贫血对维持性血液透析患者心脏结构及功能的影响

The effects of anemia on the heart structure and function in maintenance hemodialysis patients

目的 探讨维持性血液透析 (MHD)患者贫血与心脏结构及功能损害的关系。方法 收集本院 47例 MDH伴贫血患者的年龄、血压、血常规、超声心动图资料 ,治疗后 ,按照 Hb水平是否达到 90 g/L分为两组 ,进行治疗前后自身对照及两组之间比较 ,观察贫血的改善与否对血透患者心脏结构和功能的影响。结果 逐步回归分析显示贫血和高血压是引起心肌肥厚的独立危险因素。直线相关分析表明左室心肌重量指数 (LVMI)、左房内径 (LA)、左室舒张末期内径 (LVEDD)均与血红蛋白浓度 (Hb)和红细胞压积 (Hct)呈明显负相关 (P<0 .0 5)。治疗后 ,36例患者 Hb>90 g/L,1 1例 Hb<90 g/L。两组之间比较 ,>90 g/L组的心脏结构及功能明显改善 ,>90 g/L组自身前后比较 ,心脏结构及功能也明显改善 ;<90 g/L组心脏结构及功能有进一步恶化趋势。结论 贫血可以导致 MHD患者心脏肥大 ,心腔扩大 ,静息状态下心脏舒张功能受损而收缩功能代偿尚好。贫血改善有助于心脏结构及功能的恢复。

Objective To study the relationship between anemia and heart structure and function impairment in maintenance hemodialysis (MHD) patients. Methods Age, blood pressure, blood routine examination and data of color Doppler echocardiography of forty-seven MHD patients in our hospital were collected. After treatment, according to Hb level, the patients were divided into two groups, and then compared with itself before and after treatment and compared with each other in the two groups. How the improvement of anemia affected the heart structure and function was observed. Results Step regression showed that anemia and hypertension were the independent risk factors of myocardial hypertrophy. There was significant negative relationship between hemoglobin (Hb), hematocrit (Hct) levels and left ventricular mass index (LVMI), left antrum diameter (LA), left ventricle end diastolic diameter(LVEDD)( P <0.05). After treatment, 36 patients' Hb were more than 90 g/L, while 11 patients' Hb were less than that. There were significant difference in heart structure and function between the two groups.In Hb >90 g/L group, after treatment, the heart structure and function were improved significantly. And in Hb <90 g/L group, the heart structure and function have the trend of deteriorated further. Conclusions Anemia contributed to myocardial hypertrophy and ventricle enlargement in MHD patients. In resting condition, ventricular diastolic function was impaired while the systolic function compensated well. Improvement of anemia could help the restoring of heart structure and function.