维持性血液透析患者甲状旁腺素水平与左心室肥厚关系的研究  

Relationship between parathyroid hormone and left ventricular hypertrophy in patients undergoing maintenance hemodialysis

作　　者：王立瑞[1] 李江涛[1] 余晨[1] 

机构地区：[1]同济大学附属同济医院肾内科,上海200065

出　　处：《临床肾脏病杂志》2016年第10期594-597,共4页Journal Of Clinical Nephrology

基　　金：国家自然科学基金资助项目(NO.81370790;NO.81400697)

摘　　要：目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者甲状旁腺素(parathyroid hormone,PTH)水平与左心室肥厚(1eft ventrieular hypertrophy,LVH)的关系。方法选择同济大学附属同济医院血液透析中心MHD患者50例,根据患者PTH水平分成L-PTH组(PTH<300 ng/L)、H-PTH组(PTH>300 ng/L)。通过对2组患者进行心脏超声及临床生化检测,比较2组患者的心脏超声结构及LVH发生率,并作相关性分析。结果 2组患者的性别构成、年龄、血压、脑钠肽、血红蛋白、血钙和血白蛋白均无统计学差异(P>0,05)。H-PTH组的透析时间、血磷均明显高于L-PTH组[(8,66±4,91)年比(5.4±5.73)年、(1.81±0.37)mmol/L比(1.51±0.32)mmol/L,P<0.05]。H-PTH组的左室舒张末内径、左室收缩末内径、室间隔厚度与左室心肌质量指数均明显高于L-PTH组[(49.56±4.59)rmm比(45.84±5.65)mm、(32.44±4.26)mm比(29.6±5.00)mm、(11.12±1.45)mm比(10.16±1.41)mm、(144.29±31.82)g/m^3比(122.83±38.34)g/m^3,P<0.05];2组的左房内径、左室后壁厚度及射血分数均无统计学差异[(43.96±3.98)mm比(42.52±5.86)mm、(9.56±1.58)mm比(9.08±1.29)mm、(63.16±6.97)%比(65.72±6.67)%,P>0.05]。H-PTH组的LVH发生率明显高于L-PTH组(72%比40%,P<0.05)。Spearman相关性分析表明,PTH水平与左室心肌质量指数、左室舒张末内径、左室收缩末内径、室间隔厚度呈正相关(r=0.325,0.330,0.348,0.310,P<0.05),而与左房内径、左室后壁厚度、射血分数相关性无统计学意义(r=0.088,0.115,-0.210,P>0.05)。结论MHD患者PTH水平增高可能是导致左心室肥厚的重要因素之一。Objective To investigate the relationship between parathyroid hormone （PTH） and left ventricular hypertrophy （LVH） in patients undergoing maintenance hemodialysis （MHD）. Methotis Fifty MHD patients from the Dialysis Center of Tongji Hospital of Tongji University were divided into L-PTH group （PTH 〈300 ng/L） and H-PTH group （PTH 〈300 ng/L）. All cases underwent echocardiography examination and clinical biochemical tests. The relationship between echocar-diography structure and the incidence of LVH was analyzed. Results There were no significant differences in the age, gender, blood pressure, BNP, hemoglobin （Hb）, calcium and albumin between the two groups. The dialysis time and phosphorus in H-PTH group were significantly increased as compared with those in the L-PTH group [（8.66±4.91） years vs. （5.4 ± 5.73） years; （1.81± 0.37） mmol/L vs. （1.51± 0. 32） mmol/L, P%0. 05]. Left ventricular end-diastolic diameter （LVEDd）, left ventrieular end-systolic diameter （LVEDs）, interventrieular septal thickness （IVST） and left ventrieular mass index （LVMI） were significantly higher in the H-PTH group than those in the L-PTH group [（49. 56± 4. 59） mm vs. （45. 84 ± 5.65） mm, （32. 44 ± 4. 26） mm vs. （29. 6 ± 5. 00） mm; （11.12 ± 1.45） mm vs. （10. 16± 1.41） mm; （144. 29 ± 31.82） g/m3 vs. （122. 83 ±38. 34） g/m3, P d0. 05]. The left atrial diameter （LAD）, left ventricular posterior wall thickness （LVPWT） and ejection fraction （EF） had no significant difference [（43. 96 ± 3. 98） mm vs. （42. 52 ± 5.86） mm; （9. 56±1. 58） rnm vs. （9. 08 ± 1.29） mm; （63. 16 ± 6. 97） vs. （65. 72 ± 6. 67） %, P〉0. 05]. The incidence of LVH in the H-PTH group was significantly higher than that in the L-PTH group （72% vs. 40%, P〈0. 05）. Correlation analysis showed that PTH levels were positively correlated with LVMI, LVEDd, LVEDs and IVST （r= 0. 325, 0. 330, 0. 348, and 0. 310 respectively, P〈0. 05）, but

关 键 词：血液透析 甲状旁腺素 左心室肥厚 

分 类 号：R692.5[医药卫生—泌尿科学]