血液透析慢性低血压患者左心室功能及其危险因素分析

The left ventricular function and related risk factors of left ventricular hypertrophy in the hemodialysis patients with chronic hypotension

目的 应用彩色超声检查观察血液透析慢性低血压患者的心功能 ,分析其发生左心室肥厚 (LVH)的危险因素。方法 将 5 8例尿毒症血液透析患者分为慢性低血压 (LBP)、正常血压(NBP)和高血压 (HBP) 3组 ,均行心脏彩色超声检查 ,并测定尿素清除指数 (Kt/V)、透析前血红蛋白(Hb)、血浆白蛋白 (Alb)、前白蛋白 (pAlb)、血脂、C 反应蛋白 (CRP)及甲状旁腺激素等指标。将LBP组分为LVH组和非LVH组 ,比较两组情况。结果 ①LBP组心输出量显著低于其余两组 ,二尖瓣前向血流E峰与A峰比值 <1。LBP组中存在LVH的患者显著多于NBP组 ,但少于HBP组 ;②LBP组中 ,与非LVH组比较 ,LVH组糖尿病患者、Kt/V <1.2者显著增多 ,Hb、Alb、pAlb及高密度脂蛋白显著降低 ,脂蛋白 (a)及CRP显著升高。结论 血液透析LBP患者左心室收缩及舒张功能均受损 ,糖尿病、透析不充分、贫血、营养不良。

Objective To observe the left ventricular function of the hemodialysis patients with chronic hypotension using color Doppler ultrasonography and to analyze the related risk factors of left ventricular hypertrophy (LVH).Methods The color Doppler cardiac ultrasonography was performed on 58 hemodialysis patients who were divided into 3 groups,chronic hypotension (LBP) group,normal blood pressure (NBP) group and hypertension (HBP) group.The hemoglobin, plasma albumin and pre-albumin,lipid,C responsive protein,parathyroid hormone before dialysis and Kt/V were determined.Results ①The cardiac output in LBP group was lower than that in other two groups significantly.The E/A ratio of LBP group was lower than 1.The incidence of LVH was 42.1% in LBP group, which was markedly higher than that of NBP groups.②In LBP group, the incidence of diabetes,Lp (a) and CRP in patients with LVH were higher than those in patients without LVH.The Kt/V,Hb,Alb,pAlb and high density lipoprotein in patients with LVH were lower those in patients without LVH.Conclusion The systolic and diastolic function of left ventricular in the hemodialysis patients with chronic hypotension was damaged. The main risk factors of LVH included diabetes,dialysis deficiency,anemia,malnutrition,lipid disorder and inflammatory state.