维持性血液透析患者单次透析充分性影响因素分析

目的探讨维持性血液透析患者常规单次血液透析过程中透析充分性的影响因素。方法选取2016年2月至2017年1月在江苏省中医院血液净化中心规律血液透析的130例患者,观察记录患者的一般情况,性别、年龄、原发病、血管通路及单次血液透析中患者的透析前后尿素氮、透析时间、超滤量、血流量、透析后体质量及超滤量/干体质量(%),利用公式计算得出尿素清除指数(Kt/V)作为评估透析充分性指标。根据Kt/V结果分为达标组(Kt/V≥1.2)与未达标组(Kt/V1.2),采用独立样本t检验和多元线性回归分析探讨维持性血液透析患者单次血液透析充分性与临床数据的关系。结果独立样本t检验显示单次透析时间(P=0.00)、透析后体质量(P=0.00)、超滤量/干体质量(%)(P=0.02)与Kt/V相关,多元线性回归显示单次透析时间(β=0.365,P0.05)、透析后体质量(β=-0.47,P0.05)是单次血液透析Kt/V的独立影响因素,且单次透析时间与Kt/V呈正相关,透析后体质量与Kt/V呈负相关。结论维持性血液透析患者单次血液透析的透析充分性与单次透析时间呈正相关、与透析后体质量呈负相关。     

腹膜透析患者左室肥厚的相关因素分析

目的探讨腹膜透析患者左心室肥厚的发生情况及相关影响因素。 方法选取2012年9月至2013年9月在广西医科大学第一附属医院腹膜透析中心随访的腹膜透析患者89人,规律腹膜透析6个月以上。排除标准：近一个月有腹膜炎或其他部位感染史,合并有急性心衰、慢性阻塞性肺疾病、恶性肿瘤、急性心脑血管病变、风湿性心脏病、严重肝功能不全及近3个月内使用糖皮质激素及免疫抑制剂的患者。采集入选病例临床资料,并予心脏彩超检查,通过测量室间隔厚度(LVST)、左心室厚度(LVPWT)、左室舒张内径(LVEDD)计算左心室心肌重量指数(LVMI)。左室肥厚定义为LVMI男性≥115 g/m²,女性≥95 g/m²。分析患者的横断面资料,并将患者分为左室肥厚组及非左室肥厚组进行比较。采用SPSS 17.0统计软件进行数据分析。两变量相关分析用Pearson(正态资料)或Spearman(非正态资料)相关分析。左室肥厚的独立危险因素分析用二分类Logistic回归分析,P<0.05认为差异有统计学意义。 结果89例患者中,男女比为1.47∶1,年龄(48.49±12.27)岁,腹膜透析龄(25.35±24.30)个月。病因：慢性肾小球肾炎61例(68.54%)、高血压肾病16例(17.98%)、糖尿病肾病2例(2.25%)、其他病因10例(11.24%)。左心室肥厚66例(74.16%)。将左心室肥厚组与非左心室肥厚组的相关指标进行比较。两组患者的血脑利钠肽前体(NT-proBNP)、腹膜透析液肌酐与血中清肌酐比值(D/P)、血白蛋白、左室射血分数(LVEF)、LVEDD、左室收缩末期内径(LVESD)、左房内径(LAD)、LVPWT及LVST等差异有统计学意义(P<0.05)。左心室肥厚与NT-proBNP、D/P值、LVEDD、LVST、LAD、LVESD及LVPWT呈正相关(P<0.05),与LVEF呈负相关(r＝－0.222,P＝0.036)。NT-proBNP水平是左室肥厚的独立危险因素(B偏回归系数0.001,SE值：0.000,Wals值：13.45,95%CI为1.000～1.001, P<0.001)。 结论腹膜透析患者较易发生左心室肥厚,其左心室肥厚与营养状态、容量负荷及腹膜转运类型等相关,NT-proBNP水平有望成为腹膜透析患者左室肥厚的评估预测生物标志物。     

