维持性腹膜透析治疗患者左心室功能及相关因素分析

Analysis of left ventricular dysfunction and correlative factors in patients on maintenance peritoneal dialysis

目的对维持性腹膜透析治疗患者左心室功能情况及相关因素进行分析。方法选取我院肾脏病血液净化科2006～2010年期间收治的维持性腹膜透析治疗患者131例,按性别分为男性腹膜透析组和女性腹膜透析组;对所有患者均常规检测血清肌酐、尿素氮、白蛋白、血红蛋白、血钙、血磷、血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血全段甲状旁腺激素(i-PTH),超敏C反应蛋白(hs-CRP);高压液相色谱法方法检测血浆同型半胱氨酸;利用超声心动图检查评价左心室功能;利用公式计算肾小球滤过率及体质量指数(BMI)。结果两组患者年龄、舒张压、血肌酐、尿毒氮、尿酸、TC水平及BMI差异有统计学意义,男性腹膜透析组患者舒张压、血肌酐、尿毒氮、尿酸水平及BMI高于女性腹膜透析组(P<0.05或<0.01);其余指标差异无统计学意义;两组患者左心室收缩功能异常发生率差异无统计学意义,男性腹膜透析组左心室舒张末内径52(47,53)mm大于女性腹膜透析组49(45,53)mm,差异具有统计学意义(P<0.01);多因素Logistic回归分析显示,年龄、血浆白蛋白、血清TC、低密度脂蛋白胆固醇平是腹膜透析治疗患者左心室收缩功能障碍的危险因素;而收缩压是腹膜透析治疗患者左心室舒张功能障碍的危险因素。结论腹膜透析治疗患者左心室肥厚发生率较高,纠正低蛋白血症,增加透析剂量,控制血压,降低血脂可能有助于改善腹膜透析患者左心室功能异常。

Objective To analyze left ventricular dysfunction and related factors in patients on maintenance peritoneal dialysis. Methods A total of 131 patients who received chronic peritoneal dialysis were included in this study. Patients were divided into two groups： male peritoneal dialysis group and female peritoneal dialysis group. Blood examinations such as blood urine nitrogen, creatinine, uric acid, hemoglobin, calcium, phosphate, triglyceride, total cholesterol, LDL-C, HDL-C, parathyroid hormone （PTH） and high sensitivity C-reactive protein were measured, and echocardiography was performed in all patients. The level of homocysteine was measured by high pressure liquid chromatography. Glomerular filtration rate and body mass index（BMI） were also calculated. Results There were significant difference in age, BMi,level of blood urine nitrogen, creatinine, uric acid,total cholesterol and diastolic blood pressure between two groups （ P ~0.05 or ~0.01）. There were left ventricular contract dysfunction and diastolic dysfunction in both patient groups, and male group had higher rate of diastolic dysfunction with significant difference, LVDd male to female, 52 （47.53） mm larger than female 49 （45.53） mm （P d0.05）. The level of albumin, total cholesterol,LDL-C and age were risk factors for left ventricular contract dysfunction. Meanwhile, systolic blood pressure was risk a factor for diastolic dysfunction chronic peritoneal dialysis patients. Conclusion The ratio of left ventricular hypertrophy is higher in maintenance peritoneal dialysis patients. Increase of albumin level, close of dialysis, control of blood pressure, improvement of lipidemia may be helpful to improve left ventricular function of patients on maintenance peritoneal dialysis.