维持性血液透析患者并发肺动脉高压的相关因素分析  

Related Factors of Pulmonary Hypertension in Patients Receiving Long-term Maintenance Hemodialysis

作　　者：白成丽[1] 孙蔚明[1] 郭一丹[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院肾内科,北京市100038

出　　处：《中国全科医学》2013年第17期1973-1976,共4页Chinese General Practice

摘　　要：目的探讨维持性血液透析(MHD)患者肺动脉高压(PHT)的发生率及相关影响因素,以早期诊断并进行干预。方法选取我科2008—2012年收治的以动静脉内瘘作为透析血管通路、透析时间在1年以上的资料完整的MHD患者84例,根据超声心动图检测的肺动脉收缩压(PASP)>35 mm Hg诊断PHT。比较MHD合并PHT组(PHT组)和MHD不合并PHT组(非PHT组)患者的临床资料、实验室检查指标及心脏超声检查指标;比较不同透析龄、原发病、临床表现的患者PHT发生率及PASP;采用多因素Logistic回归分析MHD患者发生PHT的相关因素。结果 (1)84例患者中,36例(42.9%)并发PHT,PASP(53.1±11.8)mm Hg。与非PHT组比较,PHT组患者透析龄长,血红蛋白(Hb)水平降低,左房内径、左室舒张末内径、主肺动脉内径、右房内径及左室射血分数(LVEF)<50%、舒张早期和舒张晚期最大血流速度之比(E/A)、瓣膜钙化者比例均增高,LVEF下降,差异均有统计学意义(P<0.05)。(2)透析龄>5年组MHD患者PHT发生率及PASP高于透析龄<2年组,有呼吸困难的MHD患者PHT发生率及PASP高于无症状者,差异有统计学意义(P<0.05);而原发病为糖尿病的MHD患者PHT发生率及PASP与非糖尿病患者比较,差异无统计学意义(P>0.05)。(3)Logistic回归分析显示,Hb、瓣膜钙化、E/A与MHD并发PHT存在回归关系(P<0.05)。结论 MHD患者PHT的发生率为42.9%;透析龄>5年者PHT发生率显著升高。贫血、转移性钙化、左室舒张功能减退可能参与了MHD患者PHT的发生。Objective To investigate the incidence of pulmonary hypertension （PHT） and its correlative influential factors in patients receiving long - term maintenance hemodialysis （ MHD）, to give early diagnoses and intervention. Methods A retrospective analysis was performed on complete clinical data of 84 patients admitted for over - 1 - year MHD with internal arteriovenous fistula as hemodialysis vascular access and with echocardiography pulmonary artery systolic pressure （PASP） 〉 35 mm Hg for PHT diagnosis. The clinical data, laboratory parameters, cardiac ultrasound parameters were compared between groups PHT, non - PHT, and PHT incidence, PASP between patients with and without dialysis ages （ DA）, primary diseases, clinical manifestations. Multifactor Logistic regression analysis was used to find related factors of PHT. Results （ 1 ） Thirty - six （42. 9% ） patients were diagnosed as PHT with mean PASP （53.1 ± 11.8） mm Hg. DA was longer, hemoglobin （Hb） lower, left atrial diameter, left ventricular end-diastolic diameter, main pulmonary artery, right atrial diameter, left ventricu-lax ejection fraction （LVEF） 〈 50%, diastolic early and late diastolic peak velocity ratio （E/A） and proportion of valvular cal-cification higher, LVEF lower in PHT group than in non - PHT group, the differences were significant （P 〈0. 05）. （2） PHT incidence and PASP were higher in DA 〉 5 - year group than in 〈 2 - year group, higher in patients with dyspnea than in those without, the difference was significant （ P 〈 0. 05 ）. There was no difference in PHT incidence or PASP between MHD patients with diabetes as primary disease and those without diabetes. Logistic regression analysis showed that Hb, valvular calcification, E/A had regressive relationship to MHD combined with PHT （P 〈 0. 05）. Conclusion The incidence of PHT is 42. 9% in MHD patients, and remarkably higher in DA 〉 5 - year patients. Anemia, metastatic calcification, left ventricular diastolic dys-function

关 键 词：肾透析 高血压 肺性 超声心动描记术 危险因素 

分 类 号：R459.52[医药卫生—治疗学]