糖尿病肾病致终末期维持性血液透析患者的心脏结构及功能特点分析

Analysis Characteristics of Cardiac Structure and Function in Maintenance Hemodialysis Patients with Diabetic Nephropathy

目的:探讨糖尿病致终末期维持性血液透析患者的心脏结构及功能的特点分析。方法:选择上海市第六人民医院血液透析中心接受规律血液透析3年以上的糖尿病肾病MHD患者47例,并收集临床一般资料和生化指标。所有患者在治疗前及治疗3年后均进行心脏彩超检查,采用Sonos5500型二维彩色多普勒超声仪,S4探头,M型方法检测,测定左心室舒张末期内径(LVDd)、左心室收缩末期内径(LVDs)、左心房内径(LAD)、左心室后壁厚度(LVPWT)、室间隔厚度(IVST)、左心室射血分数(LVEF)、二尖瓣前向血流E峰与A峰比值(E/A),根据Devereux公式计算左心室心肌质量指数(LVMI)。结果:(1)比较治疗前后左心室肥大(LVH)的发生比率,LVDd、LVDs、LVPWT及LVMI值,结果发现,治疗后要高于治疗前,而LVEF较治疗前降低,说明随着透析龄的增长,心脏结构发生改变,心功能进一步恶化,甚至出现心功能衰竭。(2)比较治疗前后P、Ca×P、hs-CRP及Pro-BNP发现,治疗后明显要高于治疗前,且与心脏结构和功能密切相关,尤其是与LVMI呈正相关,与LVEF呈负相关;另外,还与LVEDd、LVEDs、LAD、LVPWT、IVST及E/A存在相关,说明钙磷代谢紊乱、微炎症状态及高Pro-BNP与糖尿病肾病MHD患者心脏结构和功能密切相关,是导致左心室肥大的重要危险因素。结论:糖尿病肾病MHD患者普遍存在左心室肥大,而且随着透析龄的增长,这种现象更为严重。高磷血症、高钙磷乘积、Hs-CRP及pro-BNP与心脏结构和功能改变关系密切。

ABSTRACT Objective：Analysis characteristics of cardiac structure and function in maintenance hemodialysis patients with diabetic neph ropathy. Methods ：47 MHD patients with diabetic nephropathy are from Nephropathy Center and have acccepted main tenance hemodialysis at last 1 year,and other correlated parameters were also measured. The left ventricular end diastolic diameter （LVDd） ,left ventricular end systolic diameter（ LVDs）, left atrial diameter（ LAD）, left ventricular posterior wall thickness （ LVP WT）, interventricular septal thickness（IVST） , Left ventricular ejection fraction（ LVEF）, rote of E/A were detected by ultrasonic car diography Before treatment and after 3 years of treatment, To calculate the left ventricular mass index （LVMI） according to the De vereux formula. Results：（ 1 ）The left ventricular hypertrophy （LVH）, LVDd,LVDs, LVPWT and LVMI were increased in compared with before treatment, while Left ventricular ejection fraction decreased significantly,This shows that cardiac structure and function fur ther deteriorated with the increase of hemodialysis duration. （2） Phosphorus, calcium phosphorus product, high sensitiving C reac tive protein and Pro BNP were increased in compared with before treatment ,and the closely related with cardiac structure and func tion, especially were positively correlated with the left ventricular mass index and negatively correlated with Left ventricular ejection fraction; On the other hand, Phosphorus, calcium phosphorus product, high sensitiving C reactive protein and Pro BNP were also correlated with LVEDd,LVEDs,LAD,LVPWT,IVST and E/A,the disorders of calcium phosphorus metabolism, micro inflammatory state and higher Pro BNP were closely related with cardiac structure and function in MHD patients with diabetic nephropathy. Con clusion ： In MHD patients with diabetic nephropathy universal existence of left ventricular hypertrophy, and along with the growth of dialysis duration, the phenomenon is more serious. On the other hand, Hyperphosphatemia, high calcium phosphorus product, Hs -CRP and pro - BNP were closely correlated with the changes of cardiac structure and function.