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维持性腹膜透析患者左心室肥厚及其相关因素分析
Left ventricular hypertrophy in maintenance peritoneal dialysis patients and the analysis of its risk factors
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DOI:
作者:
徐耀文,高琛妮,徐天,张春燕,黄晓敏,杨俪,任红
Xu Yaowen,Gao Chenni, Xu Tian, Zhang Chunyan, Huang Xiaomin, Yang Li, Ren Hong
作者单位:
上海交通大学医学院附属瑞金医院肾内科
Dapartment of Nephrology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine
关键词:
腹膜透析;左心室肥厚;多频生物电阻抗
peritoneal dialysis ; left ventricular hypertrophy ; bioelectrical impedance analysis
摘要:
【摘要】目的 心血管疾病是腹膜透析PD患者主要并发症和死亡原因,左心室肥厚是心血管常见病变。本研究以多频生物电阻抗法回顾性分析PD患者左心室肥厚(LVH)容量负荷及其相关因素。方法 选择上海交通大学医学院附属瑞金医院维持性腹膜透析治疗>15月共127例患者,采用横断面回顾性调查法。全面评估患者透析状况,包括患者基线透析年龄、腹透龄、残余尿量、超滤量、收缩压、舒张压、空腹血糖、腹透液糖负荷指数(PGLI)、血白蛋白、血红蛋白、红细胞压积、C反应蛋白、甲状旁腺激素、胆固醇、甘油三酯、每周肌酐总清除率等。采用多频生物电阻抗法测定总体液量(TBW)、细胞外液(ECW)、细胞内液(ICW)、并以身高、体重标准化细胞外液。Devereux公式计算心肌重量指数(LVMI)评估患者左心室肥厚。结果 127例PD患者(男79/女48),开始腹膜透析时均无左心室肥厚。基线平均年龄53.73±15.49岁,平均透析龄54.4月。左心室肥厚75例(59.1%)。1.依据有无LVH将患者分为两组,生化指标LVH组血白蛋白低(30.3±4.9vs32.5±5.7 g/L),残余尿量减少(304.2±54.3vs651.1±87.3ml),腹透超滤量多(892.9±520.3vs696.5±428.1ml)。LVH组ECW高(15.4±3.3vs13.9±3.2)、TBW高(37.8±8.1vs34.6±8.0)、ECW/身高的比值增高(0.09±0.02vs0.08±0.02)、ECW/体重的比值增高(0.23±0.03vs0.22±0.03)。2.LVH相关因素分析:LVMI与腹透超滤量、血肌酐、收缩压、ECW、ICW、TBW、ECW/身高、ECW/体重、nECW呈正相关,而与残余尿量、血白蛋白、活性维生素D3、甘油三酯、胆固醇呈负相关。多元线性回归分析提示收缩压、ECW/身高、残余尿量为PD患者LVH独立危险因素。结论 PD患者应该尽可能保护残肾功能,减少水盐摄入,改善机体容量负荷、增加透析超滤,控制血压,希望有助于减少左心室肥厚的发生、发展,提高患者生存率。
Objective: Cardiovascular complications are the main cause of morbidity and mortality in maintenance peritoneal dialysis (MPD) patients. Left ventricular hypertrophy (LVH) is the vital pathological change. In our research, we focus on LVH and volume load in MPD patients and its risk factors combining bioelectrical impedance analysis (BIA). Method: 127 MPD (79 males, 48 females) patients of Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, were enrolled, with a vintage time more than 15 months. None of them had LVH at the beginning of PD. We evaluated the dialysis status by collecting their baseline age, PD vintage, residual urine (RU), ultrafiltration, systolic/diastolic blood pressure (SBP/DBP), fasting glucose, peritoneal glucose index (PGLI), serum albumin, hemoglobin, hematocrit, CRP, PTH, cholesterol, triglyceride, renal weekly creatinine clearance (CCR), total body water (TBW), extracellular water (ECW), intracellular water (ICW), normalized ECW (nECW) by height and weight. We calculate left ventricular mass index (LVMI) to evaluate left ventricular hypertrophy by Devereux formula. Result: The mean baseline age of MPD patients is 53.73±15.49 years old and mean vintage time of 54.4 months. 75 (59.1%) patients had LVH. 1. We divided patients into LVH group and non-LVH group. The former group had lower RU (304.2±54.3vs651.1±87.3ml), lower serum albumin (30.3±4.9vs32.5±5.7 g/L) but higher ultrafiltration (892.9±520.3vs696.5±428.1ml). LVH group had also higher ECW (15.4±3.3vs13.9±3.2), higher TBW (37.8±8.1vs 34.6±8.0), higher ECW/height level (0.09±0.02 vs 0.08±0.02), and higher ECW/weight level (0.23±0.03 vs 0.22±0.03). The differences were significant (P<0.05). 2. Ultrafiltration, creatinine, SBP, ECW, ICW, TBW, nECW, ECW/height level and ECW/weight level had significant positive linear correlations with LVMI, while RU, serum albumin, vit-D3, cholesterol and triglyceride had significant negative linear correlations. Multivariate linear regression analysis shows that SBP, ECW/height level and RU are the independent risk factors of LVH in MPD patients. Conclusion: It is important to protect the residual renal function and to control water and salt intake as well as blood pressure. We also suggest ameliorating volume load, and increasing dialysis adequacy, so as to reduce the prevalence of LVH and improve the prognosis of MPD patients.
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