老年非终末期慢性肾脏病患者肺动脉压力的变化

Study on the changes in pulmonary artery pressure in elderly Chronic kindney disease patients without end-stage renal disease

目的探讨老年非终末期慢性肾脏病（CKD）患者肺动脉压力的变化趋势及并发肺动脉高压（PAH）的危险因素，以便早期诊断PAH及尽早干预。方法收集北京医院老年医学部肾内科2012年1月至2013年1月资料完整的慢性肾脏病2～4期，分期根据改良MDRD公式计算肾小球滤过率（eGFR），对133例门诊患者的临床资料进行回顾性分析。参照2010年美国心脏超声协会右心检测指南，肺动脉收缩压（PASP）〉35mmHg（1mmHg：0．133kPa）诊断为PAH。结果133例中并发PAH者12例（9．0％），其中男性7例，女性5例，平均（82．9±5．4）岁；其中CKD2～4期患者PAH发生率分别为2．3％、10．9％和17．6％（P〈0．05）。存在三尖瓣反流的67例可计算PASP，其中CKD2～4期组的平均PASP分别为（27．1±5．4）mmHg、（31．0±8．3）mmHg及（37．3±13．8）mmHg（均P〈0．05）；其中PAH组与非PAH组的体质指数（BMI）、eGFR及尿素氮等指标的差异有统计学意义（P〈0．05）；对各因素进行Logistic回归分析显示，CKD并发PAH与CKD高分期及低BMI显著相关（P〈0．05）。结论CKD患者并发PAH不少见，其发生与CKD分期越高及BMI下降显著相关，有必要定期行超声心动图检查，以早期诊断和及时干预PAH。

Objective To prospectively investigate the characteristics and correlative influential factors for the changes in pulmonary artery hypertension（PAH）in chronic kidney disease （CKD） patients without end-stage renal disease. Methods Complete clinical and laboratory data of 133 outpatients without ESRD （CKD stage 2, 3 and 4）in Beijing Hospital between January 2012 and January 2013 were retrospectively analyzed. Pulmonary artery systolic pressure（PASP）was assessed by echocardiograpby according to the guideline from the American Society of Echocardiography in 2010, and PASP more than 35 mmHg（1 mmHg=0. 133 kPa）was diagnosed as PAH. Results PAH was found in twelve（ 9.0 % ） patients, including 7 females and 5 males, with mean age （82.9 ± 5.4 years）. The prevalence of PAH was 2.3%,10.9% and 17.6% in the patients of CKD stage 2,3 and 4（P〈 0.05） respectively. PASP could be calculated in 67 patients in whom tricuspid regurgitation was present. The mean PASP was（27. 1 ±5.4） mmHg, （31.0±8.3）mmHg and（37.3± 13.8） mmHg in patients with CKD stage 2,3 and 4, respectively（P〈0.05 ）. Body mass index（BMI）, eGFR and BUN showed significant differences between PAH group and non-PAH group with statistical significance （P〈0.05）. Multivariate logistic regression analysis revealed that the lower BMI and the higher stage of CKD were independent risk factors for PAH （P 〈 0.05）. Conclusions PAH is not a rare complication in the CKD patients without end-stage renal disease. The incidence of PAH is significantly associated with lower BMI and the higher stage of CKD. Doppler echocardiography should he performed periodically to detect PAH in CKD patients in order to improve the prognosis of these patients.