腹膜透析发生肺动脉高压的相关因素分析-东南大学学报医学版

腹膜透析发生肺动脉高压的相关因素分析

单位：1. 南京医科大学鼓楼临床医学院肾内科, 江苏南京 210008;
2. 南京大学医学院附属鼓楼医院肾内科, 江苏南京 210008

分类号：R459.5;R544.16

出版年·卷·期（页码）：2015·34·第四期（588-592）

摘要：

目的:探讨腹膜透析(PD)患者并发肺动脉高压(PH)的发生率及相关影响因素,以早期诊断并进行临床干预。方法:选取2011年1月至2014年11月在我院肾内科病房及腹透门诊随访的透析龄>3个月且资料完整的PD患者58例,比较并发PH(PH组)和无PH(非PH组)患者的临床资料、实验室及心脏彩超检查指标。PH的诊断标准采用超声心动图检测的肺动脉压(PAP)≥35mmHg。结果:58例PD患者中男性32例,女性26例,平均PAP为(33.88±8.12)mmHg,PH发生率为46.55%。PH组平均PAP为(40.74±6.43)mmHg。PH组与非PH组在年龄、性别组成、透析龄、原发病、尿素氮、肌酐、尿酸、钙、磷、铁蛋白、C反应蛋白、尿量、残余肾功能、总Ccr 、4h腹透液与血肌酐比值(4hD/PCr)、每周Kt/v等方面的差异无统计学意义,在血红蛋白、白蛋白、甲状旁腺激素、B型尿钠肽、左心室质量指数、射血分数(EF)、左室舒张内径(LÜDd)和左室收缩内径等方面的差异有统计学意义。对以上因素进行二分类Logistic回归分析显示,血红蛋白、白蛋白、EF的下降和LÜDd的升高是PD患者并发PH的危险因素。结论:PD患者并发PH者并不少见,贫血、低白蛋白血症、EF的下降及LÜDd的增加是PD患者并发PH的独立危险因素。

Objective: To investigate the incidence and risk factors of pulmonary hypertension(PH)in patients undergoing peritoneal dialysis(PD). Methods: Between January 2011 and November 2014,58 patients who had received PD therapy for over 3 month and complete clinical data were involved in this study.The clinical data,laboratory and cardiac ultrasound parameters were compared between patients with and without PH. The diagnostic standard of PH is echocardiography pulmonary artery pressure(PAP)≥35mmHg. Results: There were 32 males and 26 females in 58 PD patients,the mean PAP was(33.88±8.12)mmHg.46.55% had PH. Mean PAP of the patients with PH was(40.74±6.43)mmHg(range:35-60mmHg). There were no significant differences regarding age, gender, dialysis duration, primary disease, blood urea nitrogen, serum creatinine, calcium, phosphorus, ferritin, C-reactive protein, urine volume, residual renal function, total creatinine clearance rate, 4-hour dialysate-to-plasma ratio for creatinine(4hD/PCr), and total weekly Kt/v between PH group and non-PH group(all P>0.05). Patients with PH had lower ejection fraction(EF), hemoglobin(Hb), albumin(ALB) and higher parathyroid, brain natriuretic peptide, left ventricular diastolic diameter(LÜDd), left ventricular systolic diameter and left ventricular mass index than those without PH(all P<0.05). Binary logistic regression analysis revealed that Hb, EF, ALB and LÜDd were independent risk factors of PH in PD patients(P<0.05). Conclusion: PH is highly prevalent in PD patients. The reduction of Hb, ALB, EF and increase of LÜDd represent independent risk factors for PH.

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