维持性血液透析患者心脏结构功能变化及相关因素分析

The structural and functional changes of heart and the related factors in patients with maintenance hemodialysis

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者心脏结构和功能的变化及其影响因素。方法应用超声心动图,观察MHD患者的心脏结构及功能变化,回顾性分析110例患者的临床资料。结果透析5年以上者LVEDD、LAD、EF斜率较透前增大(P﹤0.05);左心室舒末内径与透析间期体重增加量(r=0.279,P=0.021)、透析间期体重增加率(r=0.277,P=0.017),血iPTH水平(r=0.373、P=0.032)呈正相关,与Kt/V(r=-0.281,P=0.041)呈负相关;EF斜率与透析间期体重增加量(r=0.281,P=0.025)、透析间期体重增加率(r=0.271,P=0.019)、血iPTH水平(r=0.393,P=0.039)呈正相关,与Kt/V(r=-0.285,P=0.043)呈负相关;LVEF与透析间期体重增加量(r=-0.289,P=0.024)、透析间期体重增加率(r=-0.281,P=0.021)呈负相关,与Kt/V(r=0.278,P=0.038)呈正相关;Logistic回归分析显示,透析间期体重增加量、体重增加率、血iPTH水平及透析充分性均为左心室扩大、舒张功能减退的独立影响因素;透析间期体重增加量、体重增加率及透析充分性是左室收缩功能减退的独立影响因素。结论透析5年以上者LVEDD、LAD、EF斜率较透前增大;透析间期体重增加量、体重增加率、血iPTH水平及透析充分性为影响心脏结构和功能独立危险因素。

Objective To analyze the structural and functional changes of heart and the related factors in patients with maintenance hemodialysis. Methods The echocardiogram was used to observe the heart structure and function in maintenance hemodialysis patients. The characteristics of the patients were analyzed retrospectively. Results In patients for five years hemodialysis,the left ventricle and left atrium were enlarged,left ventricular compliance was reduced than patients for one year hemodialysis. The left ventricle diameter and left ventricular compliance was positively related to with the weight gain,percentage of body weight gain and serum iPTH level during the dialysis,and it was negatively related to inadequate dialysis. The left ventricular systolic function was negatively related toweight gain and percentage of body weight gain during the dialysis,and was positively related to inadequate dialysis. Logistic regression analyses indicated that the independent risk factors for the enlargement of left ventricle and the reduction of left ventricular compliance were weight gain,percentage of body weight gain,serum iPTH during the dialysis and inadequate dialysis,the independent risk factors for the reduction of left ventricular systolic function were weight gain,percentage of body weight gain,serum iPTH during the dialysis and inadequate dialysis. Conclusions In the patients for five years hemodialysis,the left ventricle and left atrium are enlarged,left ventricular compliance is reduced. Weight gain,percentage of body weight gain,serum iPTH during dialysis and inadequate dialysis are the independent risk factors for the structural and functional change of heart in maintenance hemodialysis patients.