上海交通大学学报（医学版）

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

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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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