慢性肾脏病并发左室肥厚现况及其危险因素

Status and risk factors of chronic kidney disease complicated by left ventricular hypertrophy

目的:探索中老年慢性肾脏病并发左室肥厚(LVH)的现况及其危险因素。方法:对我院肾内科住院的40-75岁CKD2-5期患者210例的病历资料进行回顾性分析。结果:(1)心脏舒张功能减退发生率高于收缩功能减退(79.1%VS 20.3%P=0.000);左房扩大检出率高于左室扩大检出率(46.5%VS 19.8%P=0.000);室间隔增厚检出率(IVSH)也高于左室后壁增厚检出率(LVPWH)(43.0%VS 21.1%P=0.000);LVH的发生率高于IVSH检出率(47.9%VS 35%P=0.001),其中女性LVH高于男性(73.2%VS31.0%P=0.000),然而若采用另外一种诊断标准,两者并无统计学差异(50%VS 34.5%P=0.068)。(2)IVSH组收缩压、脉压、血肌酐均高于无IVSH组。IVSH组除上述因素外血磷尚高于无IVSH组,但在CKD5期的亚组分析中仅收缩压与对照组相比有统计学差异。LVH组收缩压、脉压均高于无LVH组,而血红蛋白、体质指数则低于对照组。进一步Logistic回归分析提示仅性别、体质指数有统计学意义。结论:(1)40-75岁的心血管疾病高危的CKD患者中,采用超声心动图诊断LVH,根据公式计算的LVMI诊断阳性率最高,但诊断切点仍需进一步研究。(2)收缩压升高、脉压增大、贫血、低体质指数、女性均可能是LVH的危险因素,控制血压、纠正贫血和营养不良可能是防治LVH的重要靶点。

Objective： To explore the prevalence of left ventricular hypertrophy（LVH） and risk factors among patients with chronic kidney disease（CKD） at ages 40-75years.Methods： The medical records of 210 patients with CKD at the stage of 2-5,who were nephrology inpatients in our hospital and 40-75 years old,were analyzed retrospectively.Results：（1） The incidence of diastolic dysfunction was significantly higher than systolic dysfunction（79.1% VS 20.3% P=0.000）;The detection rate of left atrial enlargement was significantly higher than that of left ventricular enlargement（46.5% VS 19.8% P=0.000）;The detection rate of interventricular septum thickening（IVSH） was significantly higher than that of left ventricular posterior wall thickening（LVPWH）（43.0% VS 21.1% P=0.000）;LVH prevalence（according to the formula） was significantly higher than IVSH prevalence（47.9% VS 35% P=0.001）,LVH in females had significantly difference than that in male（73.2% VS 31.0% P=0.000）.However,if applying a different diagnostic criteria for LVH,no significant differences（50% VS 34.5% P=0.068）.（2） The systolic blood pressure（SBP）,pulse pressure（PP）,serum creatinine（Scr） in IVSH group were higher than those in non-IVSH.The serum phosphate in LVPWH group in addition to the above factors was still higher than those non-LVPWH group,but by subgroup analysis in CKD5,only the SBP compared with the control group was significantly different.In LVH group SBP,PP were higher than those non-LVH,and hemoglobin（Hb）,body mass index（BMI） were lower than the control group.Logistic regression analysis indicated that only gender,BMI were statistically significant.Conclusion：（1） 40-75 years old CKD patients with high risk of cardiovascular disease,diagnosed by echocardiography with different diagnostic criteria,different conclusions of LVH may be drawn,but the highest positive rate of LVH is from the formula.（2） 40-75 years CKD patients,SBP,PP,anemia,BMI,female are likely to be risk factors for LVH,which may be novel significant treatment targets.