肺动脉高压与维持性血液透析患者心血管事件和全因死亡的关系

Relationship between pulmonary hypertension and cardiovascular events,all-cause death in maintenance hemodialysis patients

目的:探讨肺动脉高压(pulmonary hypertension,PH)对维持性血液透析(maintenance hemodialysis,MHD)患者心血管事件和全因死亡的影响。方法:选择90例维持性血液透析患者,分为并发PH组和非PH组,随访4年,随访终点为新发心血管事件和全因死亡,比较两组患者的临床资料及终点事件。结果:37例(41.11%)MHD患者出现PH。PH组患者中有既往心血管疾病史的比例高于非PH组(χ~2=2.034,P<0.05);PH组患者左房内径大于非PH组(t=7.265,P<0.01)。且Logistic回归分析结果显示既往心血管疾病史和增大的左房内径为PH的独立危险因素。随访中PH组新发心血管事件率高于非PH组(χ~2=9.203,P<0.05);心血管事件的相关危险因素有:肺动脉收缩压、年龄、既往心血管疾病史、超敏C反应蛋白、左室射血分数、左室舒张功能减退。在多变量模型中,PH仍为心血管事件独立的危险因素。随访中PH组死亡率高于非PH组(χ~2=5.049,P<0.05)。死亡的危险因素有:肺动脉收缩压、年龄、既往心血管疾病史、白蛋白、左室射血分数。在多变量模型中,PH仍然为死亡的独立预测因子。结论:PH在MHD患者中较为常见,是患者心血管事件和全因死亡的独立危险因素。

Objective: To determine the impact of pulmonary hypertension(PH) on maintenance hemodialysis(MHD) patients’ s cardiovascular events and all-cause mortality. Methods:We included 90 MHD patients,divided into group with PH and group without PH.All patients had been followed up for 4 years,and the primary endpoints were all cause mortality and cardiovascular events.To compare the clinical data and the endpoint events between the two groups.Results:We found PH in 37 patients(41.11%). The incidence of previous cardiovascular disease in group with PH was significantly higher than that in group without PH(χ~2=2.034,P<0.05). The left atrial diameter in group with PH was significantly higher than that in group without PH(t=7.265,P<0.01).Logistic regression analysis revealed that previous cardiovascular disease and left atrial diameter were the independent determinants of PH.The rate of new cardiovascular events in group with PH(59.5%) was significantly higher than that in group without PH(34%)(χ~2=9.203,P<0.05).The associated variables of cardiovascular events were:systolic pulmonary arterial pressure, age, history cardiovascular disease, hs-CRP, ejection fraction,left ventricular diastolic dysfunction.In a multivariate model, the PH maintained its independent association. The mortality rate in group with PH(48.6%) was significantly higher than that in group without PH(26.4%)(χ~2=5.049,P< 0.05). In the Cox survival analysis, we found an association between mortality and systolic pulmonary arterial pressure,age, previous cardiovascular disease, Alb,ejection fraction. In a multivariate model the PH remains as independent predictor of mortality. Conclusion:Pulmonary hypertension is common in HD patients and a valuable predictor of mortality and cardiovascular events.