慢性肾脏病肺动脉压变化及其相关因素分析

The Level of Pulmonary Aterial Systolic Pressure in CKD and its Relevant Factors

目的:探讨慢性肾脏病(CKD)患者肺动脉压变化情况及其相关因素。方法:选取167例(CKD1期～CKD5期)非透析慢性肾脏病患者和17例健康对照者,测定并比较各组肺动脉压(PASP)和血浆脑钠肽(BNP)、血红蛋白(Hb)、甲状旁腺素(PTH)及钙磷乘积的差异,探讨CKD患者肺动脉压变化及其相关因素。结果:(1)从CKD1期起,肺动脉压随肾功能恶化逐渐升高,CKD3期开始其变化更加明显。CKD3期较CKD2期、CKD4期较CKD3期、CKD5期较CKD4期之肺动脉压差异均有统计学意义(P<0.01);17.96%(30/167)CKD患者合并肺动脉高压(PHT;PASP≥40mmHg);(2)与肺动脉压正常组相比,PHT组患者BUN、Scr、PTH、钙磷乘积和ln(BNP)均显著增高(P<0.05),而Hb却明显下降(P<0.01)。肺动脉压与ln(BNP)、Scr、BUN、PTH、钙磷乘积呈正相关(P<0.01),与Hb水平负相关(P<0.01)。ln(BNP)和Hb进入以肺动脉压为因变量的回归方程:y=20.404+3.556x1-0.103x2,其中y代表PASP(mmHg),x1为血浆ln(BNP)(pg/ml),x2为Hb(g/L)。结论:慢性肾脏病患者容易合并肺动脉高压,其严重程度及发生率与CKD严重程度相关。血浆脑钠肽水平和贫血程度与肺动脉高压形成密切相关。

Objective：To explore the level of pulmonary aterial systolic pressure in CKD patients and discover its relevant factors.Methods：167 CKD patients divided into five groups according to CKD stage and 17 healthy individuals were enrolled.Then We analysed pulmonary aterial systolic pressure （PASP）、plasm brain natriuretic peptide （BNP）、Hemoglobin（Hb）、Parathyroid hormone（PTH） and Calcium Phosphate product（Ca2＋×P3-） among every group,try to explore the change of pulmonary aterial systolic pressure levels in CKD patients and discover the relevant factors.Results：（1） The level of PASP increased with CKD degression from CKD1 stage,and became much higher since CKD3 stage.Significant differences （P0.01）existed between PASP of CKD3 and CKD2 stage,CKD4 and CKD3 stage,CKD5 and CKD4 stage.17.96% （30/167）CKD patients enrolled complicated with Pulmonary hypertention（PHT;PASP≥40 mmHg）;（2） Compared to patients with normal pulmonary aterial systolic pressure,the PHT group got higher BUN、Scr、PTH、Cap and ln（BNP）（P0.05）,but lower Hb level （P0.01）。PASP was positively correlated with ln（BNP）、Scr、BUN、PTH、Cap（P0.01）,negatively relevant to Hb（P0.01）。Ln（BNP） and Hb entered the regression equation： y=20.404＋3.556 x1-0.103 x2,y meant PASP（mmHg）,x1 ln（BNP）（pg/ml）,x2 Hb（g/L）。Conclusion：Pulmonary hypertention declines to be developped in CKD patients as kidney disease deteriorate.Plasm brain natriuretic peptide and Hb are both closely correlated with Pulmonary hypertention.