维持性血液透析患者发生肺动脉高压的风险因素分析

Risk factors of pulmonary hypertension for maintenance hemodialysis patients

目的对维持性血液透析患者(MHD)并发肺动脉高压(PH)的患病情况进行调查,寻找其中的风险因素,并通过文献复习探究其可能的机制。方法选取符合入选标准的MHD患者136例,收集患者的临床资料,包括原发疾病、透析年龄、透析间期体质量增加量等;行超声心动图检查获取心脏结构及功能指标,并同时测量患者内瘘直径及内瘘血流量,评估心瓣膜及外周血管钙化的程度;在超声检查前后2周内收集患者的血生化指标,如血红蛋白、白蛋白、hs-CRP、甲状旁腺激素等。上述患者根据肺动脉压检测情况分为肺动脉高压组(PH组)与肺动脉压正常组(nPH组)。结果 136例MHD患者并发PH的发生率为38.23%;原发疾病为糖尿病较非糖尿病发病率高(χ2=11.76,P<0.001)。PH组较nPH组患者的心腔增大、心肌肥厚、收缩及舒张功能下降(均P<0.05)。PH组较nPH组患者透析间期体质量增加量上升(t=8.72,P<0.05)、血红蛋白值下降(t=-4.23,P<0.05)。Logistic多元回归分析显示透析间期体重增加/干体重百分比、血红蛋白值是MHD患者发生PH的主要风险因素,回归方程为Y=34.85+4.48X1-0.22X2。结论合并糖尿病的MHD患者PH发生率较高,透析间期体质量增加量上升、贫血可通过改变心脏结构、功能,影响PH的发生。

ObjectiveThis cross-sectional survey was intended to explore the prevalence of pulmonary hypertension （PH） in maintenance hemodialysis （MHD） patients and identify potential risk factors. Through a review of related literatures, we can explore the possible mechanism of PH in MHD patients.Methods A total of 136 MHD patients were enrolled according to the inclusion criteria. The clinical data were collected such as primary disease, dialysis age, interdialytic weight gain. Doppler echocardiographic examinations were performed in two hours to assess cardiac structures and functions. And the diameter and blood flow of fistula were measured by vascular ultrasound while gauging the calcification degree of peripheral vessels and heart valves. Also, before and after two weeks of echocardiographic examinations, such biochemical parameters as hemoglobin, albumin, hs-CRP, parathyroid hormone were measured. They were divided into PH and nPH groups.ResultsThe prevalence of PH was 38.23% in 136 MHD patients and was higher in those with diabetes than without diabetes （χ2=11.76,P〈0.001）. The values of atrium and ventricle were higher, the degree of cardiac hypertrophy was greater and the cardiac systolic and diastolic function was lower in PH group than nPH group （allP〈0.05）. The value of interdialytic weight gain in PH group was significantly higher than nPH group （t=8.72,P〈0.05）. The value of hemoglobin in PH group was significantly lower than nPH group （t=-4.23,P〈0.05）. Logistic multiple regression analysis showed interdialytic weight gain and hemoglobin were major risk factors for PH in MHD patients. And the regression equation was Y= 34.85＋4.48X1-0.22X2.ConclusionThe prevalence of patients with diabetes is higher than those without diabetes, the interdialytic weight gain and anemia may cause pulmonary hypertension in MHD patientsby effecting cardiac structure and function.