慢性肾功能不全患者甲状旁腺激素与左心室肥厚及收缩功能的关系

Increased serum parathyroid hormone level is associated with left ventricular hypertrophy and systolic dysfunction in chronic renal failure

目的了解慢性肾功能不全患者甲状旁腺激素(iPTH)的增高与左心室肥厚(LVH)及收缩功能的关系。方法对258例慢性肾功能不全患者行心脏超声、心功能及血iPTH检测,并作相关分析。结果 (1)随肾功能不全肌酐清除率的下降,iPTH水平渐升高,射血分数(EF)下降,左心室心肌重量指数(LVMI)值加大,心脏损害加重。(2)CKD 3～5期iPTH与EF呈负相关,与LVMI呈正相关(P<0.05)。(3)不同原发疾病致肾功能不全iPTH水平差异无统计学意义,但高血压肾动脉硬化、糖尿病肾病所致心脏损害较慢性肾小球肾炎及其他原发病差异有统计学意义(P<0.05)。结论 iPTH增高是引起LVH及左心收缩功能改变的重要因素之一。

Objective To study the association between the increased iPTH and left ventricular hypertrophy （LVH） or left ventricular systolic dysfunction in patients with renal failure. Methods Echocardiography was performed and serum iPTH was determined in 258 patients with chronic renal failure. The correlation between serum iPTH and LVH or systolic dysfunction was analyzed. Results （ 1 ） With the decline of creatinine clearance, increased iPTH and LVMI, with lower EF were observed. （2）Significantly negative correlation was revealed between iPTH level and EF, while posi- tive correlation revealed between iPTH level and LVMI in patients at CKD 3 to 5 stage （ P 〈 0. 05 ）. （3） There was no sig- nificant difference in iPTH among patients with different primary disease. However, significant difference in cardiovascular injury was observed between patients with diabetic nephropathy or hypertensive nephropathy and the other nephropathy with different primary diseases （ P 〈 0.05 ）. Conclusion Increased serum iPTH in chronic renal failure contributes to cardio- vascular complications.