尿毒症患者心脏结构功能及相关危险因素分析

Cardiac structural and functional changes and its risk factors in patients with chronic renal failure

目的了解慢性肾衰竭(CRF)患者心脏结构、功能变化特征,并探讨高血压、贫血、血清白蛋白、血脂与心脏结构功能改变之间的关系。方法回顾性分析新缰医科大学第一医院2003年1月～12月103例未进入血液透析或刚开始进入血液透析的尿毒症患者,其多普勒超声心动图结果及其同期血压、血红蛋白、血清白蛋白、血脂,了解其规律及之间的关系。结果①103例患者超声UCG结构显示,有75.7%出现LVH,其中向心性肥厚占41.7%,离心性肥厚占34.0%;17.5%已出现向心性重构:只有6.8%结构完全正常;②19.4%左心室收缩功能障碍;③血红蛋白、收缩压、血清白蛋白、LDL在有LVH和无LVH组存在明显差异,而年龄、高血压时间、舒张压、TG、TCH和HDL之间无显著性差异。血红蛋白与左室心肌质量指数(LVMl)呈负相关,低密度脂蛋白与LVMI呈负相关,而血压、年龄、血清白蛋白、与LVMI无显著的相关性。结论CRF患者未进入透析前心血管疾病的发生率已经很高,主要表现为LVH,且以向心性肥厚为主。心脏结构功能变化可能与高血压、贫血、营养不良等因素有关。

Objective To investigate the changes of cardiac structure and function in patients with chronic renal failure （CRF）, and analyze the relationship between those changes and hypertension, anemia, serum albumin and lipid. Method One hurndred and three predialyisis and new dialysis patients with CRF were examined by echocardiography, and the levels of blood pressure, hemoglobin, serum albumin and lipid were examined by routine method. Results ①The echocardiography images showed that 75.7% of patients with CRF had left ventricular hypertrophy（LVH）. Incidence rate of left ventricular concentric hypertrophy, left ventricular eccentric hypertrophy, left ventricular concentric remodeling were 41.7%, 34.0%, 17.5%; 6.8% patients showed normal structure. ②The of rate left ventricular systolic dysfunction was 19.4%.③The hemoglobin, systolic blood pressure, serum albumin and LDL-cholesterol of group with and without LVH had statistical difference. The age, duration of hypertension, diastolic blood pressure, triglyceride, cholesterol and HDL-cholesterol had no significancet difference. Hemoglobin was found positively correlated with left ventricular mass index （LVMI）, LDL was also positively correlated with LVMI, but blood pressure, age and serum albumin had no significanit correlation. Conclusion The incidence of cardiovascular diseases （CVD） in pre-dialysis CRF patients is high, LVH, especially left ventricular concentric hypertrophy are more frequently happened. It suggests that the changes of cardiac structure and function may correlate with hypertension, anemia and malnutrition.