CAJ | 학술논문

目的：探讨经动静脉内瘘的维持性血液透析患者并发肺动脉高压（PH）的发生率及影响因素。方法：对121例经动静脉内瘘维持性血液透析患者进行超声心动图检查，测定肺动脉收缩压（SPAP），根据所测 SPAP 将研究对象分为肺动脉高压组和无肺动脉高压组，检测两组临床资料包括性别、年龄、透析龄、动静脉内瘘口直径（AVFD）、动静脉内瘘口血流量（AVFB）、血钙、甲状旁腺素、脑钠肽、高敏 C 反应蛋白（hs‐CRP）、同型半胱氨酸。结果：经动静脉内瘘血液透析121例患者中，发生 PH28例，发生率为23．14％。 PH 组患者 AVFD 、AVFB 、甲状旁腺激素（iPT H）、脑钠肽、年龄、hs‐CRP 、Hcy 在较无 PH 组明显升高（P＜0．05）。 PH 组左室射血分数（EF）、舒张早期和舒张晚期最大血流速度（E／A）较无 PH 组明显降低（P＜0．05）。结论：经动静脉内瘘行血液透析患者合并 PH 的发生率与国外报道相近，继发性甲旁亢、转移性钙化、全身微炎症反应状况、AVFD 、AVFB 、左心功能下降均可能参与 PH 的发生。
목적：탐토경동정맥내루적유지성혈액투석환자병발폐동맥고압（PH）적발생솔급영향인소。방법：대121례경동정맥내루유지성혈액투석환자진행초성심동도검사，측정폐동맥수축압（SPAP），근거소측 SPAP 장연구대상분위폐동맥고압조화무폐동맥고압조，검측량조림상자료포괄성별、년령、투석령、동정맥내루구직경（AVFD）、동정맥내루구혈류량（AVFB）、혈개、갑상방선소、뇌납태、고민 C 반응단백（hs‐CRP）、동형반광안산。결과：경동정맥내루혈액투석121례환자중，발생 PH28례，발생솔위23．14％。 PH 조환자 AVFD 、AVFB 、갑상방선격소（iPT H）、뇌납태、년령、hs‐CRP 、Hcy 재교무 PH 조명현승고（P＜0．05）。 PH 조좌실사혈분수（EF）、서장조기화서장만기최대혈류속도（E／A）교무 PH 조명현강저（P＜0．05）。결론：경동정맥내루행혈액투석환자합병 PH 적발생솔여국외보도상근，계발성갑방항、전이성개화、전신미염증반응상황、AVFD 、AVFB 、좌심공능하강균가능삼여 PH 적발생。
Objective :To clarify the incidence and affecting factors of pulmonary hypertension (PH ) in hemodialysis patients with arteriovenous fistula .Methods :Systolic pulmonary arterial pressure were estimated with Doppler echocardiography in 121 hemodialysis patients .According to the measured SPAP ,patients were divided into pulmonary hypertension group and non pulmonary hypertension group .The clinical data ,including sex ,age ,dialysis age ,arteriovenous fistula diameter(AVFD) ,arteriovenous fistula blood flow (AVFB) ,calcium ,parathyroid hor‐mone(iPT H) ,BNP ,hs‐CRP and Hcy ,were collected and analysised .Results :28 patients were found occurring PH in 121 hemodialysis patients ,with incidence was 23 .14% .Compared with non pulmonary hypertension group ,there were significant increase of AVFD ,AVFB ,iPT H ,BNP ,age ,hs‐CRP and Hcy in pulmonary hypertension group(P< 0 .05) ,and significant decrease of left ventrical EF ,E/A .Conclusion :The incidence of pulmonary hypertension we analysised was near to foreign reports .Secondary hyperparathyroidism ,metastatic calcification ,systemic micro‐inflammation status ,AVFD ,AVFB ,and decreased left ventricular function maybe involved in PH pathophysiology .