慢性肾功能衰竭患者心脏结构及心功能改变的影响因素

Factors associated with abnormal structure and function of left ventricular in patients with chronic renal failure

目的 研究慢性肾功能衰竭 (CRF)患者心脏左室肥大 (LVH)和相关危险因素。方法 CRF患者 83例 ,男 4 2例 ,女 4 1例。年龄 2 0～ 90岁 ,平均年龄 (5 3 7± 12 7)岁。彩色多普勒心脏超声检查左室舒张末内径增大 (LVEDD) ,室间隔舒张末厚度 (IVS) ,左室后壁舒张末厚度 (PWTH) ,射血分数 (EF) ,检测血Hb和HCT ,空腹血清甲状旁腺素 (PTH)及肌酐 (Cr) ,测量血压。透析患者于透析前采血和超声检查。公式计算左室心肌重量指数 (LVMI)。结果 83例CRF患者 71 8%有LVH[LVMI(179 2 8± 6 6 92 )g m2 ]。 37 35 %存在LVEDd增大 (49 6 4± 6 5 5 )mm ,5 7 83%存在IVS增厚 (12 0 6± 1 94 )mm ,5 7 83%存在PWTH增厚 (11 6 7± 1 95 )mm ,14 4 6 %有EF下降 (6 1 17± 11 16 ) %。CRF患者其PWHT、IVST、LVEDD、LVMI与PTH、Cr及血压呈正相关 ;EF与Cr、PTH、HCT、Hb及血压无相关性。结论 LVH是CRF患者预测死亡危险度的重要指标 ,而LVH与Cr水平、PTH增高、血压明显相关 ,心功能EF也与Cr、PTH增高有关 ,控制Cr水平 ,治疗甲状旁腺功能更亢进和合理的降压治疗应有助于减少左室肥厚的发生 ,提高肾功能不全患者的生存质量。

Objective To investigate the left ventricular hypertrophy (LVH) and related risk factors in patients with chronic renal failure(CRF).Methods 83 CRF patients (42 men, 41 women; average age 53.7 years).LVEDD, IVS, PWTH and EF values were detected by echocardiography in all patients.The levels of ferrohemoglobin (Hb),HCT, blood pressure ,serum parathyroid hormone(PTH) and creatinine were tested at the same time.The blood tests and echocardiography were carried out before hemodialysis(HD) in HD patient, and the left ventricular mass index was calculated.Statistical analysis of the data was performed by SPSS software.Results There were 71.8% patients with LVH[LVMI:(179.28±66.92)g/m2],37.35% with enlarged LVEDD(49.64±6.55)mm,57.83% with increased IVS(12.06±1.94)mm,57.83% with increased PWTH(11.67±1.95)mm, 14.46% with deceased EF(61.1±11.16)%.The PWHT, IVST, LVEDD and LVMI in patients with chronic renal failure had positive correlation with blood pressure(BP), increased serum PTH and creatinine.The EF value had no correlation with creatinine, PTH, HCT, Hb and blood pressure.Conclusion Left ventricular hypertrophy(LVH)is an important predict for poor prognosis in patients with chronic renal failure.The LVH was significantly associated with the levels of serum creatinine, increased PTH and blood pressure, and the EF value was also correlated with serum creatinine and PTH% As a result, the decrease of the level of serum creatinine, and the therapy of anti-hyperparathyroidism and anti-hypertension were helpful to reduce LVH and improve the life qualities of chronic renal failure patients.