透析患者中左心室肥厚现患率的性别差异

Sex difference in the prevalence of left ventricular hypertrophy in dialysis patients

目的:探讨左心室肥厚(LVH)的现患率在透析患者中是否存在性别差异。方法:本研究纳入同一透析中心的190例患者,包括40例血液透析(HD)患者和150例腹膜透析(PD)患者。使用超声心动图检查测得的指标诊断LVH。对左心室质量(LVM)分别用体表面积(BSA)和身高2.7进行标准化计算获得2种左心室质量指数(LVMI-BSA和LVMI-身高2.7)。结果:HD和PD患者的平均年龄分别为(60±14)岁和(60±13)岁,透析龄的中位数分别为43个月和20个月。HD和PD患者中男性和女性之间的年龄、糖尿病、高血压、降压药的使用情况等差异均无统计学意义,使用2种方法标化的LVMI比较均显示女性的LVH现患率高于男性(在HD患者中,使用BSA标化的LVMI来诊断LVH,男女比例分别为41.7和81.3,P<0.05;在PD患者中,使用BSA标化的LVMI来诊断LVH,男女比例分别为47.7和64.7,P<0.05;HD患者中,用身高2.7标化的LVMI来诊断LVH,男女比例分别为41.6和68.8,P=0.082;在PD患者中,用身高2.7标化的LVMI来诊断LVH,男女比例分别为52.3和74.1,P<0.01)。将患者按LVH的发生与否分为2组,发现2组之间存在明显的性别差异[用BSA标化的LVMI,HD患者中男女之间分别为为(126.1±38.7)g/m2和(136.0±48.1)g/m2,P<0.05;PD患者中,均数分别为(123.4±43.2)g/m2和(139.1±53.1)g/m2,P<0.05;用身高2.7标化的LVMI,HD患者中男女均数分别为(51.6±15.5)g/m2和(61.0±20.9)g/m2,PD患者中男女均数分别为(52.6±18.0)g/m2和(66.0±26.0)g/m2,P<0.01]。多元回归分析结果提示,女性是LVH的一个独立危险因素(用BSA标化的指数LVH为因变量时OR=2.48,95CI1.33～4.59;以身高2.7标化的指数LVH为因变量时OR=4.05,95CI1.96～8.38)。结论:透析患者LVH的现患率在女性患者明显高于男性;女性发生LVH的危险性比年龄和糖尿病匹配的男性高2.5～4倍。

Objective：to investigate the difference about the morbidity of Left ventricular hypertrophy （LVH） between male and female in dialysis patients. Method：This study enrolled 190 prevalent dialysis patients （40on HD and 150 on PD） from a single center. LVH was defined by echocardiography measurements, which were normalized by body surface area （BSA） and height^2.7 indexed, respectively. Result：There was no significant difference in age, diabetes, proportion of uncontrolled hypertension, male and female patients within each dialysis modality, antihypertensive medication and blood pressure between the prevalence of LVH （no matter indexed by BSA or height^2.7） was consistently higher in females than that in males. When these patients were divided into LVH or non-LVH groups, a significant difference in gender distribution was observed between the two groups （61.8% vs. 41.2% when BSA indexed standard was used, P〈0.01; 62.2% vs. 36.8% when height^2.7 indexed standard was used, P〈0.01）. In logistic regression analysis, females was identified as a risk factor of LVH （OR= 2.48, 95 % CI 1.33 4.59 when BSA indexed LVH was treated as dependent variable; OR=4.05, 95% CI 1.96-8.38 when height2.7 indexed LVH was treated as dependent variable） even after adjustment of age, diabetes, blood pressure and antihypertensive medication. Conclusion：This study showed that the prevalence of echocardiographically determined LVH was significantly higher in female dialysis patients than that in male dialysis patients. Compared with males, female patients had a 2.5 4 fold higher risk to develop LVH even after adjustment for other potential confounding factors.