维持性血液透析患者心脏结构及功能特点分析

Analysis on characteristics of cardiac structure and function in patients with maintenance hemodialysis

目的探讨维持性血液透析(MHD)患者的心脏结构及功能特点。方法选择血液透析3年以上的MHD患者72例,检测血生化指标:总蛋白(TP),白蛋白(Alb),三酰甘油(TG),胆固醇(Tch),血肌酐(Scr),血红蛋白(Hb),血磷(P),C反应蛋白(CRP)及全段甲状旁腺激素(iP TH)。所有患者在治疗前及治疗3年后均进行心脏彩超检查,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),根据Devereux公式计算左心室心肌质量指数(LVMI)。结果 (1)治疗后LVDd,LVDs,LVPWT及LVMI值高于治疗前,而LVEF较治疗前降低,表明透析3年以后,心脏结构发生改变,心功能进一步恶化。(2)随着血浆Scr,P,CRP,iP TH及Hb水平的改变心脏结构和功能也发生变化,说明钙磷代谢紊乱、微炎症状态、营养状态及尿毒症毒素与MHD患者心脏结构和功能有一定相关性。结论 MHD患者普遍存在左心室肥大,透析3年后,这种现象更为严重,Hb,P,Scr,CRP及iP TH与心脏结构和功能改变有一定关系。

Objective To analyze the characteristics of cardiac structure and function in patients with maintenance hemodialysis（ MHD）. Methods A total of 72 patients who had received MHD over 3 years were enrolled in the study. Such indexes,as total protein（ TP）,albumin（ Alb）,triglyceride（ TG）,total cholesterol（ Tch）,serum creatinine（ Scr）,hemoglobin（ Hb）,serum phosphorus（ P）,C-reactive protein（ CRP）,intact parathyroid（ iP TH）,were calculated synchronously. Ultrasonic cardiography was used to detect their left ventricular end-diastolic diameter（ LVDd）,left ventricular end-systolic diameter（ LVDs）,left atrial diameter（ LAD）,left ventricular posterior wall thickness（ LVPWT）,interventricular septal thickness（ IVST）,left ventricular ejection fraction（ LVEF） before treatment and after treatment. Left ventricular mass index（ LVMI） was calculated according to Devereux formula. Results（ 1） LVDd,LVDs,LVPWT and LVMI increased and LVEF decreased significantly after treatment when compared with before,which suggested that cardiac structure and function further deteriorated with the process of hemodialysis.（ 2） There were changes in Scr,P,CRP,iP TH and Hb along with deteriorating cardiac structure and function,so the disorder of calcium-phosphorus metabolism,micro-inflammatory state,nutritional status and uremic toxins were closely related with cardiac structure and function in MHD patients. Conclusion In the patients who have undergone MHD for over three years,universal existence of left ventricular hypertrophy is more serious. The changes in cardiac structure and function are closely correlated with the parameters such as Hb,P,Scr,CRP and iP TH.