并分析405例尚未行肾脏替代治疗CKD患者的24h动态心电图资料及一般临床资料,应用Logistic多元回归分析探讨严重心律失常与年龄、性别、CKD分期、糖尿病、高血压、高钾血症及左室肥大等因素间的相关性.结果 405例CKD患者中,CKD1、2、3、4、5期患者分别为69例（17.04％）、79例（19.51％）、82例（20.25％）、88例（21.73％）、87例（21.48％）.各种心律失常中偶发室早、偶发房早、频发房早、阵发性室上速、频发室早、成对室早、多源性室早及室早伴房早的比例分别为53.09％、46.91％、29.63％、29.88％、23.21％、23.21％、20.99％及23.46％.CKD 1～5期患者发生严重性心律失常的比例为45.68％,CKD 1、2、3、4、5期中的比例分别为27.54％、29.11％、42.68％、57.95％和65.52％.在CKD2、3、4期患者中,CKD分期越高,严重心律失常的发生率越高（P＜0.05）.Logistic多元回归分析显示左心室肥大、CKD分期、糖尿病、高血压及高钾血症为严重心律失常的相关因素.结论 CKD患者严重心律失常的发生率较高,CKD分期高、糖尿病、高血压、左心室肥大、高钾血症的CKD患者更易发生严重心律失常.Objective To observe the occurrence and risk factors of arrhythmia in chronic kidney disease （CKD） patients in different stages of renal function. Methods A total of 405 CKD patients were enrolled in this study and none of them received renal replacement therapy.The 24 h dynamic electrocardiogram （DCG） was performed,and baseline characteristics were compared.Multivariable Logistic regression analysis was used to examine the relationship between the severe arrhythmia and the potential risk factors,such as age,gender,CKD stage,diabetes,hypertension,hyperpotassaemia,left ventricular hypertrophy （LVH）,etc. Results There were 69 patients （17.04%）,79 patients （19.51%）,82 patients （20.25%）,88 patients （21.73 %） and 87 patients （21.48%） in CKD stage 1,2,3,4 and 5,respectively.As high as 45.68% of all the patients had severe arrhythmia,represented by 27.54%,29.11%,42.68%,57.95% and 65.52% in CKD stages 1-5 respectively.The occurrence of severe arrhythmia increased as the eGFR decreased in CKD stages 2,3,4 （p〈0.05）.On multivariable Logistic regression analysis,the occurrence of severe arrhythmia was related to LVH,CKD stage,diaberes hyertension and hyperpotassaemia are signidicantly assoxiated with severe arrhythmia.

关 键 词：肾疾病 心律失常 糖尿病 高血压 心室肥大 动态心电图 

分 类 号：R541.7[医药卫生—心血管疾病] R692.3[医药卫生—内科学]