腹膜透析患者开始透析治疗时的心血管状态及超声特点

Cardiovascular disease and echocardiographic characteristics in patients starting peritoneal dialysis

目的了解持续不卧床腹膜透析(CAPD)治疗的终末期肾脏病(ESRD)患者透析开始时的心血管状态及超声心动图(UCG)特点。方法选择我院开始CAPD时行UCG检查的ESRD患者51例,收集入院时的血压、实验室检查结果及UCG报告。计算心血管合并症和UCG异常发生率,分析UCG异常及相关因素。结果CAPD患者开始透析时的心血管合并症缺血性心脏病为37.3%,心绞痛为27.5%,心肌梗死(MI)为9.8%,心律失常为5.9%,充血性心力衰竭为9.8%,周围血管病为2.0%。UCG检出左心室肥厚的发生率为为43.1%,相关因素有男性、收缩压增高、脉压增宽、低白蛋白血症和血脂异常;左心室舒张功能不全占77.1%,相关因素有老年、贫血和低白蛋白血症;左心室收缩功能不全占5.9%,相关因素有收缩压低、脉压小、左心室收缩末期内径增大和MI。结论接受CAPD治疗的ESRD患者开始透析时心血管合并症和UCG异常的发生率很高,UCG异常与老年、高血压、贫血、低白蛋白血症等有关。

Objective To investigate the prevalence of cardiovascular disease and its echocardiography （UCG） characteristics at the initiation of continuous ambulatory peritoneal dialysis （CAPD） in patients with end-stage renal disease （ESRD）. Methods Fifty-one patients with ESRD, who had been examined by UCG at the initiation of CAPD therapy, were investigated retrospectively. Their blood pressures, blood biochemistry and UCG findings were analyzed. UCG abnormalities and their risk factors were assessed by Pearson linear correlation. Results Incidences of ischemic heart disease （IHD） ,angina pectoris, myocardial infarction （MI）, cardiac arrhythmia, congestive heart failure and peripheral vascular disease at the initiation of CAPD were 37.3% ,27.5% ,9.8% ,5.9% ,9.8% and 2.0% ,respectively. UCG examination showed that 43.1% of the patients had left ventricular hypertrophy （LVH） ,77.1% had diastolic dysfunction and 5.9% had systolic dysfunction. The independent risk factors for different UCG abnormalities were ： LVH-male gender, increased systolic blood pressure, increased pulse pressure, hypoalbuminemia and dyslipoproteinemla; diastolic dysfunction-older age, anemia and hypoalbuminemia; systolic dysfunction- decreased systolic blood pressure, decreased pulse pressure, enlarged left ventricular end-systolic diameter and MI, Conclusion The incidences of cardiovascular disease and UCG abnormalities are very high at the initiation of CAPD therapy in ESRD patients. UCG abnormalities correlate with older age, hypertension, anemia and hypoalbuminemia.