CAJ | 학술논문

目的：通过心脏彩色多普勒检查对136例维持性血液透析（MHD）患者心脏结构、功能的各项参数进行评估，并通过各项参数与肺动脉压力的相关性分析，了解引发肺动脉高压的相关因素。方法对中山大学附属第五医院血液净化中心符合研究入选标准的136例MHD患者做横断面研究。根据超声心动图的检查结果将患者分为肺动脉高压组（PH组，PASP＞35 mmHg）、肺动脉压力正常组（nPH 组，PASP≤35 mmHg），并将超声心动图检测指标与肺动脉压力做相关性分析。结果 PH组较nPH组患者的左、右心房及心室明显增大、心肌肥厚程度较重；PH组较nPH组患者心脏收缩及舒张功能下降；PH组较nPH组患者心脏处于高循环动力状态（均P＜0.05）。肺动脉压力与肺动脉内径、肺动脉最高流速、右心房内径、左心房内径、右心室内径、左心室收缩末期内径、左心室舒张末期内径、室间隔厚度、左心室质量、左心室质量指数、心输出量呈正相关（均P＜0.001）；与左心室舒张早期和舒张晚期最大血流速度之比（E/A）、左心室射血分数、左心室短轴缩短率呈负相关（均P＜0.001）。结论 MHD患者心脏的结构和功能的病变是引起肺动脉高压的重要原因之一，同时肺动脉压的升高可能进一步加重 MHD 患者的心脏病变；其中心脏舒张功能下降是引起肺动脉压升高重要因素。左心室收缩功能减低，可导致肺动脉压升高。
목적：통과심장채색다보륵검사대136례유지성혈액투석（MHD）환자심장결구、공능적각항삼수진행평고，병통과각항삼수여폐동맥압력적상관성분석，료해인발폐동맥고압적상관인소。방법대중산대학부속제오의원혈액정화중심부합연구입선표준적136례MHD환자주횡단면연구。근거초성심동도적검사결과장환자분위폐동맥고압조（PH조，PASP＞35 mmHg）、폐동맥압력정상조（nPH 조，PASP≤35 mmHg），병장초성심동도검측지표여폐동맥압력주상관성분석。결과 PH조교nPH조환자적좌、우심방급심실명현증대、심기비후정도교중；PH조교nPH조환자심장수축급서장공능하강；PH조교nPH조환자심장처우고순배동력상태（균P＜0.05）。폐동맥압력여폐동맥내경、폐동맥최고류속、우심방내경、좌심방내경、우심실내경、좌심실수축말기내경、좌심실서장말기내경、실간격후도、좌심실질량、좌심실질량지수、심수출량정정상관（균P＜0.001）；여좌심실서장조기화서장만기최대혈류속도지비（E/A）、좌심실사혈분수、좌심실단축축단솔정부상관（균P＜0.001）。결론 MHD환자심장적결구화공능적병변시인기폐동맥고압적중요원인지일，동시폐동맥압적승고가능진일보가중 MHD 환자적심장병변；기중심장서장공능하강시인기폐동맥압승고중요인소。좌심실수축공능감저，가도치폐동맥압승고。
Objective To assess the parameters of cardiac structure and function by Doppler echocardiographic examinations in a total of 136 maintenance hemodialysis(MHD) patients and assess relationship between these parameters and pulmonary artery pressure, we explorer related factors causing pulmonary hypertension in MHD patients. Methods A total of 136 MHD patients from the fifth affiliated hospital of Sun Yat-Sen University were included the cross-sectional study, they were divided into PH and nPH groups according to the echocardiographic results. We make a correction analysis for these results and pulmonary artery pressure. Results The values of left, right atrium and ventricle were statistic significantly higher in PH group than those in nPH group;the degree of cardiac hypertrophy in PH group was greater than nPH group; cardiac systolic and diastolic function in PH group was significantly lower than nPH group;the cardiac output in PH group was significantly higher than nPH group(all P<0.05). As the same time, the value of PH was positively correlated with diameter of pulmonary artery, maximum flow rate of pulmonary artery, diameter of right atrium, diameter of left atrium, diameter of right ventricular, diameter of left end-systolic ventricular, diameter of left end-diastolic ventricular, septal thickness, left ventricular mass, left ventricular mass index, cardiac output(all P<0.001);was negatively correlated with E/A, left ventricular ejection fraction, fractional shortening(all P<0.001). Conclusions The change of cardiac structure and function in MHD patients is one of possible causative factors of PH. And elevated pulmonary blood pressure may further aggravate MHD. The decline of cardiac diastolic function is an important cause of PH. A decline of left ventricular systolic function also cause PH in MHD patients.