CAJ | 학술논문

目的：探讨腹膜透析（ PD）患者并发肺动脉高压（ PH）的发生率及相关影响因素，以早期诊断并进行临床干预。方法：选取2011年1月至2014年11月在我院肾内科病房及腹透门诊随访的透析龄＞3个月且资料完整的PD患者58例，比较并发PH（ PH组）和无PH（非PH组）患者的临床资料、实验室及心脏彩超检查指标。 PH的诊断标准采用超声心动图检测的肺动脉压（ PAP）≥35 mmHg。结果：58例PD患者中男性32例，女性26例，平均PAP为（33．88±8．12） mmHg，PH发生率为46．55％。 PH组平均PAP为（40．74±6．43） mmHg。PH组与非PH组在年龄、性别组成、透析龄、原发病、尿素氮、肌酐、尿酸、钙、磷、铁蛋白、C反应蛋白、尿量、残余肾功能、总Ccr、4 h腹透液与血肌酐比值（4 hD／PCr）、每周Kt／v等方面的差异无统计学意义，在血红蛋白、白蛋白、甲状旁腺激素、B 型尿钠肽、左心室质量指数、射血分数（ EF ）、左室舒张内径（ LVDd）和左室收缩内径等方面的差异有统计学意义。对以上因素进行二分类Logistic回归分析显示，血红蛋白、白蛋白、EF的下降和LVDd的升高是PD患者并发PH的危险因素。结论：PD患者并发PH者并不少见，贫血、低白蛋白血症、EF的下降及LVDd的增加是PD患者并发PH的独立危险因素。
목적：탐토복막투석（ PD）환자병발폐동맥고압（ PH）적발생솔급상관영향인소，이조기진단병진행림상간예。방법：선취2011년1월지2014년11월재아원신내과병방급복투문진수방적투석령＞3개월차자료완정적PD환자58례，비교병발PH（ PH조）화무PH（비PH조）환자적림상자료、실험실급심장채초검사지표。 PH적진단표준채용초성심동도검측적폐동맥압（ PAP）≥35 mmHg。결과：58례PD환자중남성32례，녀성26례，평균PAP위（33．88±8．12） mmHg，PH발생솔위46．55％。 PH조평균PAP위（40．74±6．43） mmHg。PH조여비PH조재년령、성별조성、투석령、원발병、뇨소담、기항、뇨산、개、린、철단백、C반응단백、뇨량、잔여신공능、총Ccr、4 h복투액여혈기항비치（4 hD／PCr）、매주Kt／v등방면적차이무통계학의의，재혈홍단백、백단백、갑상방선격소、B 형뇨납태、좌심실질량지수、사혈분수（ EF ）、좌실서장내경（ LVDd）화좌실수축내경등방면적차이유통계학의의。대이상인소진행이분류Logistic회귀분석현시，혈홍단백、백단백、EF적하강화LVDd적승고시PD환자병발PH적위험인소。결론：PD환자병발PH자병불소견，빈혈、저백단백혈증、EF적하강급LVDd적증가시PD환자병발PH적독립위험인소。
Objective:To investigate the incidence and risk factors of pulmonary hypertension(PH)in patients undergoing peritoneal dialysis( PD) .Methods: Between January 2011 and November 2014,58 patients who had received PD therapy for over 3 month and complete clinical data were involved in this study.The clinical data, laboratory and cardiac ultrasound parameters were compared between patients with and without PH.The diagnostic standard of PH is echocardiography pulmonary artery pressure( PAP)≥35 mmHg.Results: There were 32 males and 26 females in 58 PD patients,the mean PAP was(33.88 ±8.12) mmHg.46.55% had PH.Mean PAP of the <br> patients with PH was(40.74 ±6.43)mmHg(range:35-60 mmHg).There were no significant differences regarding age, gender, dialysis duration, primary disease, blood urea nitrogen, serum creatinine, calcium, phosphorus, ferritin, C-reactive protein, urine volume, residual renal function, total creatinine clearance rate, 4-hour dialysate-to-plasma ratio for creatinine(4 hD/PCr), and total weekly Kt/v between PH group and non-PH group(all P>0.05). Patients with PH had lower ejection fraction ( EF ) , hemoglobin ( Hb ) , albumin ( ALB ) and higher parathyroid, brain natriuretic peptide, left ventricular diastolic diameter ( LVDd ) , left ventricular systolic diameter and left ventricular mass index than those without PH( all P<0.05) .Binary logistic regression analysis revealed that Hb, EF, ALB and LVDd were independent risk factors of PH in PD patients(P<0.05).Conclusion: PH is highly prevalent in PD patients.The reduction of Hb, ALB, EF and increase of LVDd represent independent risk factors for PH.