移植肾失功患者左心室结构与功能分析

Left ventricular structure and function in renal transplant patients after graft failure

目的评价肾移植失功患者的左心室结构与功能,探讨其发生原因。方法选取因移植肾失功行维持性血液透析治疗的终末期肾脏病患者39例为移植肾失功组,选取同期未行肾移植而开始维持性血液透析治疗的终末期肾脏病患者46例为初发血透组。两组患者均在初次透析前行心脏多普勒超声和实验室检查,比较两组患者实验室指标及左心室结构、功能指标。结果两组患者Hb、血白蛋白、TC、TG、甲状旁腺素比较差异均无统计学意义(均P>0.05);移植肾失功组患者血肌酐、血清铁、总铁结合力、转铁蛋白饱和度均低于初发血透组(均P<0.05),C反应蛋白高于初发血透组(P<0.05)。两组患者左心房内径、左心室收缩及舒张末期内径等心脏结构指标及左心室射血分数、左心室短轴缩短率等心脏功能指标比较差异均无统计学意义(均P>0.05)。移植肾失功组患者室间隔收缩及舒张末期厚度、左心室后壁收缩及舒张末期厚度、左心室重量指数均高于初发血透组(均P<0.05)。移植肾失功组患者左心室肥厚发生率高于初发血透组(P<0.05)。两组患者左心室收缩、舒张功能减退发生率比较差异均无统计学意义(均P>0.05)。结论移植肾失功患者一般状态和左心室结构与功能均较差,移植肾再失功及免疫抑制剂的使用可能是上述现象发生的原因。

Objective To investigate the left ventricular structure and function in renal transplant patients after graft failure.Methods Thirty nine renal graft failure patients undergoing maintenance hemodialysis（graft failure group） and 46 nontransplant patients with end-stage renal disease undergoing hemodialysis（primary hemodialysis group） were enrolled in the study. The Doppler echocardiography and laboratory examinations were performed before primary dialysis. The laboratory parameters, left ventricular structure and function indexes were compared between the two groups. Results There were no significant differences in Hb, serum albumin, TC, TG, parathyroid hormone between the two groups（P〈0.05）. The serum creatinine, serum iron, total iron binding capacity and transferrin saturation in renal graft failure group were lower, and the C reactive protein was higher than those in primary hemodialysis group（P〈0.05）. There were no significant differences between the two groups in left atrial diameter, left ventricular systolic and diastolic end diameter, left ventricular ejection fraction,and left ventricular short axis shortening rate（P〈0.05）. The ventricular septal end systolic thickness, ventricular septal end diastolic thickness,left ventricular posterior wall end systolic thickness, left ventricular posterior wall end diastolic thickness and left ventricular mass index in the renal graft failure group were higher than those in primary hemodialysis group（P〈0.05）. The incidence of left ventricular hypertrophy was higher in the renal graft failure group（P〈0.05）. There was no significant difference in the incidence of left ventricular systolic and diastolic dysfunction between the two groups（P〈0.05）. Conclusion The general state, cardiac structure and function in kidney-allograft-loss patients are poor, which may be associated with the use of immunosuppressive agents.