慢性肾脏病患者左心房增大的危险因素及对预后的影响分析  

Analysis of the risk factors for left atrial enlargement and its impact on prognosis in chronic kidney disease

作　　者：吕涛 李文[1] 姚峥[1] 吴雷云[1] 张爱华 LYU Tao;LI Wen;YAO Zheng;WU Lei-yun;ZHANG Ai-hua(Department of Nephrology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院肾内科,北京100053

出　　处：《中国血液净化》2024年第2期106-110,共5页Chinese Journal of Blood Purification

摘　　要：目的 分析慢性肾脏病(chronic kidney disease,CKD)非透析患者左心房增大(left atrial enlargement,LAE)的危险因素、发生率及对预后的影响。方法 选择2018年1月—2019年12月CKD 1~5期尚未进入透析,在首都医科大学宣武医院肾内科病房住院治疗且进行超声心动图检查的患者,将患者分为LAE组和非LAE组,收集患者人口学资料和生化检验资料。随访时间截至2021年11月1日,全因死亡为随访的终点事件。结果 共纳入524例患者,LAE发生率为57.06%(299/524)。多因素Logistic回归分析结果显示:合并慢性心血管疾病(OR=3.365,95%CI:1.896~5.970,P<0.001)、合并高脂血症(OR=1.845,95%CI:1.042~3.265,P=0.036)及低血钙(OR=0.273,95%CI:0.082~0.912,P<0.035)为CKD患者出现LAE的独立影响因素。随访过程中60例患者死亡,KaplanMeier生存曲线分析结果显示存在LAE的CKD组累积生存率降低(Log-rankχ^(2)=13.093,P<0.001),多因素COX回归分析结果显示:年龄(HR=1.036,95%CI:1.011~1.062,P=0.005)及合并慢性心血管疾病(HR=2.175,95%CI:1.133~4.176,P=0.020)是CKD患者全因死亡的独立危险因素。结论 50%以上的CKD 1~5期非透析患者发生LAE,合并慢性心血管疾病、合并高脂血症及血钙偏低为CKD非透析患者出现LAE的独立危险因素。合并LAE的CKD患者死亡风险显著增高,但不是CKD患者全因死亡的独立危险因素。Objective To analyze the risk factors,prevalence and prognostic effects of left atrial enlarge-ment(LAE)in chronic kidney disease(CKD)without dialysis treatment.Methods The CKD patients at stage 1~5 not treated with dialysis and hospitalized in the Department of Nephrology,Xuanwu Hospital of Capital Medical University from January 2018 to December 2019 were subjected to echocardiography exami-nation.They were then divided into LAE group and non-LAE group according to the diagnostic criteria of LAE.Their demographic and biochemical data were collected.They were followed up until November 2021,All-cause death or loss of follow-up was the end point event.Results This study enrolled a total of 524 CKD patients,in which 299 had LAE(57.06%).Multivariate logistic regression showed that pre-existing chronic cardiovascular disease(OR=3.365,95%CI:1.896~5.970,P<0.001),hyperlipidemia(OR=1.845,95%CI:1.042~3.265,P=0.036)and hypocalcemia(OR=0.273,95%CI:0.082~0.912,P<0.035)were the indepen-dent influencing factors for LAE in CKD patients.CKD patients with LAE had lower survival rate than those without LAE by Kaplan-Meier analysis(Log-rank,χ^(2)=13.093,P<0.001).Multivariate Cox regression showed that age(HR=1.036,95%CI:1.011~1.062,P=0.005)and chronic cardiovascular disease(HR=2.175,95%CI:1.133~4.176,P=0.020)were the independent risk factors for all-cause death in CKD patients.Con-clusions The prevalence of LAE is more than 50%in CKD patients at stage 1~5.Chronic cardiovascular dis-ease,hyperlipidemia and hypocalcemia are the independent risk factors for LAE in CKD patients.LAE in-creases the risk of all-cause death,but is not the independent risk factor for all-cause death in non-dialysis CKD patients.

关 键 词：左心房增大 慢性肾脏病 预后 危险因素 

分 类 号：R692[医药卫生—泌尿科学]