老年肾替代治疗患者左心室功能异常及相关因素分析

Analysis of left ventricular dysfunction and related factors in elderly patients with renal replacement therapy

目的对老年肾替代治疗患者左心室功能异常的情况及相关因素进行分析。方法选取天津医科大学第二医院肾脏病血液净化科2007～2009年收治的老年肾替代治疗患者100例,按肾替代治疗方式分为血液透析组和腹膜透析组;同时选取同期健康查体老年人80例作为对照。对所有患者均常规检测血清肌酐、尿素氮、白蛋白、血红蛋白、血钙、血磷、血清胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白-胆固醇(HDL-C)、低密度脂蛋白-胆固醇(LDL-C)、血全段甲状旁腺激素(i-PTH);高压液相方法检测血浆同型半胱氨酸;利用超声心动检查评价左心室功能。结果两组老年肾替代治疗患者血红蛋白水平存在差异,老年血液透析组患者高于老年腹膜透析组,其余生化指标无统计学意义;两组老年肾替代治疗患者左心室功能异常发生率差异无统计学意义,但后壁厚度差异具有统计学意义,腹膜透析组患者高于血液透析组;与健康查体老年对照组相比,老年肾替代治疗组各项左心功能指标与健康查体老年对照组相比差异均具有统计学意义(P<0.01或P<0.05)。多因素Logistic回归分析显示,血浆白蛋白水平是老年肾替代治疗患者左心室收缩功能障碍的危险因素。结论不同肾替代治疗方式下,老年肾替代治疗患者左心室功能异常发生率无差异,纠正低蛋白血症,增加透析剂量,减轻心脏负荷可能有助于改善左心室收缩功能。

Objective To analyze left ventricular dysfunction and related factors in elderly patients with renal replacement therapy.Methods A total of 100 patients who received chronic renal replacement therapy were included in this study.Patients were divided into two groups:hemodialysis group and peritoneal dialysis group.There were also 80 healthy elder people as control group.Indicators such as blood urine nitrogen,creatinine,hemoglobin,calcium,phosphate,triglyceride,total cholesterol,LDL-C,HDL-C,i-PTH were measured,and echocardiography were performed in all patients.The level of homocysteine was measured by HPLC.Results There were left ventricular systolic dysfunction and diastolic dysfunction in both patient groups,but there were no significant difference.Meanwhile,peritoneal group had high LVPWT level than hemodialysis group.Significant difference of left ventricular function were also found between elderly patient group and health control group(P<0.05).The level of albumin was risk factor for left ventricular systolic dysfunction.Conclusions Different pattern of renal replacement therapy have no impact on left ventricular dysfunction.Increase of albumin level,doze of dialysis and prevention of overload may be helpful to improve left ventricular systolic function.