腹膜透析病人左室肥厚相关危险因素分析

Risk Factors of Left Ventricular Hypertrophy in Patients with Peritoneal Dialysis

目的探讨腹膜透析病人左室肥厚(LVH)发生情况及其相关影响因素。方法选取2014年1月—2016年1月就诊于山西医科大学第一医院肾内科行持续性不卧床腹膜透析的67例病人,对其基线及随访临床资料进行回顾性分析,采用Logistic回归模型探讨LVH的相关危险因素。结果 67例病人中48例(71.64%)病人经超声心动图诊断为LVH。LVH组透析龄长于非LVH组(P=0.043),LVH组血清白蛋白水平低于非LVH组[(36.35±4.04)g/L vs(42.0±2.80)g/L,P=0.003],肌酐和葡萄糖比值(D/P)高于非LVH组(0.73±0.11vs 0.50±0.09,P=0.006),LVH组脑钠肽前体(NT-proBNP)水平显著高于非LVH组[(6 804.9±3 488.2)ng/L vs(1 658.2±2 127.3)ng/L,P=0.002]。透析龄、血清白蛋白水平、D/P值、NT-proBNP水平是LVH的危险因素,OR值(95%CI)分别为1.471(1.103~2.014)、1.063(1.002~1.159)、1.087(1.049~1.273)、3.877(1.938~7.769),均P<0.05。结论腹膜透析病人较易发生左室肥厚,血清白蛋白、透析龄、NT-proBNP、D/P值等是其危险因素。

Objective To evaluate the prevalence of left ventricular hypertrophy（LVH）in patients with peritoneal dialysis and analyze the associated risk factors.Methods This cross-sectional study enrolled 67 patients with peritoneal dialysis,LVH was accessed using echocardiogram and determined by left ventricular mass index（LVMI）.We compared the prevalence of LVH in patients between the LVH and non-LVH groups.Logistical regression was used to analyze the associated risk factors of LVH.Results Fortyeight cases（71.64%）were diagnosed as LVH by echocardiogram.Compared with non-LVH group,LVH group had a longer duration of dialysis（36.7 months vs 24.5 months,P=0.043）,a higher serum albumin level[（36.35±4.04）g/L vs（42.0±2.80）g/L,P=0.003],higher D/P value[（0.73±0.11）vs（0.50±0.09）,P=0.006],and higher N-terminal pro-brain natriuretic peptide（NT-proBNP）level[（6 804.9±3 488.2）ng/L vs（1 658.2±2 127.3）ng/L,P=0.002].Logistical regression analysis indicated dialysis vintage,serum albumin,D/P value and NT-proBNP were the risk factors of LVH,OR（95% CI）were 1.471（1.103-2.014）,1.063（1.002-1.159）,1.087（1.049-1.273）and 3.877（1.938-7.769）,respectively.Conclusion Peritoneal dialysis patients were associated with increased prevalence of LVH,serum albumin,dialysis vintage,NT-proBNP level and D/P value were the associated risk factors.