维持性血液透析患者肺动脉高压的临床研究

CLINICAL STUDY OF PULMONARY HYPERTENSION IN MAINTENANCE HEMODIALYSIS PATIENTS

目的探讨维持性血液透析患者(MHD)肺动脉高压(PAH)的发病机制。方法 96例MHD患者按血管通路分为动静脉内漏组(AVF组)69例和中心静脉长期导管组(CVC组)27例,应用彩色多普勒超声测量患者肺动脉压(PAP)水平,记录AVF组内瘘血流量Q、内瘘血管直径d和内瘘平均血流速度V,同时根据甲状旁腺素(iPTH)水平将MHD患者分为L-PTH、M-PTH、H-PTH三组,测定三组PAP。结果 AVF组和CVC组患者共有35例(36.45%)伴有PAH,其中AVF组28例(40.58%),包括轻度7例(10.14%),中度11例(15.94%),重度10例(14.49%);CVC组7例(25.93%),包括轻度2例(7.41%),中度2例(7.41%),重度3例(11.11%),二组在PAH发病率及疾病程度上差异均有统计学意义;不同iPTH水平患者,PAH发生率存在明显差异;亚组相关分析显示,AVF组患者PAH发病率与iPTH(r=1.985,P<0.01)、动静脉内瘘血流量Q(r=2.143,P<0.01)、内瘘血管内径d(r=1.776,P<0.01)以及内瘘平均血流速度(r=1.874,P<0.01)呈正相关。结论 MHD患者伴发PAH较为普遍,PAH的发生与iPTH水平以及动静脉内瘘本身密切相关。

Objective To investigate the pathogenesis of pulmonary hypertension （PAH） in the maintenance hemodialysis （MHD） patients. Methods Totally 96 MHD patients were divided into two groups according to the vascular channel, 69 cases in arteriovenous fistula group （AVF group） and 27 cases in central venous catheter group （CVC group ）. Pulmonary artery pressure （PAP） of all MHD patients were measured by doppler ultrasound, and fistula blood flow capacity Q, blood flow velocity V and fistula vessel diameter d in AVF group were recorded. On the other hand, all MHD patients were divided into three groups, including L- PTH group, M- PTH group and H- PTH group according to the level of parathyroid hormone （iPTH）. Results AVF group and CVC group with a total of 35 cases （36. 45%） with PAH, there were 28 cases （40.58%） in AVF group, including 7 cases （10.14%） of mild PAH, 11 cases （15.94%） of medium PAH, 10 cases （14.49%） of serious PAH, there were 7 cases （25.93%1 in CVC group, including 2 cases （7.41%） of mild PAH, 2 cases （7.41%） of medium PAH, 3 cases （11.11%） of serious PAH, there were significant differences hetween two groups in the incidence and extent of PAH. There were the same results with different levels of iPTH in the groups. Subgroup correlation analysis showed that there were positive correlations between the incidence of PAH and iPTH （ r = 1. 985, P〈0. 01 ）, fistula blood flow capacity Q（ r = 2. 143, P〈0.01 ） and fistula vessel diameter d（ r = 1. 874, P〈0.01）in AVF group . Conclusion PAH is relatively an common phenomenon in MHD patients , the occurrence of PAH is closely related to the level of iPTH and arteriovenous fistula in itself.