终末期肾病透析人群中不同透析方式对左心室肥厚的影响分析  

Influence Analysis of Different Dialysis Methods to Left Ventricular Hypertrophy in ESRD Patients

作　　者：梁宇诣 杨荟[1] 曾玉纯[1] 张黎黎[1] 徐安平[1] LIANG Yu-yi;YANG Hui;ZENG Yu-chun;ZHANG Li-li;XUAn-ping(Department of Nephrology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,510120)

机构地区：[1]中山大学孙逸仙纪念医院肾内科,510120

出　　处：《岭南急诊医学杂志》2022年第5期418-420,433,共4页Lingnan Journal of Emergency Medicine

基　　金：国家自然科学基金面上项目(81870481);广东省自然科学基金面上项目(2021A1515011625)。

摘　　要：目的:比较血液透析和腹膜透析两种透析方式对终末期肾病透析人群左心室肥厚的影响。方法:本研究为回顾性队列研究。研究对象选取2007年1月至2016年12月间于中山大学孙逸仙纪念医院肾内科接受一种透析治疗(一周三次的血液透析或持续非卧床腹膜透析)的终末期肾病患者,收集患者启动维持性透析前后1个月内的心脏彩超检查结果作为基线数据,中位观察间隔22月,收集观察终点患者的心脏彩超及其他检查结果。结果:共入选99例患者,分为血液透析组(n=58)和腹膜透析组(n=41)。两组患者在性别、年龄、透析龄、BMI、平均动脉压、血红蛋白、血清钠、钙、磷、25-OH维生素D3、甲状旁腺素(PTH)、甘油三酯、高密度脂蛋白胆固醇(HDL)、糖尿病患病率、基线左心室肥厚指数(LVMI)等方面上均无统计学差异(P>0.05)。单因素分析中,LVMI改变值与血压、血红蛋白、甘油三酯、钙磷乘积、使用ACEI/ARB类药物相关。多因素回归分析中,在校正了钙磷乘积、血红蛋白、甘油三酯等影响因素后,LVMI的改变与平均动脉压、透析方式以及应用ACEI/ARB类药物独立相关(P<0.05)。结论:透析方式是终末期肾病人群中左心室肥厚进展的独立影响因素,且腹膜透析优于血液透析。Objective:To compare the influence to left ventricular hypertrophy(LVH)between hemodialysis(HD)and peritoneal dialysis(PD).Methods:A retrospective cohort study was conducted in end stage renal disease(ESRD)patients maintaining dialysis with complete follow⁃up data from 2007 to 2016 in Sun Yat⁃sen Memorial Hospital.Data of 1 month around the initiation of dialysis were collected as the baseline,and for an median of 22 months interval,the endpoint data were collected.Results:99 patients were included,divided into HD group(n=58)and PD group(n=41).No significant difference were found between two groups in gender,age,dialysis duration,BMI,systolic BP,hemoglo⁃bin,serum natrium,calcium,phosphorus,25⁃OH vitamin D3,parathyroid hormone(PTH),triglyceride,HDL,preva⁃lence of DM,baseline left ventricular mass index(LVMI)(P>0.05).In univariate analysis,delta LVMI was associated with blood pressure,hemoglobin,triglyceride,calcium phosphorus product,and use of ACEI/ARB drugs.In the multi⁃variate regression analysis,after adjusting the influence ofcalcium phosphorus product,hemoglobin and triglyceride,delta LVMI was independently related to the mean arterial pressure,dialysis mode and the use of ACEI/ARB drugs(P<0.05).Conclusion:Dialysis methods is an independent factor influencing the progression of left ventricular hypertro⁃phy,with peritoneal dialysis superior to hemodialysis.

关 键 词：终末期肾病 血液透析 腹膜透析 心肾综合征 左心室肥厚 

分 类 号：R692.5[医药卫生—泌尿科学]