腹膜透析患者的甲状旁腺激素与左心室肥厚的相关性研究

The association between serum iPTH and left ventricular hypertrophy in peritoneal dialysis patients

目的 探讨持续性非卧床腹膜透析患者甲状旁腺激素与左心室肥厚的关系. 方法 回顾性分析2006年1月～2013年8月深圳市第二人民医院肾内科腹膜透析患者的临床资料.将患者分为3组：全段甲状旁腺激素（iPTH）＜150pg/ml（A组,n=36）,iPTH为150～300 pg/ml（B组,n=36）,iPTH＞300pg/ml（C组,n50）.彩超评价心脏结构和功能改变,统计腹膜透析患者左心室肥厚的发生率,对腹膜透析患者血清iPTH与射血分数（EF）、室间隔厚度（IVST）、左心室质量指数（LVMI）进行相关性研究.同时分析性别、年龄、高血压、糖尿病、全段甲状旁腺激素（iPTH）、血清C反应蛋白（CRP）、三酰甘油、总胆固醇、血清N末端脑钠肽前体（BNP）、腹膜透析氮质清除指数（腹膜透析Kt/V）、腹膜透析龄等指标对腹膜透析患者发生左心室肥厚的影响. 结果 本组122例腹膜透析患者发生左心室肥厚共74例,发生率为60.7％,其中男性41例（55.4％）,女性33例（44.6％）.60岁以上患者发生左心室肥厚共38例（51.4％）,60岁以下患者发生左心室肥厚共36例（48.6％）,左心室肥厚组患者平均年龄56.20±14.57岁,非左心室肥厚组患者平均年龄54.17±15.21岁,两组患者年龄无统计学差异（t=2.452;P=0.230）.iPTH与EF呈负相关（P=0.004）,与IVST、LVMI呈正相关（P分别为0.001和0.020）.多因素非条件Logistic回归分析显示高血压（P=0.013）,糖尿病（P=0.015）,iPTH （P=0.035）均与腹膜透析患者发生左心室肥厚显著相关. 结论 本组腹膜透析患者左心室肥厚发生率为60.7％.iPTH升高与左心室肥厚及左心收缩功能改变显著相关.

Objective To study the association between serum iPTH and left ventricular hypertrophy （LVH） and to explore the incidence and related factors of LVH in peritoneal dialysis （PD） patients in a single dialysis center. Methods Clinical data of the 122 PD patients admitted to Shenzheng Second People＇ s Hos- pital during the period from Jan. 2006 to Aug. 2013 were recruited and retrospectively analyzed. Subjects were divided into three groups, group A （iPTH〈 150 pg/ml, n=36）, group B （iPTH 150~300 pg/ml, n=36）, and group C （iPTH〉300 pg/ml, n=50）. Correlation analysis was conducted between serum iPTH and the echocardiographic indicators of EF, IVST, and LVMI. Regression analysis was used to determine the relation- ship between LVH and the parameters of gender, age, hypertension, diabetes, serum iPTH, CRP, uric acid, BNP and homocysteine, Kt/V, and PD duration. Results LVH was found in 74 （60.7%） cases including 41 males （55.4%） and 33 females （44.6%）. In the 74 LVH patients, 38 patients （51.4%） were 〉60 years old and 36 patients （48.6%） were 〈60 years old. The average age was 56.20±14.57 years old in LVH patients and was 54.17±15.21 years old in patients without LVH （t=2.452; P=-0.230）. Serum iPTH correlated negatively with EF （P=-0.004） and positively with IVST （P=0.001） and LVMI （P=0.020）. Multivariate logistic regression anal- ysis showed that hypertension （P=0.013）, diabetes （P=0.015）, and iPTH （P=-0.035） were the independent risk factors for LVH in PD patients. Conclusion The incidence of LVH in this series of PD patients was 60.7%. Higher serum iPTH contributed to cardiovascular complications in PD patients.