维持性腹膜透析患者左心室舒张功能异常筛查及危险因素分析  

Screening and risk factor analyses of abnormal left ventricular diastolic function in maintenance peritoneal dialysis patients

作　　者：章倩莹[1] 徐天[1] 李晓[1] 黄晓敏[1] 张春燕[1] 任红[1] ZHANG Qian-ying;XU Tian;LI Xiao;HUANG Xiao-min;ZHANG Chun-yan;REN Hong(Department of Nephrology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院肾内科,上海200025

出　　处：《中国血液净化》2022年第7期487-491,共5页Chinese Journal of Blood Purification

摘　　要：目的 探讨射血分数正常的维持性腹膜透析(peritoneal dialysis,PD)患者左心室舒张功能异常的发生率及其危险因素。方法 采用横断面调查。收集2020年11月~2021年3月间至上海交通大学附属瑞金医院随访并行心脏超声检查的维持性PD患者资料,筛查左心室射血分数>50%的患者,以舒张早期二尖瓣血流速度(early diastolic transmitral flow velocity,E)和二尖瓣环舒张早期运动速度(early diastolic mitral annular velocity,e’)比值(E/e’)筛查左心室舒张功能不全。比较左心室舒张功能异常(E/e’>14)与对照组(E/e’≤14)患者心脏超声参数及临床、生化指标差异,并探讨PD患者左心室舒张功能异常的危险因素。结果 共103例患者,左心室舒张功能异常组(n=31)尿素清除指数(Kt/V)、血压达标率低于对照组(U/χ^(2)=1406.000、4.382,P=0.037、0.036),氨基末端B型利钠肽前体(N-terminal pro b-type natriuretic peptide,NT-proBNP)、体质量、体质量指数(body mass index,BMI)、体表面积、水肿发生率高于对照组(U/t/χ^(2)=690.000、2.390、2.484、2.051、12.322,P=0.002、0.019、0.015、0.043、<0.001)。Logistic回归提示:NT-proBNP高(OR=5.790,95%CI:1.724~19.440,P=0.004),BMI升高(OR=1.226,95%CI:1.028~1.462,P=0.023),水肿(OR=3.827,95%CI:1.190~12.310,P=0.024)是PD患者左心室舒张功能异常的独立危险因素。结论 水肿、NT-proBNP高、BMI升高与维持性腹膜透析患者发生左心室舒张功能异常独立相关。Objectives To investigate the incidence and risk factors of abnormal left ventricular diastolic function in maintenance peritoneal dialysis(PD)patients with normal ejection fractions.Methods This study was a cross-sectional survey.Echocardiography data as well as clinical and laboratory data of the maintenance PD patients who came to Ruijin Hospital affiliated to Shanghai Jiao Tong University for follow-up between November 2020 and March 2021 were collected.PD patients with left ventricular ejection fraction>50%were enrolled for the screening study.Echocardiographic parameters,clinical and laboratory data were compared between patients with abnormal left ventricular diastolic function and control patients.Binary logistic regression was used to analyze the risk factors for abnormal left ventricular diastolic function in the PD patients with normal ejection fraction.Results A total of 103 patients were enrolled in the study.Abnormal left ventricular diastolic function(E/e’>14)was found in 31 patients.In the PD patients with abnormal left ventricular diastolic function,fractional urea clearance(Kt/V)[median 2.0(1.7,2.3)vs.2.1(1.9,2.6),U=1406.000,P=0.037]and qualified blood pressure rate(29.0%vs.51.4%,c2=4.382,P=0.036)were lower,and N-terminal pro b-type natriuretic peptide(NT-proBNP)[median 12131.0(5242.0,30883.0)pg/ml vs.2981(940.4,14665.0)pg/ml,U=690.000,P=0.002],body weight(63.7±11.9kg vs.58.2±10.2kg,t=2.390,P=0.019),body mass index(BMI)(23.9±3.5kg/m^(2) vs.22.2±3.1kg/m^(2),t=2.484,P=0.015),body surface area(BSA)(1.7±0.2m^(2) vs.1.6±0.2m^(2),t=2.051,P=0.043),and incidence of edema(67.7%vs.30.6%,c2=12.322,P<0.001)were higher,as compared with those in the control group(E/e’≤14).Logistic regression indicated that higher NT-proBNP(OR=5.790,95%CI 1.724~19.440,P=0.004),increased BMI(OR=1.226,95%CI 1.028~1.462,P=0.023)and edema(OR=3.827,95%CI 1.190~12.310,P=0.024)were the independent risk factors for ab-normal left ventricular diastolic function in PD patients with normal eject fraction.Conclusion Edema,high

关 键 词：腹膜透析 左心室舒张功能异常 危险因素 

分 类 号：R459.5[医药卫生—治疗学]