维持性血液透析患者心脏结构与功能改变及左心室舒张功能减退的相关影响因素分析

Cardiac Structural and Functional Changes of Maintenance Hemodialysis Patients and Associated Risk Factors: A Cross Sectional Study

目的检测维持性血液透析(MHD)患者的心脏结构和功能改变,并探讨左心室舒张功能减退的相关影响因素。方法回顾性纳入2012年广东省中医院透析科收治的血液透析1年以上且病情稳定的患者100例,均在行透析治疗前应用多普勒超声检测心脏结构与功能各项指标,收集患者的相关临床信息及同期实验室检查结果。采用多元逐步回归模型分析影响左心室舒张功能减退的相关因素。结果 100例MHD患者中左心室心肌肥厚和左心室舒张功能减退发生率分别为82%和69%。根据舒张早期和晚期最大血流速度比(E/A)分为舒张功能减退组(E/A<1,n=69)与舒张功能正常组(E/A≥1,n=31),两组患者的年龄、超滤量、超滤量/体质量、体质指数、右心室内径、左心室舒张末期内径间差异有统计学意义(P<0.05);多元逐步回归分析显示,右心室内径和超滤量/体质量是左心室舒张功能的影响因素。结论 MHD患者左心室心肌肥厚和左心室舒张功能减退发生率高;透析超滤量与MHD患者心脏舒张功能减退有一定的相关性,合理控制容量负荷对保护心脏功能有重要意义。

Objective To evaluate the changes of cardiac structure and function of maintenance hemodialysis （MHD） patients by color Doppler echocardiography and its risk factors for left ventricular diastolic dysfunction （LVDD）. Methods The indicators of cardiac structure and function were tested in 100 patients who had been on dialysis for over 1 year and in stable status before MHD. Relevant clinical information and laboratory results were collected. Stepwise multiple regression analysis was used to analyze the factors influencing LVDD. Results The incidences of left ventricular hypertrophy （LVH） and LVDD were 82%, 69%, respectively. The patients were divided, based on early and late diastolic peak velocity ratio （E/A）, into groups diastolic dysfunction （ E/A 〈 1, n = 69 ）, normal diastolic function （ E/A ≥, n = 31 ）. There was significant difference in age, ultrafiltration, ultrafiltration volume/body weight, BMI, right ventricular diameter, left ventricular end -diastolic diameter between 2 groups （ P 〈 0. 05 ）. Multiple stepwise regression analysis showed that right ventricular diameter ultrafiltration/body weight was a factor influencing left ventricular diastolic function. Conclusion The incidences of LVH and LVDD are high in MHD patients. Ultrafiltration is related to LVDD. Rational control volume overload is of importance in protecting cardiac function.