血液透析患者心脏瓣膜返流的危险因素及预后影响  

Risk factors and prognostic influence of valvular regurgitation in maintenance dialysis patients

作　　者：杨仲煌 贾李跃 王牡丹 朱源 董芍芍 YANG Zhong-Huang;JIA Liyue;WANG Mudang(Department of Nephrology,Wenzhou Peoples's Hospital,Wenzhou 325000,China)

机构地区：[1]温州市人民医院肾内科,浙江温州325000

出　　处：《全科医学临床与教育》2021年第10期886-888,共3页Clinical Education of General Practice

摘　　要：目的探讨维持性血液透析患者心脏瓣膜返流的危险因素及对生存预后的影响。方法选取长期血透患者101例,收集患者临床资料、基线实验室指标及心脏彩超结果。根据心脏彩超结果判断是否存在心脏瓣膜返流,将患者分为心脏瓣膜返流组与无心脏瓣膜返流组,比较两组年龄、贫血程度、心胸比,行Kaplan-Meier生存分析,对可能导致心脏瓣膜返流的相关因素采用多因素回归分析。结果与无心脏瓣膜返流组比较,心脏瓣膜返流组患者年龄大,贫血程度重,心胸比大,差异均有统计学意义(t分别=5.83、3.06、5.01,P均<0.05);多因素回归分析显示,高龄、贫血以及心胸比大是血液透析患者发生心脏瓣膜返流的高危因素(OR分别=1.08、0.96、1.13,P均<0.05);生存曲线显示,心脏瓣膜返流组患者5年生存率低于无心脏瓣膜返流组(χ^(2)=6.62,P<0.05)。结论贫血控制不佳、容量负荷重、高龄的血液透析患者更易发生心脏瓣膜返流,且会影响患者预后,应引起重视,制定相应策略,改善患者预后。Objective To investigate the risk factors and survival prognostic impact of valvular regurgitation in mainte-nance dialysis patients.Methods A total of 101 maintenance dialysis patients were enrolled.The clinical data,laboratory examination and color doppler echocardiography results of these patients were obtained.According to echocardiography results,the patients were divided into the valvular regurgitation group and the non-valvular regurgitation group.The clinical features of age,anemia severity,cardiothoracic ratio were compared between two groups.The Kaplan-Meier survival analysis were used in data analysis of the valvular regurgitation,and logistic regression were used in statistic analysis of risk factors leading to valvular regurgitation.Results Compare to the non-valvular regurgitation group,patients in the cardiac valve regurgitationgroup were older,more severe anemia,higer cardiothoracic ratio(t=5.83,3.06,5.01,P<0.05).The multi variate regression analysis result shows that elder age,anemia and higher cardiothoracic ratio were the risk factors of val-vular regurgitation happend in dialysis patients(OR=1.08,0.96,1.13,P<0.05).The Kaplan-Meier analysis shows that the five-year survival rate of the valve regurgitation group was lower than that of the non-valvular regurgitation group(χ^(2)=6.62,P<0.05).Conclusion Hemodialysis patients with uncontroled anemia,volume overload and elder age are predi-sposed to valvular regurgitation which can affect the prognosis.It is necessary to take caution and develop strategy to improve the prognosis of these patients.

关 键 词：心脏瓣膜返流 维持性血液透析 心胸比 

分 类 号：R692.5[医药卫生—泌尿科学] R542.5[医药卫生—外科学]