上海交通大学学报(医学版) ›› 2018, Vol. 38 ›› Issue (5): 505-.doi: 10.3969/j.issn.1674-8115.2018.05.004

• 论著·临床研究 • 上一篇    下一篇

维持性血液透析患者左心室肥厚进展情况和相关危险因素分析

陈小妹 1,陈孜瑾 2,马晓波 2,张春丽 2,钱莹 2,俞海瑾 2,陈晓农 2   

  1. 1. 皖南医学院第一附属医院肾脏内科,芜湖 241001;2.上海交通大学医学院附属瑞金医院肾脏内科,上海 200025
  • 出版日期:2018-05-28 发布日期:2018-05-28
  • 通讯作者: 陈孜瑾,电子信箱:czj11765@rjh.com.cn。陈晓农,电子信箱:cxn10419@rjh.com.cn。为共同通信作者。
  • 作者简介:陈小妹(1980—),女,主治医师,硕士生;电子信箱: 565152399@qq.com。
  • 基金资助:
    国家自然科学基金(81600590);国家卫生和计划生育委员会公益性行业科研专项基金(OUMP2014-002);国家科技支撑计划项目(2015BA112B05);上海市卫生和计划生育委员会基金(20154Y0015);上海市科学技术委员会项目(15441903505,16DZ1930502)

Progression of left ventricular hypertrophy in maintenance hemodialysis patients and analysis of risk factors

CHEN Xiao-mei1, CHEN Zi-jin2, MA Xiao-bo2, ZHANG Chun-li2, QIAN Ying2, YU Hai-jin2, CHEN Xiao-nong2   

  1. 1. Nephrology Division, the First Hospital Affiliated to Wannan Medical College, Wuhu 241001, China; 2. Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2018-05-28 Published:2018-05-28
  • Supported by:
    National Natural Science Foundation of China, 81600590; Special Fund for Scientific Research of Public Welfare Industry of National Health and Family Planning Commission, OUMP2014-002; Project of National Science and Technology Supporting Plan, 2015BA112B05; Foundation of Shanghai Municipal Commission of Health and Family Planning, 20154Y0015; Project of Science and Technology Commission of Shanghai Municipality, 15441903505, 16DZ1930502

摘要: 目的 ·观察维持性血液透析( maintenance hemodialysis,MHD)患者左心室肥厚( left ventricular hypertrophy,LVH)的进展情况,分析影响 LVH进展的危险因素。方法 ·选取 2012年 7月上海交通大学医学院附属瑞金医院血液净化中心病情稳定的 MHD患者为研究对象,随访 1年;收集入组时和 1年后患者的临床资料和实验室指标,通过超声心动图评估左心室质量。定义 1年后左心室心肌质量指数进展超过 5%为 LVH进展。结果 ·共 71例 MHD患者纳入研究,男性 44例,中位年龄 55.9岁,中位透析龄 152.1个月。入组时, 22例(30.99%)患者合并 LVH。LVH组患者服用钙离子拮抗剂、血管紧张素酶抑制剂的比例较高,氨基末端 B型脑钠肽前体( NT-proBNP)水平较高,组间差异均有统计学意义( P<0.05)。随访 1年,31例患者出现 LVH进展, 40例患者 LVH好转或稳定; LVH进展组患者总胆固醇和低密度脂蛋白胆固醇( LDL-C)均较 LVH无进展组显著增加( P<0.05)。单因素和多因素 Logistic回归结果显示, LDL-C和总胆固醇是 LVH进展的危险因素 (OR2.515,95% CI为 1.219~ 5.910,P0.013;OR1.950,95% CI为 1.127~ 3.375,P0.017)。结论 · LVH是 MHD患者常见的心血管并发症之一;LVH患者使用高血压药物治疗的比例更高;LDL-C和总胆固醇是 LVH进展的危险因素。

关键词: 左心室肥厚, 维持性血液透析, 低密度脂蛋白, 胆固醇

Abstract: Objective &middot; To observe the progression of left ventricular hypertrophy (LVH) in maintenance hemodialysis (MHD) patients, and to analyse risk factors of the progression of LVH. Methods &middot; SMHD patients of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were enrolled in July 2012. These patients were followed for 1 year. Clinical characteristics and laboratory indices were collected at baseline and 1-year follow-up. Left ventricular mass (LVM) was evaluatedultrasonic cardiogram. Left ventricular mass index (LVMI) increased more than 5% was defined as LVH progression. Results &middot; Totally 71 MHD patients were enrolled in this study. 44 patients were males, with median age 55.9 years old, median dialysis vintage 152.1 months. 22 (30.99%) patients had LVH at enrollment. A significant higher percentage of MHD patients used calcium-channel binder (CCB) and angiotensin-converting-enzyme inhibitor (ACEI) in LVH group, while a significant higher NT-proBNP level was also showed in LVH group. 31 patients had LVH progression while 40 patients didn&rsquo;t after 1 year. Patients in progression group had significant higher levels of total cholesterol and low-density lipoprotein cholesterol (LDL-C). In univariable and multivariable Logistic regression, total cholesterol and LDL-C were independent risk factors of LVH progression (OR2.515, 95% CI 1.219-5.910, P0.013; OR1.950, 95% CI 1.127-3.375, P0.017). Conclusion &middot; LVH is one of the common cardiovascular complications in MHD patients. The proportion of of antihypertensive drugs is higher in the patients with LVH. Higher LDL-C and total cholesterol levels are risk factors for the progression of LVH.

Key words: left ventricular hypertrophy, maintenance hemodialysis, low-density lipoprotein, cholesterol

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