维持性血液透析患者心脏结构功能的改变及其相关因素分析  

Changes in cardiac structure and function in maintaining hemodialysis patients

作　　者：张月[1] 洪大情[1] 高辉[1] 吴姝琨[1] 王政通[1] 王君如[1] 王莉 何强[1] 王芳 

机构地区：[1]四川省医学科学院.四川省人民医院肾内科,四川成都610072

出　　处：《实用医院临床杂志》2013年第6期32-34,共3页Practical Journal of Clinical Medicine

摘　　要：目的评估维持性血液透析患者心脏结构功能改变情况,分析其相关性。方法应用心脏彩超测定57例维持性血液透析患者室间隔厚度(IVSD)、左室后壁厚度(LVPWD)及左室射血分数(LVEF),计算左室重量指数(LVMI)。测定血压、iPTH、ALB、TG;骨盆正位、腹部侧位及双手正位X射线检查患者血管钙化情况并评分。结果左室肥厚患者34例(59.65%),瓣膜受损者26例(45.61%),节段运动异常者8例(14.4%)。IVSD与收缩压、血磷、钙磷乘积及TG正相关,与ALB负相关;LVPWD与收缩压、血TG正相关;EF值与iPTH负相关;LVMI与ALB负相关,与TG正相关。男性LVMI、IVSD、LVPWD、ALB、钙磷乘积及X射线评分显著高于女性(P<0.05)。高血压组LVMI、IVSD、LVPWD及血磷、钙磷乘积显著高于非高血压组(P<0.05)。结论维持性血液透析患者心脏结构功能改变患病率高,而高血压、营养不良、高酯血症与之相关。Objective To assess the changes in cardiac structure and function in maintaining hemodialysis （MHD）patients in our hemodialysis center and investigate the association factors. Methods Fifty-seven MHD patients were enrolled in the study. Blood pressure, serum albumin（ ALB）, serum parathyroid hormone （iPTH）, serum triglyceride （TG）, and x-ray calcification score were meas-ured. Cardiac structure index such as IVSD, LVPWD and LVEF were determined by echocardiography. Moreover, LVM was calculated by using Deverux and Reichex formula and then divided by BSA to obtain LVMI. Results Thirty-four patients（59.65% ）were found to have LVH. ALB was negatively correlated with LVMI （ r = -0. 352, P = 0. 021 ）, and TG was positively correlated with LVMI （ r = 0. 293, P = 0. 048 ）. In male group, LVMI, IVSD, LVPWD, ALB, calcium-phosphorus product and x-ray calcification score were signifi-cant higher than that in female group. In the hypertension group, LVMI, IVSD, LVPWD, serum phosphorus and calcium-phosphorus product were significant higher than that in normal BP group. Conclusion There is higher prevalence of cardiac structure and function changes in MHD patients, and it might be associated with gender, hypertension, malnutrition and hypertriglyceridemia.

关 键 词：维持性血液透析 心脏彩超 左心室肥厚 

分 类 号：R459.5[医药卫生—治疗学] R331.31[医药卫生—临床医学]