维持性血液透析患者血清甲状旁腺激素水平与心功能评价的相关性研究

The association between parathyroid hormone and cardiac function in patients under maintenance hemodialysis

目的 探讨维持性血液透析（MHD）患者全段甲状旁腺激素（iPTH）水平的变化与左心室结构和功能的相关性，评估iPTH对MHD合并心力衰竭早期诊断、治疗及判定预后的临床价值。方法 随机选取沈阳军区总医院血液净化科186名MHD患者。入选标准为：血液透析3次／周，每次4h；年龄在18～75岁；透析年限6个月以上，10年以下；无急性心血管事件。利用放免法检测患者透析前iPTH水平、电化学发光免疫分析法检测透析血浆B型钠尿肽前体（pro—BNP）水平。左心室肥厚（LVH）可由心脏超声检查判断。超声心动图检测患者左心房内径（LAD）、左心室舒张末内径（LVDd）、室间隔厚度（IVST）、左心室后壁厚度（LVPwT）、左心室射血分数（LVEF）等，计算左心室重量（LVM），左心室心肌重量指数（LVMI）。根据2009年KDIGO指南iPTH水平的目标范围，按iPTH正常参考值上限水平2～9倍为界将患者分为3组，探讨iPTH与MHD患者左心功能的关系。结果 iPTH≥549．9pg／ml组患者的LAD、LVMI、LVDd、IVST、LVPwT显著高于iPTH≤122．2pg／ml，122．2～549．9pg／ml组（P〈0．05）。随着iPTH的增长，患者pro—BNP水平升高，有统计学差异（P〈0．05）。随着iPTH的增长，iPTH与NYHA心功能分级呈正相关，血清iPTH水平与LAD、LVMI、LVDd、LVDs、IVST、LVPwT、左心室收缩功能、pro—BNP呈正相关（P〈0．05），与LVEF呈负相关（P〈0．05）。结论 MHD患者iPTH水平与左心室功能密切相关，可能成为诊断及评估患者心功能的一个重要标志物。

Objective To investigate the relationship between intact parathyroid hormone （iPTH） and left ventricular structure and function, and to evaluate the clinical value of iPTH for the early diagnosis, treatment and prognosis of heart failure. Methods A total of 186 maintenance hemodialysis （MHD） patients treated in Hospital of Shenyang Military Area Command were recruited in this study. They were treated with maintenance hemodialysis （MHD） 3 times a week and 4 h a session with the dialysis age of 6 months to 10 years, and were 18-75 years old without acute cardiovascular events. Serum iPTH was determined by radioimmunoasssy, and pro-BNP by electro-chemiluminescence. Eehocadiography was used to measure left atrial size （LAD）, ventricular diastolic diameter （LVDd）, interventricular septal thickness （IVST）, left ventricular posterior wall thickness （LVPwT）, left ventrieular ejection fraction （LVEF）, left ventricular mass （LVM） and LVM index （LVMI） for the assay of left ventricular hypertrophy. According to the 2009 KDIGO guidance and 2～9 times of iPTH upper limits （normal range 11.7～61.1 pg/ml）, the patients were stratified into three groups, iPTH ≥549.9 pg/ml group, iPTH ≤122.2 pg/ml group and 122.2～549.9 pg/ml group to investigate the relationship between iPTH and left ventricular structure and function. Result LAD, LVMI, LVDd, VST and LVPwT were significantly higher in the iPTH ≥549.9 pg/ml group than those in the iPTH ≤122.2 pg/ml and 122.2～549.9 pg/ml groups （P〈0.05）. Serum iPTH was positively correlated with pro-BNP levels （P〈0.05）. Serum iPTH increased along with the increase of NYHA class, iPTH level was positively correlated with LAD, LVMI, LVDd, LVDs, IVST, LVPwT, left ventrieular systolic function and pro-BNP （P〈0.05）, and was negatively correlated with LVEF （P〈0.05）. Conclusion In MHD patients, serum iPTH is closely related to left ventricular function, iPTH may become an important factor for the evaluation of heart function.