不同容量负荷腹膜透析患者左心室肥厚发生率及相关危险因素  

Incidence and risk factors of left ventricular hypertrophy in peritoneal dialysis patients withdifferent hydration statuses

作　　者：李峰[1] 苏新玙 刘苗 严豪[1] 李振元[1] 沈亦蔚 袁江姿[1] 倪兆慧[1] 方炜[1] Li Feng;Su Xinyu;Liu Miao;Yan Hao;Li Zhenyuan;Shen Yiwei;Yuan Jiangzi;Ni Zhaohui;Fang Wei(Department of Nephrology, Shanghai Research Center for Peritoneal Dialysis, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China)

机构地区：[1]上海交通大学医学院附属仁济医院肾脏内科上海市腹膜透析研究中心,200127

出　　处：《中华肾脏病杂志》2018年第2期81-86,共6页Chinese Journal of Nephrology

基　　金：国家自然科学基金(81370864、81670691);上海市教育委员会高峰高原学科建设计划(20152211)

摘　　要：目的探讨不同容量负荷的腹膜透析（腹透）患者左心室肥厚（LVH）的发生率，分析LVH的相关危险因素。方法病例来自2016年9月至2017年1月上海交通大学医学院附属仁济医院的规律腹透患者，采集患者的人口学资料、生化指标。应用多频生物电阻抗技术测定患者容量超负荷（overhydration，OH）水平；用心脏彩色多普勒超声检测患者心脏结构改变。根据LVH诊断标准将人选患者分为LVH组及非LVH组；根据OH评估指标分为正常容量组（OH≤1．1L）和容量超负荷组（OH〉1．1L）。评估不同容量负荷组患者LVH发生率；用Logistic回归法分析患者LVH发生的危险因素。结果共113例腹透患者入选，LVH组患者60例（53．1％）。正常容量组33例（29．2％），其中LVH10例（30．3％）；容量超负荷组80例（70．8％），其中LVH50例（62．5％）；容量超负荷组中亚临床容量超负荷（SCOH）组34例（42．5％），其中LVH17例（50．0％）；临床容量超负荷（COH）组46例（57．5％），其中LVH33例（71．7％）。多因素Logistic回归分析结果显示，高OH（OR=1．730，95％CI：1.274—2．348，P〈0．001）和低血红蛋白（OR=O．965，95％C1：0．940—0．991，P=0．008）是LVH发生的独立危险因素。结论LVH在腹透患者中发生率高，尤其是容量超负荷的腹透患者。高OH和低血红蛋白是LVH发生的独立危险因素。Objective To investigate the incidence of left ventricular hypertrophy （LVH） in peritoneal dialysis （PD） patients with different hydration statuses, and analyze the risk factors of LVH in PD patients. Methods PD patients in Renji Hospital, Shanghai Jiao Tong University School of Medicine from September 2016 to January 2017 were enrolled. Demographic data of patients were collected and biochemical parameters were measured. Hydration status index overhydration （OH） was measured by bioimpedance spectroscopy, and LVH was diagnosed by echocardiography. Logistic regression was used to analyze the risk factors of LVH. Results A total of 113 PD patients aged 58.98（48.89, 65.33） years with median PD duration 46.20（18.08, 72.75） months were enrolled in present study, among whom 60 patients （53.1%） had LVH. OH 〉 1.1 L was detected in 80 patients （70.8%）, among whom 34 patients （42.5%） had subclinical overhydration （SCOH）. LVH was howeverdiagnosed in 33（71.7%） clinical overhydrated （COH） patients and 17（50.0%） SCOH patients （n=34）. In the normal hydrated （OH~〈I.1 L） patients （n=33）, LVH was detected in 10 patients （30.3%）. Multivariate logistic regression showed that high OH （OR=1.730, 95%CI 1.274-2.348, P 〈 0.001） and low hemoglobin （OR=0.965, 95%CI 0.940-0.991, P=0.008） were the independent risk factors of LVH. Conclusions LVH is common in PD patients, especially in overhydrated patients. High OH and low hemoglobin were the independent risk factors of LVH.

关 键 词：腹膜透析 水肿 肥大 左心室 电阻抗 

分 类 号：R692.5[医药卫生—泌尿科学]