血液透析患者并发肺动脉高压的相关因素及预后

The related factors and prognosis of pulmonary hypertension in patients receiving long-term hemodialysis

目的:探讨血液透析(HD)患者并发肺动脉高压(PH)的相关因素及预后。方法:选取2014年6月之前在我院血液透析中心行HD治疗的患者90例进行前瞻性随访1年,比较并发PH(PH组)和无PH(非PH组)患者的临床资料、心脏彩超、血管钙化相关指标及预后。结果:PH组的血白蛋白水平、Kt/V显著低于非PH组,其血尿素氮和肌酐显著高于非PH组(P<0.05)。两组血管钙化相关指标如冠脉钙化积分、腹主动脉和心脏瓣膜钙化、甲状旁腺激素、钙、磷、碱性磷酸酶、25羟维生素D比较差异均无统计学意义。PH组的左室收缩末期、舒张末期内径、左房内径、左室质量指数均显著大于非PH组,PH组左室射血分数显著低于非PH组(P<0.05)。Logistic回归分析结果显示,左房内径的增加与HD患者并发PH显著相关(OR=2 538.116,P=0.000)。PH组的全因死亡率高于非PH组,但差异无统计学意义。PH组中急性心功能不全发生率(35.13%)显著高于非PH组。结论:HD患者并发PH者较为常见,低白蛋白血症、尿毒症毒素、心脏结构及功能异常以及容量负荷可能参与HD患者并发PH的发生。

Objective： To investigate the related factors and prognosis of pulmonary hypertension（ PH） in patients receiving long-term hemodialysis（ HD）. Methods： 90 patients who had received HD therapy for over 1 year before June 2014 were enrolled and analyzed prospectively. Clinical variables were compared between patients with and without PH receiving HD. Follow-up until June 2015,record of the death,cardiovascular events and prognosis.Results： Patients with PH had lower Hb,Kt / V,EF and higher BUN,Scr,LVDd,LVDs,LAD and LVMI than those without PH（ P〈0. 05）; There were no significant differences in parathyroid hormone,calcium,phosphate,alkaline phosphatase, 25（ OH） D, calcification about abdominal aorta and cardiac valve, coronary artery calcification. Logistic regression analysis revealed that LAD was independent risk factor of PH in HD patients（ OR =2 538. 116,P = 0. 000）. Followed up for 1 year,the survival curve showed that all-cause mortality was higher in PH group than that in non-PH group,but had no significant difference. The incidence of acute cardiac insufficiency was higher significantly in PH. Conclusion： PH is highly prevalent in HD patients. The hypoalbuminemia,uremic toxins,cardiac dysfunction and fluid overload may be involved in the occurrene of PH.