腹膜透析充分性对心脏结构和功能的影响  

Association of dialysis adequacy in cardiac structure and function among peritoneal dialysis patients

作　　者：顾怡钰 杨昕宇 徐明珠[1] 徐家梁 张铭炀 蒋廷波[1] GU Yiyu;YANG Xinyu;XU Mingzhu;XU Jialiang;ZHANG Mingyang;JIANG Tingbo(Department of Cardiology,The First Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属第一医院心血管内科,苏州215000

出　　处：《肾脏病与透析肾移植杂志》2021年第1期25-30,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：苏州大学附属第一医院心血管专业组临床试验能力提升项目(201900180019);江苏干部保健科研课题(BJ15010)。

摘　　要：目的:探讨腹膜透析(PD)充分性对患者心脏结构和功能的影响。方法:回顾性纳入2016年5月至2019年5月苏州大学附属第一医院行持续不卧床腹膜透析(CAPD)的ESRD患者99例,分为透析不充分组45例(Kt/V<1.7且总Ccr<50 L/1.73m^(2))及透析充分组54例(Kt/V≥1.7且总Ccr≥50 L/1.73m^(2))。收集患者基本信息、实验室检查结果及常规心脏彩超结果,持续规律腹透并随访12个月,比较两组患者上述指标的变化,并记录PD相关不良事件发生与否。采用Pearson或Spearman相关分析探讨心脏结构功能与PD充分性指标间的相关性。结果:透析充分组心房内径、室间隔厚度(IVS)、左室收缩末期内径(LVSD)、左室舒张末期内径(LVDD)、左室后壁厚度(LVPW)、左心室质量指数(LVMI)、三尖瓣返流压差均较透析不充分组低,左心室射血分数(LVEF)高于透析不充分组,随访12个月后两组患者的左房内径(LAD)、IVS终点较起点增高,对比均有统计学意义(P<0.05)。透析充分性相关指标与心脏结构功能存在不同程度相关性。结论:提高PD充分性对延缓心室重构,维持心脏功能有重要意义。Objective:To investigate the effect of peritoneal dialysis(PD) adequacy on the cardiac structure and function among patients with end-stage renal disease(ESRD),and the correlation between them. Methodology:A total of 99 patients with ESRD who were undergoing continuous ambulatory peritoneal dialysis(CAPD) from May 2016 to May 2019 in the First Affiliated Hospital of Soochow University were retrospectively enrolled in this study. They were divided into inadequate dialysis group of 45 patients(Kt/V<1.7 and total Ccr<50 L/1.73 m2) and adequate dialysis group of 54 patients(Kt/V≥1.7 and total Ccr≥50 L/1.73 m2). Baseline data, biochemical indicators and echocardiographic characteristics were collected. All patients were followed up for 12 months to compare differences of the parameters mentioned above. We also recorded the occurrence of PD-related adverse events between two groups. Pearson or Spearman correlation analysis was used to explore correlation between cardiac structure and function with PD adequacy. Results:The atrial diameter, interventricular septal thickness(IVS),left ventricular end-systolic diameter(LVSD),left ventricular end-diastolic diameter(LVDD),left ventricular posterior wall thickness(LVPW),left ventricular mass index(LVMI) and tricuspid regurgitation pressure in adequate dialysis group were lower than those in inadequate dialysis group, and left ventricular ejection fraction(LVEF) was higher. Left atrial diameter(LAD) and IVS of two groups were both higher than that at baseline after 12 months of follow-up(P<0.05). Correlation analysis shows that PD adequacy has varying degrees of correlation with cardiac structure and function. Conclusion:Improving PD adequacy is of great significance for improving ventricular remodeling and maintaining cardiac function.

关 键 词：腹膜透析 透析充分性 心脏结构和功能 

分 类 号：R692.5[医药卫生—泌尿科学]