甲状旁腺激素对维持性血液透析患者心肌损伤及重构的影响  

Effect of parathyroid hormone on myocardial damage,cardiac structure and function in patients undergoing maintenance hemodialysis

作　　者：冯艳翠[1] 张海红[1] 黄纪文[1] 

机构地区：[1]广东省开平市中心医院肾内科,529300

出　　处：《白求恩医学杂志》2014年第3期224-226,共3页Journal of Bethune Medical Science

摘　　要：目的探讨甲状旁腺激素(PTH)对维持性血液透析(MHD)患者心肌损伤及重构的影响。方法将192例MHD患者根据PTH水平分为高PTH组(PTH>300 pg/ml,104例)和低PTH组(PTH≤300 pg/ml,88例)。对两组血液生化指标、心脏结构及功能指标进行对比。结果高PTH组磷(P)、全段甲状旁腺素(iPTH)、心肌肌钙蛋白I(cTnI)水平均高于低PTH组(P<0.01);两组血清肌酐(Scr)、血红蛋白(Hb)、白蛋白(Alb)、钙(Ca2+)水平比较均无显著差异(P>0.05);高PTH组左心室舒张末内径(LVDd)、室间隔舒张末厚度(IVSdT)、左心室后壁舒张末厚度(LVPTdW)、左心室心肌重量指数(LVMI)均大于低PTH组(P<0.01);高PTH组射血分数(EF)小于低PTH组(P<0.01);高PTH组二尖瓣舒张早期和舒张晚期最大血流速度比(E/A)<1比例高于低PTH组(P<0.01)。结论 PTH水平与MHD患者心肌损伤、心脏结构与功能间有密切联系,MHD患者临床常发生继发性甲状旁腺功能亢进,进而出现cTnI增高、左心室肥厚及心功能下降。Objective To investigate the effect of parathyroid hormone（ PTH） on myocardial damage,cardiac structure and function in maintenance hemodialysis（ MHD）. Methods One hundred and ninety-two cases with MHD were respectively analyzed.Based on PTH level,patients were divided into high PTH group（ PTH 300 pg /ml,n = 104） and low PTH group（ PTH≤300 pg /ml,n = 88）. The Blood biochemical parameters,cardiac structure and function of two groups were compared. Results Phosphorus（ P）,cardiac troponin I（ cTnI）,and intact parathyroid hormone（ iPTH） levels of high PTH group were higher than that of low PTH group（ P〈0.01）. Serum creatinine（ Scr）,albumin（ Alb）,calcium（ Ca^2＋）,and hemoglobin（ Hb） levels of two groups had no significant difference（ P〉0.05）. The left ventricular end-diastolicdimension（ LVDd）,interventricular septum end-diastolic thickness（ IVSdT）,Left ventricular posterior wall end-diastolicthickness（ LVPWdT）,and Left ventricle mass index（ LVMI） of high PTH group were higher than that of low PTH group（ P〈0.01）. The ejection fraction（ EF） of high PTH group were lower than that of low PTH group（ P〈0.01）,but E /A ratio of high PTH group was higher than that of low PTH group（ P〈0.01）. Conclusion Parathyroid hormone level is closely linked with the myocardial injury,cardiac structure and function in patients with maintenance hemodialysis,and the patients may suffer from consistent secondary hyperparathyroidism with an increased level of cTnI level,left ventricular hypertrophy and cardiac functional deterioration.

关 键 词：维持性血液透析 甲状旁腺激素 心肌损伤 

分 类 号：R692.5[医药卫生—泌尿科学]