合并肺动脉高压的慢性肾脏病3~5期患者左心室结构及功能的改变

Changes of left ventricular structure and function in stage 3-5 chronic kidney disease patients with pulmonary hypertension

目的 了解合并肺动脉高压(PH)的慢性肾脏病(CKD)3~5期患者左心室结构、功能的改变.方法 收集2016年1月至2018年6月期间在本院肾内科住院的CKD 3~5期非透析患者的临床资料,PH组患者37例,非PH组患者57例.用彩色多普勒超声心动图检测心脏结构和功能,比较、分析PH组与非PH组的临床指标和超声心动图参数.结果 PH组的估算的肾小球滤过率(eGFR)和血红蛋白(Hb)显著低于非PH组(P<0.05);PH组的血肌酐(Cr)、血磷(P)、钙磷乘积(Ca×P)、全段甲状旁腺激素(iPTH)、脑钠肽(BNP)和高敏C反应蛋白(hsCRP)显著大于非PH组(P<0.05);PH组的左心室内径(LVD)、左心室质量指数(LVMI)和二尖瓣舒张早期血流峰值和二尖瓣环舒张早期运动速度之比(E/E’)显著大于非PH组(P<0.05);PH组的缩短分数(FS)和左心室射血分数(EF)显著小于非PH组(P<0.05);肺动脉收缩压(PASP)与收缩压、Cr、P、Ca×P、hsCRP、BNP、LVMI、LVD、E/E'呈显著正相关,PASP与eGFR、Hb、Ca、EF、FS呈显著负相关.结论 CKD患者发生PH与肾功能减退、贫血、钙磷代谢紊乱、炎症反应相关,合并PH的CKD患者左心室收缩和舒张功能显著减低.

Objective To investigate the changes of left ventricular structure and function in stage 3-5 chronic kidney disease (CKD) patients with pulmonary hypertension (PH).Methods Clinical data of 94 cases of non-dialysis stage 3-5 CKD patients hospitalized in the department of nephrology in our hospital from January 2016 to June 2018 were collected,including 37 patients with PH and 57 patients without PH.Cardiac structure and function were measured with echocardiography.The clinical and echocardiographic parameters of PH group and non PH group were compared.Results Estimated glomerular filtration rate (eGFR) and hemoglobin in the PH group were significantly lower than those in the non-PH group (P<0.05).The serum creatinine (SCr),serum phosphorus (P),calcium-phosphorus product,intact parathyroid hormone,brain natriuretic peptide (BNP),and high-sensitivity C-reactive protein (hsCRP) in the PH group were significantly higher than those in the non-PH group (P<0.05).Left ventricular diameter (LVD),left ventricular mass index (LVMI),and the ratio of mitral early diastolic peak flow and mitral annular early diastol-ic velocity (E/E') in the PH group were significantly higher than those in the non-PH group (P<0.05).The fractional shortening (FS) and left ventricular ejection fraction (EF)in the PH group were significantly lower than those in the non PH group (P<0.05).There was a significant positive correlation between pulmonary artery systolic pressure (PASP) and systolic blood pressure,SCr,P,calciumphosphorus product,hsCRP,BNP,LVMI,LVD,E/E';PASP was negatively correlated with eGFR,Hb,serum calcium,EF,and FS.Conclusions Renal dysfunction,anemia,calcium and phosphorus metabolic disorders,inflammation were correlated with the incidence of PH in CKD patients.Left ventricular systolic and diastolic function were significantly decreased in CKD patients with PH.