终末期肾病病人伴发肺动脉高压的临床研究

Clinical study of pulmonary artery hypertension in patients with end-stage renal disease

目的:回顾性分析进行血液透析的终末期肾病(ESRD)病人肺动脉压力(PAP)情况,探讨ESRD病人肺动脉高压(PAH)的发生情况及可能的影响因素。方法:选择128例ESRD病人,其中进行血液透析的66例病人作为观察组,无血液透析的62例病人作为对照组,应用超声心动图对病人的PAP进行评估,比较2组病人一般资料、超声心动图结果。并将观察组分为无PAH和PAH组,比较2组实验室检查以及心脏超声指标,分析PAH发病的可能影响因素。结果:观察组与对照组血清肌酐、尿素氮、白蛋白、血红蛋白、血钙、血磷、25(OH)D、全段甲状旁腺激素(iPTH)、PAP差异均有统计学意义(P<0.05~P<0.01)。观察组PAH发生率为33.3%,高于对照组的17.7%(P<0.05)。PAH组与无PAH组血清iPTH、血液透析时间差异有统计学意义(P<0.05和P<0.01)。PAH组与无PAH组的左心房内径、左室舒张末期内径、左心室质量指数、左室射血分数差异均有统计学意义(P<0.05)。Logistic回归分析显示,左室舒张末期内径、左心房内径、左心室质量指数、左室射血分数、iPTH与PAH的发生有关(P<0.05)。结论:ESRD病人PAH常见,长期血液透析病人发生率更高,左心室结构及功能的改变与PAH密切相关。

Objective:To analyze the pulmonary artery pressure(PAP)of 128 end-stage renal disease(ESRD)patients treated with hemodialysis,investigate the occurrence of pulmonary artery hypertension(PAH)in patients with ESRD,and analyze the possible influencing factors of PAH.Methods:Among 128 ESRD patients,66 cases treated with hemodialysis and 62 cases without hemodialysis were divided into the observation group and control group,respectively.The PAH in two groups was evaluated by echocardiography,and the general data and echocardiographic results between two groups were compared.The observation group was subdivided into the non-PAH group and PAH group,the laboratory tests and cardiac ultrasound indicators were compared between two groups,and which was used to analyze the possible influencing factors of PAH.Results:The differences of the serum levels of creatinine,urea nitrogen,albumin,hemoglobin,blood calcium,blood phosphorus,25(OH)D,intact parathyroid hormone(iPTH),and PAP between the observation group and control group were statistically significant(P<0.05 to P<0.01).The incidence rate of PAH in observation group(33.3%)was higher than that in control group(17.7%)(P<0.05).The differences of the serum iPTH and hemodialysis time between PAH group and non-PAH group were statistically significant(P<0.05 and P<0.01).The differences of left atrial diameter,left ventricular end-diastolic diameter,left ventricular mass index and left ventricular ejection fraction between the PAH group and non-PAH group were statistically significant(P<0.05).The results of unconditional logistic regression analysis showed that the left ventricular end-diastolic diameter,left atrial diameter,left ventricular mass index,left ventricular ejection fraction and(iPTH)were correlated the with occurrence of PAH(P<0.05).Conclusions:PAH is common in patients with ESRD,and the incidence rate of which in long-term hemodialysis patients is higher,and the changes of left ventricular structure and function are closely related to PAH.