老年维持性血液透析患者肺动脉高压与超声心动图参数的相关性

Correlation of echocardiographic parameters and pulmonary hypertension in elderly patients with maintenance hemodialysis

目的调查老年维持性血液透析(maintenance hemodialysis,MHD)患者肺动脉高压的发生率,分析MHD患者肺动脉高压与超声心动图参数的相关性。方法选择2011年1月至2015年1月廊坊市第四人民医院行MHD的尿毒症患者163例,根据透析后24 h内超声心动图的检查结果将患者分为肺动脉高压组(静息状态下肺动脉收缩压>35 mm Hg)及非肺动脉高压组(静息状态下肺动脉收缩压≤35 mm Hg)。应用单因素和多因素非条件Logistic回归模型,分析超声心动参数与肺动脉高压的相关性。结果 163例MHD患者合并肺动脉高压59例,肺动脉高压发生率为36.20%;肺动脉高压组的肺动脉内径、左右心房内径、右心室内径、左心室舒张末期内径、左心室收缩末期内径、左心室质量指数、左室射血分数等超声心动图参数与非肺动脉高压组比较,差异均有统计学意义(P<0.05);Logistic回归显示左心室舒张末期内径、左心房内径、左心室质量指数、左室射血分数等与肺动脉高压的发生有关联(P<0.05)。结论老年MHD患者左心室结构及功能的改变与肺动脉高压密切相关。

Objective To investigate the incidence of pulmonary hypertension in patients with maintenance hemodialysis（ MHD） and the correlation of echocardiographic parameters with pulmonary hypertension. Methods163 cases of patients with uremia undergoing MHD were chosen as the research objects in the Fourth People＇s Hospital of Langfang City from January 2011 to January 2015. All patients were divided into pulmonary hypertension group（ pulmonary artery systolic pressure at resting state 〉35 mm Hg） and non pulmonary hypertension group（ pulmonary artery systolic pressure at resting state ≤ 35 mm Hg） according to the findings of echocardiography within 24 h after dialysis. The correlation of echocardiographic parameters and pulmonary hypertension was analyzed by unconditioned multifactor Logistic regression model. Results There were 59（ 36. 20%） cases with pulmonary hypertension in 163 cases of MHD patients, including 33 cases of mild pulmonary hypertension（ 20. 25%）, 17 cases of moderate pulmonary hypertension（ 10. 43%） and 9 cases of severe pulmonary hypertension（ 5. 52%）. The echocardiography parameters of pulmonary hypertension group such as inside diameter of pulmonary artery,left atrium diameter,right ventricular diameter,left ventricular end-diastolic diameter,left ventricular end systolic diameter,left ventricular mass index,left ventricular ejection fraction showed statistical difference with no pulimonary hypertension group（ P〈0. 05）. Logistic reyression showed the left ventricular end-diastolic diameter,left atrial diameter,left ventricular ejection fraction and left ventricular mass index were significantly associated with the occurrence of pulmonary hypertension（ P〈0. 05）. Conclusions The change of left cardiac structure and function is significantly associated with pulmonary hypertension in elderly patients with MHD.