持续不卧床腹膜透析患者中不同血压表型与左心室肥厚患病率之间的关系研究

The relationship between different blood pressure subtypes and left ventricular hypertrophy in CAPD patients

目的探讨持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者中不同的血压表型与左心室肥厚的患病率之间的关系及对左心室心肌重构的影响。方法选择127例CAPD患者,根据诊室测量的肱动脉血压将患者分为4组:正常血压组(46例):收缩压(SBP)<140mmHg(1mm Hg=0.133kPa)且舒张压(DBP)<90mm Hg;孤立收缩期高血压(isolated systolic hypertension,ISH)组(42例):SBP≥140mm Hg且DBP<90mm Hg;双期高血压(systolic/diastolic hypertension,SDH)组(39例):SBP≥140mm Hg且DBP≥90mm Hg;孤立舒张期高血压(isolated diastolichypertension,IDH)组(0例):SBP<140mm Hg且DBP≥90mm Hg。收集患者基本资料、血生化检查资料,并采用超声心动图检查评估3组患者的心脏形态功能及血流动力学指标,包括左心室质量(LVM)、左心室质量指数(LVMI,身高2.7标化的LVM)、左心室肥厚(LVH)患病率、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)、左心室舒张期早晚期二尖瓣口血流频谱(E峰、A峰、E/A)、心输出量(CO)、心脏指数(CI)、心每搏输出量(SV)、心每搏指数(SI)、总外周阻力(TPR)和总外周血管阻力指数(TPRI)等,并将血压表型、体质量指数(BMI)、性别、透析龄、血肌酐(SCr)、TPRI等纳入左心室肥厚的可能危险因素进行多因素logistics回归分析。结果 3组间基本资料、血脂状态、贫血状况差异均无统计学意义(P>0.05);SBP、DBP、平均动脉压(MAP)、脉压(PP),SDH组>ISH组>正常血压组(P<0.01),LVM、LVMI在ISH组和SDH组均高于正常血压组(P<0.05);LVH的患病率在ISH组为76.2%,在SDH组为71.8%,均高于正常血压组(50.0%,P<0.05)。LVEF、LVFS,SDH组和ISH组均低于正常血压组(P<0.01)。LVEDD和LVESD在SDH组和ISH组高于正常血压组(P<0.01),E峰在3组间无差异,而A峰在SDH组低于ISH组(P<0.01),E/A在SDH组高于ISH组及正常组(P<0.01);TPR和TPRI在SDH组高于ISH组和正常血压组。多因素logistics回归分析显示,ISH组和SDH组患LVH的风险分别是正常血压组的2.01倍和1.74倍;女性患LVH的风险是男性的1.36倍;透析龄每增加一个月患LVH的风险增加0.03倍。结论 CAPD患者中,高血压表型是左心室肥厚的独立危险因素,SDH表型患者外周血管阻力较高,左心室舒张功能减低明显,而ISH表型患者LVH患病率和危险度较高,因此高血压不同表型对心血管损伤机制可能存在差异,其中ISH压型对心脏重构的影响较大,LVH患病危险度较高。

Objective To explore the correlation of blood pressure subtype with the prevalence of left ventricle hypertrophy （LVH） and the left ventricle remodeling in continuous ambulatory peritoneal dialysis （CAPD） patients. Methods One hundred and twenty-seven CAPD patients were enrolled in this study. Patients were divided into four groups：① normotension group （n=46）：systolic blood pressure （SBP） 140 mm Hg and diastolic blood pressure （DBP） 90mmHg; ② isolated systolic hypertension （ISH） group （n=42）：SBP =140 mm Hg and DBP 90 mm Hg; ③ systolic-diastolic hypertension （SDH） group （n= 39）：SBP =140 mm Hg and DBP=90 mm Hg;④ isolated diastolic hypertension （IDH） group （n=0）：SBP 140 mmHg and DBP =90 mmHg. Cardiac function and cardiovascular hemodynamic indices were assessed by echocardiography. Blood biochemical exami-nations were conducted. Results There were no differences in basic information,lipid metabolism status and anemia among the 3 groups （P〈0.05）. SBP,DBP,mean arterial pressure and pulse pressure were greater in SDH group than in ISH group,and were greater in ISH group than in normotension group （P〈0.01）. Left ventricular mass （LVM） and left ventricular mass index （LVMI） were higher in ISH and SDH groups than in normotension group （P〈0.05）. The prevalence of LVH was 76.2% in ISH group,and was 71.8% in SDH group,higher than that in normotension group （50%,P〈0.01）. Left ventricular ejection fraction （LVEF） and left ventricular fractional shortening （LVFS） were lower in SDH and ISH groups than in normotension group （P〈0.01）. Left ventricular end diastolic dimension （LVEDD） and left ventricular end systolic dimension （LVESD） were higher in SDH and ISH groups than in normotension group （P〈0.01）. The ratio between early （E） and late （atrial,A） ventricular filling velocity （E/A ratio） was higher in SDH group than in ISH and normotension groups （P〈0.01）. Total peripheral resistance （TPR） and total peripheral resistance index （TPRI） were higher in SDH group than in ISH and normotension groups （P〈0.01）. Multivariate logistic regression analysis showed that the risk to develop LVH was 2.01 folds higher in ISH group and 1.74 folds higher in SDH group than in normotension group. Other risk factors for LVH included female （B=1.36,P〈0.012） and dialysis duration （B=0.029,P〈0.045）. Conclusions In CAPD patients,the risk for LVH was higher in SDH and ISH groups than in normotension group. Blood pressure subtype was an independent risk factor for LVH. Patients with ISH and SDH had a higher risk for left ventricular remodeling. ISH had a greater impact on cardiac remodeling and a higher risk for LVH.