终末期肾病非透析患者左心室肥厚的危险因素分析

Risk factors of left ventricular hypertrophy in non-dialysis dependent end-stage renal disease patients

目的探讨终末期肾病(ESRD)非透析患者左心室肥厚(left ventricularhy pertrophy,LVH)的危险因素。方法纳入2019年1月至2019年7月中山大学附属第一医院的ESRD非透析患者,采集患者的人口学资料、生化指标。应用多频生物电阻抗分析仪(bioelectrical impedance analysis,BIA)测定患者容量负荷水平;用心脏彩色多普勒超声检测患者心脏结构改变。根据LVH诊断标准将患者分为LVH组及非LVH组,计算ESRD非透析患者的LVH发生率。用Logistic回归法分析患者LVH的危险因素。结果共105例患者被纳入本研究,年龄(47.03±12.56)岁(21~78岁),其中男性63例(60.5%),LVH发生率为70.5%(74/105)。与非LVH组相比,LVH组患者年龄、糖尿病占比、钙离子通道拮抗剂使用比例、夜间收缩压、细胞外液/身高(ECW/Height)及水肿指数(ECW/TBW)均较高,差异有统计学意义(均P<0.05)。Spearman相关性分析结果显示,糖尿病(r=0.345,P<0.001)、夜间收缩压(r=0.286,P<0.001)、夜间舒张压(r=0.251,P=0.012)、使用钙离子通道拮抗剂(r=0.381,P=0.013)、ECW/TBW(r=0.383,P=0.005)、ECW/Height(r=0.298,P=0.003)、脑钠肽(r=0.315,P=0.005)、24h尿钾排泄量(r=-0.248,P=0.023)、24h尿钠排泄量(r=0.257,P=0.025)及血红蛋白(r=0.307,P=0.018)均与LVH呈相关关系。Logistic回归分析结果显示,在校正了性别、年龄、糖尿病、夜间血压、降压药、ECW/TBW、尿钠排泄量、血红蛋白等因素后,夜间舒张压升高(OR=2.036,95%CI1.144~3.623,P=0.016)、ECW/TBW升高(OR=1.232,95%CI1.025~1.523,P=0.014)是ESRD非透析患者LVH发生的独立危险因素。结论LVH在ESRD非透析患者中的发生率较高。容量超负荷及夜间舒张压升高是ESRD非透析患者LVH发生的独立危险因素。

Objective To investigate the risk factors of left ventricular hypertrophy (LVH) in non-dialysis dependent end-stage renal disease (ESRD) patients. Methods ESRD patients in the First Affiliated Hospital of Sun Yat-sen University from Jan to July 2019 were enrolled. Demographic data of patients were collected and biochemical parameters were measured. Hydration status index (extracellular water/total body water, ECW/TBW) was measured by bioelectrical impedance analysis (BIA), and LVH was diagnosed by echocardiography. Patients were divided into LVH group and non-LVH group according to LVH diagnostic criteria, and the incidence of LVH in ESRD non-dialysis patients was calculated. Logistic regression was used to analyze the risk factors of LVH. Results A total of 105 non-dialysis dependent ESRD patients aged (47.03±12.56) years (21-78 years) were enrolled in present study, among whom 74 patients (70.5%) had LVH. Compared to non-LVH group, patients in LVH group had higher proportion of diabetes and calcium antagonist used, higher value of ECW/TBW and ECW/Height, higher level of night systolic pressure, and were older (all P<0.05). Spearman correlation analysis showed LVH was positively correlated to diabetes (r=0.345, P<0.001), night systolic pressure (r=0.286, P<0.001), night diastolic pressure (r=0.251, P=0.012), calcium antagonist used (r=0.381, P=0.013), ECW/TBW (r=0.383, P=0.005), ECW/Height (r=0.298, P=0.003), 24 h sodium urinary excretion (r=0.257, P=0.025), brain natriuretic peptide (r=0.315, P=0.005) and hemoglobin (r=0.307, P=0.018), and negatively correlated to 24 h potassium urinary excretion (r=-0.248, P=0.023). Logistic regression showed that increased night diastolic pressure (OR=2.036, 95%CI 1.144-3.623, P=0.016) and ECW/TBW (OR=1.232, 95%CI 1.025-1.523, P=0.014)were the independent risk factors of LVH after adjusting for gender, age, diabetes, nocturnal blood pressure, antihypertensive drugs used, ECW/TBW, urinary sodium excretion and hemoglobin. Conclusions LVH is common in non-dialysis dependent ESRD patients. Over hydration and high night diastolic blood pressure are the independent risk factors of LVH in non-dialysis dependent ESRD patients.