慢性肾脏病患者肺动脉高压的危险因素及对预后的影响

The influencing factor and prognostic value of pulmonary arterial hypertension in chronic kidney disease patients

目的 观察慢性肾脏病(chronic kidney disease,CKD)患者肺动脉高压(pulmonary arterial hypertension,PAH)发生率、危险因素及对预后的影响。方法 收集2018年1月1日~2019年12月31日在首都医科大学宣武医院肾内科住院的CKD患者的一般资料,进行心脏超声检查,分析PAH情况,并对患者进行随访,随访截止时间2021年11月1日,终点事件为全因死亡。应用Logistic回归分析CKD患者PAH的危险因素,COX比例风险回归模型分析CKD患者死亡的风险因素。结果 570例CKD患者中发生PAH的患者52例,PAH发生率为9.12%。在52例PAH患者中轻度22例(42.31%),中度25例(48.08%),重度5例(9.61%)。多因素Logistic回归分析显示:年龄(OR=1.036,95%CI:1.008~1.063,P=0.010)、合并慢性心脏基础疾病(OR=4.373,95%CI:2.271~8.423,P<0.001)、血红蛋白低于110g/L(OR=2.218,95%CI:1.024~4.801,P=0.043)为CKD患者出现PAH的危险因素。对570例患者进行平均27.3个月的随访,死亡67例(11.7%),失访113例(19.8%),Kaplan-Meier生存分析显示合并PAH的CKD组生存率比非PAH组降低(Log-rank,χ^(2)=7.089,P=0.009),多因素COX回归模型显示:高龄(HR=2.502,95%CI:1.354~4.621,P=0.003)和贫血(HR=2.486,95%CI:1.397~4.423,P=0.002)为CKD患者全因死亡的独立危险因素。结论 CKD 1~5期患者PAH发生率为9.12%,年龄、合并慢性心脏基础疾病、低血红蛋白为CKD患者出现PAH的危险因素,PAH组生存率比非PAH组低,高龄和贫血为CKD患者全因死亡的独立危险因素。

Objective To observe the incidence,risk factors,and prognostic value of pulmonary arterial hypertension(PAH)in chronic kidney disease(CKD)patients at stage 1-5 and without dialysis.Methods A total of 570 CKD patients at stage 1-5 admitted to the Department of Nephrology,Xuanwu Hospital,Capital Medical University during the period from January1,2018 to December 31,2019 were recruited.They were divided into PAH group and non-PAH group.They were followed up until November 1,2021,and the end event was all-cause mortality.Logistic regression was used to analyze the risk factors for PAH in the CKD patients,and Cox proportional hazards regression model was used to analyze the risk factors for death in these patients.Results The incidence of PAH in the CKD patients was 9.12%(52/570),including 22 patients with mild PAH(42.31%),25 patients with moderate PAH(48.08%),and 5 patients with severe PAH(9.61%).Multivariate logistic regression showed that age(OR=1.036,95%CI:1.008~1.063,P=0.010),complicated with chronic heart disease(OR=4.373,95%CI:2.271~8.423,P<0.001)and hemoglobin lower than 110g/L(OR=2.218,95%CI:1.024~4.801,P=0.043)were the risk factors for PAH in CKD patients.The 570 CKD patients were followed up for an average of 27.3 months,in which 67 cases(11.7%)died and 113 cases(19.8%)lost the follow-up.Kaplan-Meier survival analysis showed that the survival rate of the CKD patients in PAH group was significantly lower than those in non-PAH group(log-rank test:χ2=7.089,P=0.009).Multivariate Cox regression model showed that older age(HR=2.502,95%CI:1.354~4.621,P=0.003)and anemia(HR=2.486,95%CI:1.397~4.423,P=0.002)were the independent risk factors for all-cause death in CKD patients.Conclusions The incidence of PAH in CKD patients at stage 1-5 was 9.12%.Age,preexisted chronic cardiac disease and lower hemoglobin level were the risk factors for PAH.The survival rate of CKD patients in PAH group was significantly lower than those in non-PAH group.Older age and anemia were the independent risk factors for all-cause mortality in CKD patients.