363例维持性血液透析患者心脏结构及功能改变特点分析

Analysis of changes in cardiac structure and function in 363 patients with maintenance hemodialysis

目的了解维持性血液透析(MHD)患者心脏结构及功能的改变特点。方法收集2020年1月前在广州市花都区人民医院登记的透析龄≥3个月的363例MHD患者的信息,行超声心动图筛查,分析心脏结构及功能的改变特点。结果MHD患者最常见的心脏结构及功能异常改变依次是瓣膜反流(69.7%)、左心室肥厚(LVH)(51.8%)、左心室舒张功能障碍(29.8%)、瓣膜钙化(11.6%)、左心室收缩功能障碍(10.2%);随着年龄的增大,MHD患者的左心室射血分数降低,左心室舒张功能障碍、左心房扩大及肺动脉高压的比例增多(均P<0.05)。363例MHD患者中有188例合并LVH(51.8%),发现LVH患者较非LVH患者平均单次超滤量更大、BNP水平更高、患2型糖尿病比例更多、左心室射血分数更低(均P<0.05),且患者更容易出现胸闷、胸痛、活动后气促、心衰等症状(均P<0.05)。结论多数MHD患者合并不同程度的心脏结构改变,尽早干预、减少单次超滤量、控制血糖有利于提高MHD患者的透析质量、减少心血管事件的发生。

Objective To investigate the characteristics of cardiac structure and function changes in maintenance hemodialysis(MHD)patients.Methods The information of 363 MHD patients with dialysis age≥3 months who were registered in Huadu District People's Hospital of Guangzhou City before January 2020 was collected,and the echocardiographic screening was performed to analyze the changes in cardiac structure and function.Results The most common abnormal changes of heart structure and function in MHD patients were valve regentation(69.7%),left ventricular hypertrophy(LVH)(51.8%),left ventricular diastolic dysfunction(29.8%),valve calcification(11.6%),and left ventricular systolic dysfunction(10.2%).With the increase of age,the left ventricular ejection fraction of MHD patients decreased,and the proportion of left ventricular diastolic dysfunction,left atrial enlargement and pulmonary hypertension increased(all P<0.05).Among 363 MHD patients,188(51.8%)had LVH.It was found that LVH patients had higher average single ultrafiltration volume,higher brain natriuretic peptide(BNP)level,more type 2 diabetes,lower left ventricular ejection fraction(all P<0.05),and were more prone to chest tightness,chest pain,post activity shortness of breath,heart failure and other symptoms compared with the non-LVH patients(all P<0.05).Conclusions Most MHD patients have different degrees of cardiac structural changes.Early intervention,reduction of single ultrafiltration volume and control of blood glucose are beneficial to improve the dialysis quality of MHD patients and reduce the occurrence of cardiovascular events.