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  

Clinical features and risk factors of patients in 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肾内科,江门

出　　处：《国际移植与血液净化杂志》2016年第5期18-23,共6页International Journal of Transplantation and Hemopurification

摘　　要：目的 分析慢性肾脏病（chronic kidney disease,CKD）4 ～5期合并肺动脉高压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日至2015年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（pulmonary hypertension,PH）组及非PH组,分析两组患者的临床及实验室检查资料.结果 PH组血红蛋白（Hb）比非PH组低,而全段甲状旁腺激素（iPTH）较非PH组高（P＜0.05）.PH组各心室心房内径、肺动脉内径均较非PH组长,射血分数较非PH组低（P＜0.05）.PH组瓣膜钙化、心包积液的发生率较非PH组高,差异具有统计学意义（P＜0.05）.在血液透析亚组,PH组平均透析次数较非PH组低[（2.44±0.50）次vs （2.83±0.38）次,P=0.00],而PH组Hb较非PH组低,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）.在腹膜透析亚组,PH组平均年龄较非PH组大[（53.49± 11.59）岁vs （46.19±12.82）岁,P=0.033].贫血、甲状旁腺激素增高是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机能亢进症及透析充分是治疗CKD合并PH的重措施.Objective To analysis the clinical features and risk factors of in chronic kidney disease （CKD）4-5 phase complicated with pulmonary hypertension（PH）.Methods The consecutive patients who were diagnosed as CKD 4-5 phase wene enrolled between January 1,2015 and December 31,2015 in the Nephrology Department at the Central Hospital of Jiangmen.According to level of pulmonary arterial pressure,the patients were divided into the PH-group and the non-PH-group.The clinical and laboratory examinations of the patients were compared.Results The level of hemoglobin（Hb） was lower （P =0.008）and the serum parathyroid hormone was higher（P =0.013） in the PH-group.The dimensions of left atrium,right atrium,left ventricle and right ventricle were longer in the PH-group.The ejection fraction was lower in the PH-group（P =0.042）.The probability of calcification of valves（56.43% vs 33.33%,P =0.001） and hydropericardium（42.85% vs.28.21%,P =0.032） was higer in the PH-group.In the sub-group in hemodialysis patients,average time of dialysis was fewer in the PH-group（P =0.00）,the Hb was lower and the serum creatinine and BUN levels were higher in the PH-group.In the sub-group in the peritoneal dialysis,average age of PH-group was higher（（53.49 ± 11.59） years old vs （46.19 ± 12.82） years old,P =0.033）.Anemia and hyperparathyroidism were the risk factors of CKD complicated with PH.Anemia and higher serum creatinine were the risk factors of hemodialysis complicated with PH.Old age was the risk factor of peritoneal dialysis complicated with PH.Conclusions The construction of heart in CKD patients changes and systole function was weaken with the PH develop.To control the anemia and hyperpamthyroidism and to ensure 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]