尿毒症患者心脏结构的改变与甲状旁腺素关系的探讨

Relationship of cardiac structure and function changes with parathyroid hormone in uremic patients

目的 探讨尿毒症患者心脏结构的改变与全段甲状旁腺素之间的关系.方法 将119例尿毒症患者分为血液透析组61例、非血液透析组58例,比较2组室间隔厚度、左心室后壁厚度、射血分数、左心室心肌重量指数及全段甲状旁腺素水平.结果 血液透析组左心室肥厚48例,非血液透析组左心室肥厚39例,2组室间隔厚度、左心室后壁厚度明显增厚,无明显差异.血液透析组左心室收缩功能不全5例,非血液透析组左心室收缩功能不全1例.2组全段甲状旁腺素较正常人群（7～53 pg/ml）均明显升高,血液透析组高于非血液透析组.血液透析组左心室心肌重量指数高于非血液透析组.2组全段甲状旁腺素与室间隔厚度、左心室后壁厚度、左心室心肌重量指数呈正相关.结论 尿毒症患者血全段甲状旁腺素升高是影响左心室结构与功能的重要因素之一.

Objective To discuss the relationship of cardiac structure and function changes with intact parathyroid hormone in uremic patients. Methods 119 cases of uremia were divided into hemodialysis group （n = 61, including 32 males and 29 females） and non-hemodialysis group（n = 58, including 37 males and 21 females）. Two groups were compared by echocardiography and intact parathyroid hor- mone level. Results （1） Left ventricular hypertrophy occurred in 48 patients（including 21 males and 27 females） in hemodialysis group, and 39 patients（including 22 males and 17 females） in non-hemodi- alysis group. Thickened interventricular septal thickness and left ventricular posterior wall thickness were found in both two groups. There were 5 patients who had left ventricular systolic dysfunction in hemodialysis group, while 1 case in non-hemodialysis group; （2）Intact parathyroid hormone levels in hemodialysis group were significantly higher than in non-hemodialysis group（P〈0. 05）. Besides, the intact parathyroid hormone levels in both groups were higher than in normal controls. However,there was no significant difference in interventricular septal thickness and left ventricular posterior wall thickness between two groups（P〈0. 05）. Left ventricular mass index in hemodialysis group was high- er than in non-hemodialysis group（P〈0. 05） ; （3）Parathyroid hormone levels were positively correlated with interventricular septal thickness, left ventricular posterior wall thickness and left ventricular mass index in hemodialysis group, as well in non-hemodialysis group. Conel^ions Increased serum intact parathyroid hormone in uremic patients was one of the important factors that affected left ventrieular structure and function.