血液透析患者并发肺动脉高压的影响因素分析

Analysis of factors affecting pulmonary hypertension in hemodialysis patients

目的评估血液透析(hemodialysis,HD)患者肺动脉高压(pulmonary hypertension,PH)的发生率以及PH发病中可能的影响因素。方法 HD患者90例,检测肺动脉收缩压(systolic pulmonary arte-rial pressure,SPAP)和其他心脏结构和功能指标,并同期进行动静脉内瘘口血流量(arteriovenous fistula's blood flow,AVFB)、动静脉内瘘口直径(diameter of arteriovenous fistula,AVFD)的检测。将患者分为PH组和无PH组,比较两组患者临床和实验室数据。结果 24例发生PH,发生率为26.67%;PH组患者SPAP为(48.63±16.16)mmHg(1mmHg=0.133kPa),AVFD(2.90±0.80)mm,AVFB(545.91±355.27)ml/min,心瓣膜钙化的发生率为58.33%。甲状旁腺激素、心瓣膜钙化发生率在PH组明显升高(P<0.01),PH组左心室射血分数、舒张早期和舒张晚期最大血流速度之比(E/A)显著低于无PH组(P<0.01)。Logistic回归分析显示,甲状旁腺激素水平和心瓣膜钙化是PH发生的主要相关因素。结论本研究HD患者PH的发生率与国外研究结果类似。继发性甲状旁腺功能亢进、转移性钙化可能参与HD患者PH的发生。

Objectives This study evaluated the incidence of pulmonary hypertension（PH） and the possible factors causing PH among hemodialysis（HD） patients.Methods Ninety HD patients were surveyed in this study.Systolic pulmonary arterial pressure（SPAP） and parameters relating to cardiac structure and function were assayed,and arteriovenous fistula（AVF） blood flow and AVF diameter were measured.The patients were then assigned into the PH group or the PH negative group.Laboratory and clinical data were compared between the 2 groups.Results PH was detected in 24 patients（26.67%）.In PH group,SPAP was 48.63±16.16mmHg,AVF diameter was 2.90±0.80mm,AVF blood flow was 545.91±355.27ml/min,and cardiac valvular calcification was found in 14 patients（58.33%）.Patients with PH had a significantly higher PTH level and higher incidence of cardiac valvular calcification than those without PH（P0.01）.Left ventricular ejection fraction（LVEF） and E/A ratio were significantly lower in PH group（P0.01）.Logistic regression found that PTH and cardiac valvular calcification were the major factors for PH.Conclusions The incidence of PH in HD patients is similar to that reported from other countries.Secondary hyperparathyroidism and transferable calcification may take part in the pathogenesis of PH in HD patients.