新入血液透析患者伴发心力衰竭及其危险因素的研究

Study on prevalence and relative risk factors of chronic heart failure in the new hemodialysis patients

目的：调查我院近10年来新入血液透析患者慢性心力衰竭（CHF）患病状况，并对相关因素进行分析。方法：1997年1月1日至2006年12月31日10年间，在我院确诊为终末期肾病（ESRD）并行血液透析治疗的患者252例，回顾性分析并发CHF的临床特点，多因素Logistic回归分析该组患者CHF相关危险因素。结果：症状性CHF患病率高达54．2％，32．4％的患者因药物无法控制的中重度心衰而进入血液透析；CHF患者中左室射血分数（LVEF）〈50％的比例仅为14．1％，12．2％的患者左室短轴缩短率（IJVFs）〈25％，而E／A〈1的比例高达85．3％。CHF组血清肌酐清除率（Ccr）显著高于非CHF组（P=0．038）；多因素Logistic回归显示冠心病（OR2．651，CI1．108～6．342）、原发病为高血压（OR2．355，CI1．011～5．489），心脏结构功能异常包括左室高电压（OR1．894，c，1．110～3．940）、心律失常（OR2．751，CI1．456～5．196）、LVEF〈50％（OR2．608，CI 1．156—5．887）、舒张期左房内径（LA）增大（〉3．3cm，OR4．313，CI1．927～9．655）、心胸比例增大（OR2．662，c，1．397—5．017）与CHF的高患病率独立相关。结论：ESRD患者进入透析时CHF患病率较高，且以LVEF正常的心袁为主。既往存在心血管疾病及已经存在的心脏结构异常是CHF的重要危险因素。

Objective To investigate the prevalence and clinical correlation of chronic heart failure（CHF） among new dialysis patients in a hemodialysis center in China. Methods We retrospectively studied the clinical reeords of 252 patients with new dialysis between January 1997 and December 2006. The data on the demographic and the epidemiolog- ic aspects of these patients were examined. Multivariate logistic regression analysis was used to assess the relationship of factors to the presence of CHF. Chronic heart failure was diagnosed according to the criteria made by ACC/AHA Primary valvular disease, cor pulmonale, and noncardiac causes of symptoms were excluded. Results Among the 252 new dialysis patients, the prevalence of CHF was 54.2%. CHF was the main inducer for the new hemodialysis patients, which ac- counting for 32.4% of all patients. In all patients with CHF,the percentage of left ventricular ejection fraction（LVEF） 〈 50% and left ventrieular fractional shortening （LVFS） 〈 25% was 14. 1%, 12.2%, respectively. Meanwhile, E/A 〈 1 was accounted for 85.3 %. Unexpectedly, the value of creatinine clearance rate （ Ccr,P = 0.038） was significantly higher in CHF patients than that in non-HF patients. Hypertension （ OR 2.355, CI 1.011 - 5. 489）, CAD （ OR 2.651, CI 1. 108 - 6.342） were significantly associated with CHF. The structural cardiac abnormalities, including electrocardiography showing left ven- trieular hypertrophy （ LVH, OR 1. 894, CI 1. 305 - 3. 940）, LVEF 〈 50% （ OR 2. 608, CI 1.156 - 5. 887 ）, inside diameter of left atrium （LA） 〉3.3 cm （OR 4.313,CI 1.927 -9.655） ,arrhythmia （OR 2.751 ,CI 1.456 -5. 196） and increasing of cardiothoracic ratio （ OR 2.662, CI 1. 397 - 5. 017） were also strongly correlated with the presence of CHF＇. Conclusions This study suggests that the prevalence of CHF is still very high among the new hemodialysis patients in Chinese dialysis center,which is characterized by normal LVEF. More attention should be paid to the predialysis patient education, and ear- lier access to dialysis program might be an important strategy to reduce the morbidity of CHF.