CAJ | 학술논문

目的观察维持性血液透析(MHD)患者并发肺动脉高压(PH)的临床特点及影响因素.方法收集2008年6月至2009年5月收治资料完整的MHD患者102例(透析龄均超过1年),利用超声心动图检测肺动脉收缩压(PASP)、心脏其他结构和功能指标,并根据PASP大小分为两组,PASP≥35 mm Hg(1 mm Hg=0.133 kPa)为PH组,PASP＜ 35 mm Hg为非PH组.记录两组患者的性别、年龄、透析龄、血管通路、透析间期尿量,同时记录透析前血生化、甲状旁腺激素、血红蛋白及透析后血尿素氮并计算尿素清除指数(Kt/V).结果 102例MHD患者中26例确诊为PH,PH发生率为25.5％(26/102).PH组右房横径、右房长径、肺动脉内径[(32.00±8.13)、(41.00±9.15)、(24.38±3.88) mm]高于非PH组[(27.44±4.43)、( 36.45±8.88)、(21.78±2.46)mm],LVEF[(55.59±7.88)％]低于非PH组[(59.09±5.69)％],差异有统计学意义(P＜ 0.01或＜0.05).PH组和非PH组钙磷乘积、甲状旁腺激素、血磷、血红蛋白比较差异有统计学意义[(61.36±17.83)mg2/dl2比(53.24±18.28) mg2/dl2、(365.95±178.65) ng/L比(287.02±209.91) ng/L、(2.24±0.60) mmol/L比( 1.95±0.68) mmol/L、(98.65±25.69)g/L比(114.29±22.31)g/L] (P＜ 0.05).Logistic回归分析显示,甲状旁腺激素、血红蛋白及钙磷乘积是MHD患者并发PH的主要危险因素.结论 MHD患者PH发生率高,继发性甲状旁腺功能亢进、钙磷乘积升高、贫血可能参与了MHD患者PH的发生.
목적 관찰유지성혈액투석(MHD)환자병발폐동맥고압(PH)적림상특점급영향인소.방법 수집2008년6월지2009년5월수치자료완정적MHD환자102례(투석령균초과1년),이용초성심동도검측폐동맥수축압(PASP)、심장기타결구화공능지표,병근거PASP대소분위량조,PASP≥35 mm Hg(1 mm Hg=0.133 kPa)위PH조,PASP＜ 35 mm Hg위비PH조.기록량조환자적성별、년령、투석령、혈관통로、투석간기뇨량,동시기록투석전혈생화、갑상방선격소、혈홍단백급투석후혈뇨소담병계산뇨소청제지수(Kt/V).결과 102례MHD환자중26례학진위PH,PH발생솔위25.5％(26/102).PH조우방횡경、우방장경、폐동맥내경[(32.00±8.13)、(41.00±9.15)、(24.38±3.88) mm]고우비PH조[(27.44±4.43)、( 36.45±8.88)、(21.78±2.46)mm],LVEF[(55.59±7.88)％]저우비PH조[(59.09±5.69)％],차이유통계학의의(P＜ 0.01혹＜0.05).PH조화비PH조개린승적、갑상방선격소、혈린、혈홍단백비교차이유통계학의의[(61.36±17.83)mg2/dl2비(53.24±18.28) mg2/dl2、(365.95±178.65) ng/L비(287.02±209.91) ng/L、(2.24±0.60) mmol/L비( 1.95±0.68) mmol/L、(98.65±25.69)g/L비(114.29±22.31)g/L] (P＜ 0.05).Logistic회귀분석현시,갑상방선격소、혈홍단백급개린승적시MHD환자병발PH적주요위험인소.결론 MHD환자PH발생솔고,계발성갑상방선공능항진、개린승적승고、빈혈가능삼여료MHD환자PH적발생.
Objective To observe the clinical characteristics and influential factors of pulmonary hypertension (PH) in maintenance hemodialysis (MHD) patients.Methods One hundred and two patients with MHD patients whose therapy time were all more than one year were enrolled from June 2008 to May 2009.Pulmonary arterial systolic pressure (PASP) and parameters related with cardiac structure and function were checked out by echocardiography.These patients were divided into two groups according to PASP:PH group[PASP≥35 mm Hg( 1 mm Hg =0.133 kPa)] and non-PH group(PASP ＜ 35 mm Hg).Gender,age,dialysis time,dialysis access and urine volume during dialysis was recorded.The blood biochemistry,parathyroid hormone (PTH),hemoglobin,postdialysis urea nitrogen was recorded too and Kt/V was calculated.Results PH was detocted in 26 MHD patients (25.5％,26/102).Right atrium transverse diameter,right atrium long diameter and pulmonary artery internal diameter in PH group [(32.00 ± 8.13),(41.00 ±9.15),(24.38 ± 3.88) mm] were higher than those in non-PH group [(27.44 ± 4.43),(36.45 ±8.88 ),(21.78 ± 2.46) mm] and LVEF in PH group [(55.59 ± 7.88 )％] was lower than that in non-PH group [(59.09 ± 5.69)％] (P ＜ 0.01 or ＜ 0.05).There were significant differences in calcium-phosphorus product,PTH,serum phosphorus and hemoglobin between PH group and non-PH group [(61.36 ± 17.83)mg2/dl2 vs.(53.24 ± 18.28) mg2/dl2,(365.95 ± 178.65) ng/L vs.(287.02 ±209.91 ) ng/L,(2.24 ±0.60)mmol/L vs.( 1.95 ± 0.68) mmol/L,(98.65 ± 25.69) g/L vs.( 114.29 ± 22.31 ) g/L] (P ＜ 0.05 ).Logistic regression found that PTH levels,hemoglobin and calcium-phosphorus product were the major risk factors for PH.Conclusions Morbidity of PH in MHD patients is obviously high.Secondary hyperparathyroidism,anemia and high calcium-phosphorus product level may take part in the pathogenesis of PH in MHD patients.