维持性血液透析患者左心室舒张功能不全的影响因素分析

Analysis of influencing factors for left ventricular diastolic dysfunction in maintenance hemodialysis patients

目的对影响维持性血液透析(maintenance hemodialysis,MHD)治疗患者左心室舒张功能不全(left ventricular diastolic dysfunction)危险因素进行相关性探讨并提供临床依据。方法依据超声临床标准将94例入组样本分为左心室舒张功能不全组及左心室舒张功能正常组,应用统计学方法对2组病例基本资料、临床及生化指标和水负荷进行差异性比较;应用Logistic回归性分析维持性血液透析患者发生左心室舒张功能障碍危险因素相关性。结果依据velocity E/velocity e’(E/e’)为标准将入组94例MHD患者分为2组:E/e’≤15为非LVDD组患者73例(77.66%);E/e’>15为LVDD组21例(22.34%)。LVDD组与非LVDD组收缩压(systolic pressure,SBP)比较差异有统计学意义(P<0.05);LVDD患者前白蛋白(PA)、血红蛋白(hemoglobin,Hb)水平低于非LVDD组,水负荷(overhydration,OH)高于非LVDD组,差异有统计学意义(P<0.05);Logistic回归分析证实OH是引起MHD患者发生LVDD独立危险因素。结论有效控制MHD患者OH是预防LVDD出现的有效手段,同时对于MHD患者应定期进行多普勒超声心动图检查,以期早期发现、早期进行治疗,提高患者的生存质量及延长生存期。

Objective To explore the risk factors for left ventricular diastolic dysfunction(LVDD)in patients with maintenance hemodialysis(MHD)and to provide clinical references.Methods According to ultrasonic clinical standards,94 cases were divided into LVDD group and non-LVDD group.Baseline data,clinical and biochemical indexes and fluid load of the two groups were compared.Logistic regression analysis was used to analyze the risk factors for left ventricular diastolic dysfunction in MHD patients.Results According to the standard of the velocity E/velocity e’(E/e’),94 MHD patients were divided into non-LVDD group(E/e’≤15,n=73,77.66%)and LVDD group(E/e’>15,n=21,22.34%).There was a significant difference in the systolic blood pressure(SBP)between groups(P<0.05).Patients in LVDD group presented significantly lower pre-albumin(PA)and hemoglobin(Hb),but significantly higher overhydration(OH)than those of non-LVDD group(P<0.05).Logistic regression analysis confirmed that OH was an independent risk factor for LVDD in MHD patients.Conclusion An effective control of OH in MHD patients contributes to prevent the occurrence of LVDD.Meanwhile,a regular doppler echocardiography should be performed in MHD patients,thus achieving the goals of early detection,early management and improvement of the quality of life and survival.