腹膜透析患者发生肺动脉高压危险因素分析

The risk factors for pulmonary hypertension in peritoneal dialysis patients

目的探讨腹膜透析(peritoneal dialysis,PD)患者肺动脉高压(pulmonary hypertension,PH)的发生率及其危险因素。方法采取回顾性收集109例PD患者的临床资料、检验指标及心脏彩超结构,使用组问比较、单因素及多因素logistics回归分析探讨肺动脉收缩压(pulmonary artery systolic pressure,PASP)的影响因素。结果 109例患者中PH占50例(45.87%),PH组血浆白蛋白(albumin,ALB)、血红蛋白(hemoglobin,Hb)、左心室射血分数(left ventricular ejection fraction,LVEF)较非肺动脉高压组(no pulmonary hypertension,N-PH)组低(t=4.424,P<0.001;t=3.318,P=0.001;t=2.287,P=0.024);血清钙磷乘积值(t=-2.198,P=0.030)、左心房大小(left atrial diame ter,LA)(t=-3.961,P<0.001)、肺动脉主干(main pulmonary artery,MPA)(t=-2.878,P=0.005)、左心室收缩末期直径(left ventricular end systolic dimension,LVDs)(t=-3.438,P=0.001)、左心室舒张末期直径(left ventricular end diasrolic diameter,LVDd)(t=-2.662,P=0.009)、室间隔厚度(interventricular septal thickness,IVST)(t=-2.953,P=0.004)较N-PH组高。单因素回归分析结果显示,ALB(B=-0.206,P<0.001)、Hb(B=-0.033,P=0.002)、LVEF(B=-0.050,P=0.027)与PASP呈负相关;钙磷乘积(B=0.421,P=0.035)、LA(B=0.138,P=0.001)、LVDd(B=0.084,P=0.013)、LVDs(B=0.114,P=0.003)与PASP呈在正相关;多因素回归分析结果显示,ALB(OR=0.786,95%CI 0.690~0.896,P<0.001)、LA(OR=1.117,95%CI 1.019~1.224,P=0.018)、钙磷乘积(OR 2.509,95%CI 1.312~4.799,P=0.005)是PASP的独立危险因素。结论 PD患者中PH发生率较高,低白蛋白血症、左心房扩大、钙磷乘积增高为PH发生的独立危险因素。

Objective To analyze the risk factors and prevalence of pulmonary hypertension （PH） in peritoneal dialysis （PD） patients. Methods Clinical, laboratory and echocardiographic data from 109 PD patients were retrospectively analyzed. The risk factors for PH were investigated by comparison between groups. Logistic regression was used for the analyses. Results Fifty of the 109 patents （45.87%） had PH. Compared to the patients without PH, patients with PH had lower levels of plasma albumin （ALB） （t=4.424, P〈 0.001）, hemoglobin （Hb） （t=3.318, P=-0.001） and left ventricular ejection fraction （LVEF） （t=-2.287, P= 0.024）, and higher levels of calcium-phosphorus product （t=--2.198, P=-0.030）, left atrial diameter （LA） （t=- 3.961, P〈0.001）, main pulmonary artery （MPA） （t=-2.878, P=-0.005）, left ventricular end-systolic diameter （LVDs） （t=-3.438, P=0.001）, left ventricular end-diastolic diameter （LVDd） （t=-2.662,P=-0.009） and interven- tricular septal thickness （IVST） （t=--2.953, P=0.004）. Univariate regression analyses showed that pulmonary artery systolic pressure （PASP） was negatively correlated with ALB （β=-0.206, P〈0.001）, Hb （β=-0.033, P= 0.002） and LVEF （β=-0.050, P=-0.027）, and was positively correlated with calcium-phosphorus product （β= 0.421, P=-0.035）, LA （β=0.138, P=-0.001）, LVDd （β=0.084, P=-0.013） and LVDs （β=0.114, P=-0.003 ）. Multivariate regression analyses displayed that ALB （OR 0.786, 95% CI 0.690-0.896, P〈0.001）, LA （OR 1.117, 95% CI 1.019-1.224, P=-0.018） and calcium-phosphorus product （OR 2.509, 95% CI 1.312-4.799, P= 0.005） were the independent risk factors for PASE Conclusions PH was relatively prevalent in PD patients. The decreased ALB and increased LA and calcium-phosphorus product were the independent risk factors for PH in PD patients.