腹膜透析患者左心室舒张功能不全的影响因素分析  

The influence factors for left ventricular diastolic dysfunction in peritoneal dialysis patients

作　　者：荣新 李丹丹[1] 王瑞峰[1] 郝丽[1] 方思华[2] 刘桂凌[1] RONG Xin;LI Dan-dan;WANG Rui-feng;HAO Li;FANG Si-hua;LIU Gui-ling(Department of Nephrology;Department of Ultrasound,the Second Affiliated Hospital of Anhui Medical University,Hefei 230000,China)

机构地区：[1]安徽医科大学第二附属医院肾脏内科,合肥230000 [2]安徽医科大学第二附属医院超声科,合肥230000

出　　处：《中国血液净化》2018年第11期731-734,共4页Chinese Journal of Blood Purification

基　　金：安徽省哲学社会科学规划项目[尿毒症腹膜透析患者的社会心理因素与医疗救治成本关系的干预研究(项目批准号:AHSKY2015D70)]

摘　　要：目的调查维持性腹膜透析患者左心室舒张功能状况,探索左心室舒张功能不全的影响因素。方法利用彩色多普勒超声评价心脏舒张功能,130名腹膜透析患者中有123名患者诊断为左心室舒张功能不全,将左室舒张功能不全者分为Ⅰ级舒张功能不全组和Ⅱ级舒张功能不全组,比较2组的人口学特征、临床及实验室指标,分析影响腹膜透析患者左室舒张功能不全的因素。结果本研究中腹膜透析患者左心室舒张功能不全发生率高达94.6%。其中Ⅱ级舒张功能不全占35.4%。Ⅱ级舒张功能不全组的体质量指数(t=-2.058,P=0.042)、血磷(t=-2.699,P=0.008)和脑钠肽(t=-2.588,P=0.011)与Ⅰ级舒张功能不全组相比差异显著。Logistic回归分析发现,高体质量指数(OR=1.316,95%CI:1.117～1.550, P=0.001)、高总胆固醇(OR=2.034,95%CI:1.153～3.588,P=0.014)、高磷(OR=3.855,95%CI:1.477～10.059,P=0.006)和高脑钠肽(OR=1.003,95%CI:1.001～1.004,P=0.003)是腹膜透析患者左室舒张功能不全的危险因素。结论腹膜透析患者大多合并左室舒张功能不全。高体质量指数、高总胆固醇、高磷及高脑钠肽是左心室舒张功能不全的危险因素。Objective To investigate the status of left ventxicular diastolic function and to explore the influence factors for left ventxicular diastolic dysfunction in patients with maintenance peritoneal dialysis （PD）. Methods Cardiac diastolic function was evaluated by color Doppler ultxasound. In the 130 PD patients, 123 patients were diagnosed with grade I or grade II left ventxicular diastolic dysfunction according to file findings of color Doppler ultxasound. Demographic characteristics, clinical and laboratory indicators were compared between patients with grade I and grade II left ventxicular diastolic dysfunction to analyze the risk factors for left ventricular diastolic dysfunction. Results The prevalence of left ventricular diastolic dysfunction was 94.6%, in which 35.4% were grade II diastolic dysfunction. Body mass index （BMI） （t=--2.058, P=0.042）, blood phosphorus （t=-2.699, P=0.008） and brain natxiuretic peptide （BNP） （t=-2.588, P=0.011） were significantly different between the PD patients with grade II and grade I diastolic dysfunction. Logistic regression analysis found that higher levels of BMI （OR= 1.316, 95% CI： 1.117- 1.550, P=0.001）, total cholesterol （OR= 2.034, 95% CI： 1.153-3.588, P=0.014）, serum phosphorus （OR=3.855, 95% CI： 1.477-10.059, P =0.006） and BNP （OR=l.003, 95% CI： 1.001-1.004, P=0.003） were file risk factors for left ventricular diastolic dys- function. Conclusions Left ventricular diastolic dysfunction occulted in most PD patients. Higher levels of BMI, total cholesterol, serum phosphorus and BNP were file risk factors for left ventxicular diastolic function.

关 键 词：腹膜透析 舒张功能 体质量指数 总胆固醇 磷 脑钠肽 

分 类 号：R318.16[医药卫生—生物医学工程]