维持性血液透析患者不同射血分数心力衰竭的危险因素分析  

The risk factors for the different types of heart failure in maintenance hemodialysis patients

作　　者：文锐[1] 代思源[2] 覃娇[1] 李芊[1] WEN Rui;DAI Si-yuan;QIN Jiao;LI Qian(Department of Nephrology,Changsha Central Hospital,Changsha 410000,China,22Department of Nephrology,Xiangya Hospital,Central South University,Changsha 410000,China)

机构地区：[1]湖南省长沙市中心医院肾内科,长沙410000 [2]中南大学湘雅医院肾内科,长沙410000

出　　处：《中国血液净化》2018年第9期598-603,共6页Chinese Journal of Blood Purification

摘　　要：目的探讨维持性血液透析合并心力衰竭患者中射血分数保留型(heart failure with preserve ejection fraction,HFpEF)、中间型(heart failure with mid-range of ejection fraction,HFmrEF)以及降低型(heart failure with reduced ejection fraction,HFrEF)心力衰竭的发生率及其危险因素。方法回顾性收集152例维持性血液透析合并心力衰竭住院患者的临床资料、实验室指标及心脏彩超结果,组间比较不同类型心力衰竭的临床特征,多因素logistics回归分析探讨影响左室射血分数(left ventricular ejection fraction,LVEF)的危险因素,并通过多元线性回归分析进行验证。结果 152例患者中HFpEF为110例(72.4%)、HFmrEF为16例(10.5%)、HFrEF为26例(17.1%)。HFrEF组Ⅳ级心力衰竭高于HFpEF组(χ2=6.369,P=0.041);HFpEF组收缩压(systolic blood pressure,SBP)、尿酸(uric acid,UA)、血浆白蛋白(albumin,ALB)高于HFrEF组(t=3.144,P=0.002;t=2.131,P=0.033;t=2.933,P=0.003);HFrEF组血红蛋白(hemoglobin,HB)高于HFpEF组和HFmrEF组(t=3.211,P=0.001;t=0.789,P=0.005)。HFpEF组E/A(E峰/A峰)比值明显低于HFrEF组(t=2.971,P=0.003);HFpEF组左房内径(left atrium,LA)、左室舒张末期直径(left ventricular end-diastolic dimension,LVEDd)低于HFmrEF组(t=3.055,P=0.002;t=5.461,P=0.000)和HFrEF组(t=2.151,P=0.031;t=4.307,P=0.000)。多因素Logistic回归分析结果提示维持性血液透析合并心力衰竭患者中LVEF与SBP呈正相关性(OR0.338,95%CI 0.086~0.263,P<0.001),而与HB(OR 0.188, 95%CI-0.024^-0.033,P=0.010)和LVEDd(OR 0.563,95%CI-1.421^-0.743,P<0.001)呈负相关,并通过多元线性回归分析进行验证(t=7.906, P=0.004;t=-4.191,P=0.025;t=-5.582,P=0.011),提示SBP、HB、LVDd可能是LVEF的独立影响因素。结论维持性血液透析合并心力衰竭患者主要表现为射血分数保留型心力衰竭,可能与贫血、高血压导致心脏重塑有关。bjective To analyze the risk factors and prevalence of different types of heart failure（HF） in maintenance hemodialysis（MHD） patients with HF. Methods Clinical, laboratory and echocardiographic data of 152 MHD patients with HF were retrospectively analyzed. The risk factors for HF were investigated by comparison of HF with preserve ejection fraction（HFpEF）, HF with mid-range of ejection fraction（HFmrEF） and HF with reduced ejection fraction（HFrEF） groups. Multivariate logistic regression and multivariate linear regression analyses were used for the analyses. Results A total of 152 MHD cases with HF were enrolled in this study; 110 of the 152 patients（72.4%） had HFpEF, 16（10.5%） had HFmrEF, and 26（17.1%） had HFrEF. Compared to HFpEF group, patients in HFrEF group had higher prevalence of grade Ⅳ HF（χ2=6.369,P=0.041） and lower levels of systolic pressure（SBP, t=3.144, P=0.002）, uric acid（UA, t=2.131, P=0.033） and plasma albumin（ALB, t=2.933, P=0.003）. Compared to HFpEF and HFmrEF groups, patients in HFrEF group had higher level of hemoglobin（HB）（t=3.211, P=0.001, compared to HFpEF group; t=0.789, P=0.005,compared to HFmrEF group）. Compared to HFmrEF and HFrEF groups, patients in HFpEF group had lowerlevels of left atrium（LA; t=3.055, P=0.002, compare to HFmrEF group; t=2.151, P=0.031, compared to HFrEF group）, and left ventricular end diastolic diameter（LVDd; t=5.461, P〈0.001, compared to HFmrEF group; t=4.307, P=0.000, compared to HFrEF group）. Multivariate logistic regression displayed that SBP（OR0.338, 95% CI 0.086～0.263, P=0.000）, HB（OR 0.188, 95% CI-0.024～-0.033, P=0.010）, and LVDd（OR0.563, 95% CI-1.421～-0.743, P0.000） were the risk factors for left ventricular ejection fraction（LVEF）.The risk factors for LVEF were also verified by multivariate linear regression（t=7.906, P=0.004 for SBP; t=-4.191, P=0.025 for HB; t=-5.582, P=0.011 for LVDd）. Conclusions HFpEF was relatively prevalent in MDH patients with HF. Increase

关 键 词：维持性血液透析 心力衰竭 危险因素 

分 类 号：R318.16[医药卫生—生物医学工程]