慢性肾脏病4~5期合并肺动脉高压患者的临床特征及危险因素分析  

Clinical Features and Risk Factors of Patients with Chronic Kidney Disease 4-5 Phase Complicated with Pulmonary Hypertension

作　　者：欧阳楚君[1] 胡菂菂[1] 韦锋[1] 

机构地区：[1]广东省江门市中心医院,广东江门529000

出　　处：《中国医学创新》2017年第5期57-60,共4页Medical Innovation of China

摘　　要：目的:分析慢性肾脏病(CKD)4~5期合并肺动脉高压(PH)患者的临床特征及相关危险因素。方法:分析比较2015年1月1日-12月31日于江门市中心医院肾内科就诊的CKD 4~5期患者,根据其是否存在肺动脉高压,分为肺动脉高压(PH)组与非PH组,分析对比两组患者的临床及实验室检查资料。结果:(1)共纳入218例患者,PH组140例(64.22%),非PH组78例(35.78%),两组患者年龄、性别比例、BMI、各原发病比例比较,差异均无统计学意义(P>0.05);(2)PH组的血红蛋白(Hb)比非PH组的低,PH组的甲状旁腺激素(i PTH)较非PH组高,PH组的各心室心房内径、肺动脉内径均较非PH组长,射血分数较非PH组低,PH组的瓣膜钙化、心包积液的发生率较非PH组高,差异均有统计学意义(P<0.05);(3)在血液透析亚组,PH组的平均透析次数较非PH组的低,而PH组的Hb较非PH组的低,血清尿素氮(BUN)、血清肌酐(Scr)较非PH组高,差异均有统计学意义(P<0.05);(4)在腹透亚组,PH组的平均年龄较非PH组的大(P<0.05);(5)贫血、i PTH增高是CKD发生PH的危险因素;在血液透析患者中,贫血、Scr升高是其发生PH的危险因素。高龄则是腹膜透析患者发生PH的危险因素。结论:CKD合并PH的患者的心脏结构发生变化,左心室收缩功能较差,纠正贫血、控制继发性甲状旁腺功能亢进症及透析充分是治疗CKD合并PH的重要措施。Objective： To analyze the clinical features and risk factors of chronic kidney disease （ CKD ） 4-5 phase complicated with pulmonary hypertension （ PI-I ） .Method： The consecutive patients who were diagnosed as CKD 4-5 phase enrolled from January 1, 2015 to December 31, 2015 in the nephrology department at the central hospital of Jiangmen. According to level of pulmonary arterial pressure, the patients can be divided into PH-group and non-PH-group.The clinical and laboratory examinations of them were compared.Result： C 1 ） 218 patients were enrolled with grouping 140 cases （64.22%）to PH- group and 78 cases （ 35.78% ） to non-PH-group.Age, sex ratio, BMI and primary diseases of two groups had no statistical significance （ P〉0.05 ） . （ 2 ） The level of hemoglobin （ Hb ） was lower and the serum parathyroid hormone （Scr） was higher in the PH-group （ P〈0.05 ） .The dimensions of left atrium, right atrium, left ventricle, right ventricle were longer in the PH-group （P〈0.05） .The ejection fraction was lower in the PTT-group （P〈0.05） .The probability of calcification of valves and hydropericardium was higer in the PH-group （ P〈0.05 ） . （ 3 ） In the sub-group in hemodialysis （ HD ） patients, average time of dialysis was fewer in the PH-group, Hb was lower and Scr and BUN levels were higher in the PH-group （ P〈0.05 ） . （ 4 ） In the sub-group in the peritoneal dialysis, average age of PH-group was higher （ P〈0.05 ） . （ 5 ） Anemia and hyperparathyroidism were the risk factors of CKD complicated with PH.Anemia and higher Scr were the risk factors of HD complicated with PH.Old age was the risk factor of PD complicated with PH.Conclusion： The construction of heart in CKD patients changes and systole function are weaken with PH develop.Controlling the anemia and hyperparathyroidism and ensuring the sufficiency of dialysis are the important measures to treat CKD complicated with PH.

关 键 词：慢性肾脏病 肺动脉高压 

分 类 号：R692[医药卫生—泌尿科学] R544.1[医药卫生—外科学]