尿毒症难治性继发性甲状旁腺功能亢进症患者肺动脉压变化及其相关因素分析  

Pulmonary hypertension and correlative factor analysis in refractory secondary hyperparathyroidism of uremia patients

作　　者：王艺萍[1] 赵娜[1] 刘煜[2] 宋玉环[1] 覃莲香[1] 肖跃飞[1] 张凌[3] 姚力[4] 

机构地区：[1]航天中心医院肾内科,北京100049 [2]国防大学第二门诊部保健科,北京100049 [3]中日友好医院肾内科,北京100029 [4]中日友好医院微创外科,北京100029

出　　处：《兰州大学学报（医学版）》2014年第3期17-21,共5页Journal of Lanzhou University（Medical Sciences）

基　　金：北京市首都医学发展科研基金项目(2009-3023)

摘　　要：目的评估尿毒症难治性继发性甲状旁腺功能亢进症患者肺动脉高压(PH)的发生情况以及PH发病中可能的影响因素。方法 76例甲状旁腺切除术前的尿毒症继发难治性甲状旁腺功能亢进症患者为治疗组,30例同期不伴有严重甲状旁腺功能亢进症的维持性血透患者作为对照组。所有患者均于透析前测定血清肌酐、白蛋白、血清钙、血清磷、碱性磷酸酶、血红蛋白,全段甲状旁腺激素等指标,并于透析次日超声心动图测量肺动脉收缩压和其他心脏结构和功能指标;根据肺动脉收缩压将治疗组患者分为PH组和无PH组,比较两组实验室以及心脏超声指标,分析肺动脉高压发病的可能影响因素。结果治疗组PH的发生率为34.2%,对照组PH的发生率为16.7%,二者比较有显著性差异(P<0.05);PH组患者全段甲状旁腺激素显著高于无PH组(P<0.01)、血清钙显著低于无PH组(P<0.05);PH组左房前后径、主肺动脉内径、右室前后径、左室舒张末径、左室后壁厚度、左心室心肌质量指数、心脏瓣膜钙化的发生率均高于无PH组,左室射血分数、舒张早期和舒张晚期最大血流速度之比均低于无PH组,差异均有统计学意义(P<0.05)。结论与对照组相比,治疗组PH的发生率更高,程度更重;甲状旁腺激素水平是其独立影响因素。Objective To analyze the incidence of pulmonary hypertension （PH） and the possible factors causing PH in uremia patients with refractory secondary hyperparathyroidism （SHPT）.Methods 76 maintenance hemodialysis （MHD） uremia patients with refractory SHPT were assigned as case group and 30 MHD uremia patients without refractory SHPT were assigned as control group.The plasma biochemical features,including serum creatinine,albumin,calcium,phosphorus,alkaline phosphatase,hemoglobin and intact parathyroid hormone were collected before hemodialysis.Systolic pulmonary arterial pressure （SPAP） and parameters relating to cardiac structure and function,including left atrial diameter （LA）,main pulmonary artery diameter （PA）,right ventricular anteroposterior direction （RVD）,left ventricular end-diastolic diameter （LVDd）,left ventricular posterior wall thickness （LVPWT）,left ventricular myocardial quality index （LVMI）,ejection fraction （EF） and the ratio of early diastolic E to late diastolic A were assayed in the following day of hemodialysis.The SHPT patients were further divided into PH group and PH negative group according to SPAP.The plasma biochemical features and clinical data were compared.Results Compared with control group,the incidence and severity of PH were significantly higher in SHPT group （34.2％ vs 16.7％,P ＜ 0.05）.SHPT patients with PH had a significantly higher iPTH level and lower calcium level than those SHPT patients without PH （P ＜ 0.01 and P ＜ 0.05,respectively）.The LA,PA,RVD,LVDd,LVPWT,LVMI and incidence of cardiac valvular calcification were significantly higher,but EF and E/A ratio were significantly lower in PH group （P ＜ 0.01and P ＜ 0.05,respectively）.Logistic regression analysis indicated that PTH was the independent risk factor for PH.Conclusion The incidence and severity of PH in refractory SHPT patients are higher than patients without refractory SHPT.The level of iPHT is the independent risk factor for PH in refractory SHPT.

关 键 词：维持性血液透析 继发性甲状旁腺功能亢进症 肺动脉高压 

分 类 号：R941.42[医药卫生—药剂学]