血清甲状旁腺激素水平与3～5期慢性肾脏病患者左室肥厚的相关性

Correlation between Serum Parathyroid Hormone and Left Ventricular Hypertrophy in Patients with Stage 3～5 Chronic Kidney Disease

目的:探讨血清全段甲状旁腺激素(i PTH)水平与3~5期慢性肾脏病(CKD)患者左室肥厚(LVH)的相关性。方法:将60例首诊未行血液透析的患者按CKD的3、4、5期分为A、B、C组,超声心动图测量其射血分数(EF)、左室舒张末期内径(LVDd)、左室收缩末期内径(LVDs)、室间隔厚度(IVST)及左室后壁厚度(LVPTW),计算左室心肌重量指数(LVMI);患者入院时抽取空腹静脉血,采用全自动生化分析仪测定血清肌酐(Scr)、尿素氮(BUN)及钙(Ca^(2+))、磷(P)浓度,采用血细胞分析仪测定血红蛋白(HGB)、红细胞比容(HCT),采用电化学发光分析法测定血清iPTH水平;采用Spearman对血液学指标与LVMI、血清i PTH与心功能指标的相关进行分析。结果:3组CDK患者Scr、BUN、血清P、iPTH、LVDd、LVDs、IVST、LVPTW及LVMI随CDK分期的增加而升高,血清Ca^(2+)、HGB、HCT及EF随CDK分期的增加而降低,Scr、BUN、iPTH、LVDd、LVMI及EF在3组间两两比较差异有统计学意义(P<0.05),血清P、血清Ca^(2+)、HGB、HCT、LVDs、LVPTW及IVST在3~4期CKD组与CKD5期组比较,差异有统计学意义(P<0.05);Spearman结果显示,患者血清Scr、BUN及P与LVMI呈正相关(r=0.638、0.600、0.499,P<0.01),HGB与LVMI和HCT呈负相关(r=-0.583、-0.598,P<0.01),血清Ca与LVMI无相关性(r=-0.347,P>0.01);血清iPTH水平与LVDd、LVDs及LVMI呈正相关(r=0.642、0.548、0.577,P<0.01),与IVST、LVPTW无相关性(r=0.014、0.052,P均>0.01),与EF呈负相关(r=-0.604,P<0.01)。结论:3~5期CKD患者都可能发生左室肥厚,i PTH水平可能是影响左室结构的重要因素。

Objective： To investigate the correlation between serum parathyroid hormone and left ven- tricular hypertrophy in patients with chronic kidney disease stage 3 - 5. Methods： 60 cases of patients with CKD who didnt undergo hemodialysis in first diagnosis were divided into A, B, and C group ac- cording to pathological stage 3, 4 and 5, respectively. Echocardiography was used to measure ejection fraction （EF）, left ventricular end diastolic diameter （LVDd）, left ventricular end systolic diameter （LVDs）, interventricular septal thickness （IVST） and left ventricular posterior wall thickness （LVPTW）, and the left ventricular mass index （LVMI） was calculated. Patients＇fasting venous blood was collected in admission to hospital. The automatic biochemical analyzer was adopted to detect serum creatinine（Scr）, urea nitrogen （BUN）, calcium （ Ca2＋ ） concentration and phosphorus（P） concentration. The blood cell analyzer was adopted to detect hemoglobin（ HGB）, hematocrit （HCT） and op- tical analysis of electrochemistry was adopted to detect serum iFFH level. Spearman was used to ana- lyze the correlation between hematological parameters and LVMI, serum iPTH and cardiac function in- dexes. Results： The Ser, BUN, serum P, iPTH, LVDd, LVDs, IVST, LVPTW and LVMI increased with CDK staging increased while serum calcium （Ca2＋ ） HGB, HCT and EF decreased with CDK staging increased in the three groups. There were statistically significant differences in Set, BUN, iPTH, LVDd, LVMI and EF between the three groups （P 〈 0.05 ）. There were statistically significant differences in serum P, serum Ca2＋ , HGB, HCT, LVDS, LVPTW and IVST between and CKD 3 -4 stage and CKD stage 5 （P 〈 0.05 ）. Spearman results showed that Ser, BUN and P were positively correlated with LVMI （r = 0. 638, 0. 600, 0. 499, P 〈 0.01 ）, HGB was negatively correlated with LVMI and HCT （r = - 0. 583, - 0. 598, P 〈 0.01 ） , and there was no correlation between serum Ca2＋ and LVMI （r = -0. 347, P 〉0.01）. Serum iPTH levels were positively correlated with LVMI, LVDd and LVDs （r=0. 642, 0. 548, 0. 577, P 〈0.01）, not correlated with IVST, LVPTW （r = 0. 014, 0. 052, P 〉 0.01 ）, and negatively correlated with EF（ r = - 0. 604 , P 〈 0.01 ）. Conclu- sion ： Left ventricular hypertrophy may occur in patients with CKD stage 3 ~ 5, and the iPTH level may be an important factor affecting the left ventricular structure.