血液透析充分性的影响因素分析

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者单次血液透析充分性的影响因素。方法选取2019年3月在航空总医院血液净化中心行规律血液透析的109例患者,观察记录患者的临床资料,包括性别、年龄、体质量指数、原发病、血管通路及单次血液透析中患者的透析前后尿素氮、透析时间、超滤量、血流量、干体质量和超滤率等。根据单室尿素清除率(single-pool Kt/V,spKt/V)结果分为达标组(spKt/V≥1.2)与未达标组(spKt/V1.2),分析探讨MHD患者单次血液透析充分性与临床数据的关系。结果单因素分析显示性别、透析相关性凝血、泵控血流量、动静脉内瘘、干体质量共5个因素与spKt/V相关(P0.05),二元Logistic回归分析显示性别(OR=4.345,95%CI 1.240～15.070,P0.05)、透析相关性凝血(OR=5.497,95%CI 1.213～27.125,P0.05)、动静脉内瘘作为血管通路(OR=0.105,95%CI 0.012～0.889,P0.05)和泵控血流量(OR=0.984,95%CI 0.969～0.998,P0.05)是单次血液透析spKt/V的独立影响因素。结论 MHD患者单次血液透析充分性与患者性别、透析相关性凝血、泵控血流量及使用动静脉内瘘作为血管通路密切相关。     

单中心维持性血液透析充分性的评价

目的评估分析兰州军区兰州总医院血液净化中心维持性血液透析患者血液透析充分性的情况,为进一步规范化制定血液透析处方和评估血液透析质量提供依据,进而提高维持性血液透析患者的生活质量。方法采用单中心横断面调查的对照研究方法,应用在线尿素清除率监测(online clearance monitoring,OCM)尿素清除指数(Kt/V),统计分析2014年5月~6月我院血液净化中心维持性血液透析患者211例的人口统计学资料、血液透析处方、超滤量、血流量,以测定的单次Kt/V值≥1.2为透析达到充分性的标准,并对Kt/V值达到和未达到充分性的2组患者临床资料进行对比分析。结果①211例维持性血液透析患者单次Kt/V值为0.65~1.88,平均Kt/V值为(1.11±0.20);其中74例患者(占35.0%)单次Kt/V值≥1.2;137例患者(占65.0%)单次Kt/V值1.2,146例患者(146/211,占69.1%)单次Kt/V值≥1.0。②对Kt/V值达到和未达到充分性的2组患者临床资料进行对比分析发现,2组患者的男女比例[(30/44)比(122/15)]及体质量[(56.0±10.1)kg比(68.8±12.3)kg]均有统计学差异(P0.05),而超滤量[(2.62±0.69)L比(2.74±1.02)L]及血流量[(234.8±21.4)ml/min比(232.4±30.4)ml/min]则无统计学差异(P0.05)。结论①OCM用于维持性血液透析的充分性监测方便、快速;②本中心维持性血液透析患者的血液透析充分性总体达标率低,需综合评估,个体化处方,加强患者管理;③男性、体质量较高的患者达标率低,需重视此类患者的透析充分性评估,并进一步调整血液透析处方。     

血液透析患者冠状动脉钙化的危险因素

目的 研究血液透析患者冠状动脉钙化情况,并分析其相关危险因素.方法 选择行血液透析治疗的患者201例,横断面调查所有患者血红蛋白、透析前后血清钙、血清磷、血清钾、尿素氮、肌酐、全段甲状旁腺激素、总蛋白、白蛋白、总胆固醇、甘油三酯、C反应蛋白、血清铁、铁蛋白、总铁结合力和冠状动脉钙化情况,分析冠状动脉钙化相关危险因素.结果 201例血液透析患者中发生冠状动脉钙化137例,总钙化发生率为68.2％.冠状动脉钙化组与无钙化组比较,年龄、性别、高血压、糖尿病、收缩压、脉压差、血钾、血磷、Kt/V及腰臀比差异均有统计学意义(P＜0.05).年龄、透析龄、性别、收缩压、脉压差、血钾、血磷为冠状动脉钙化的独立危险因素(P＜0.05);Kt/V为冠状动脉钙化的独立保护因素(P＜0.05).结论 血液透析患者冠状动脉钙化的发生率偏高;年龄、透析龄、性别、收缩压、脉压差、血钾、血磷为冠状动脉钙化的独立危险因素;Kt/V为冠状动脉钙化的独立保护因素.     

在线尿素清除率监测对血液透析充分性评估的研究

目的探讨在线尿素清除率监测(on-line clearance monitoring,OCM)对血液透析充分性的评估价值。方法选取规律血液透析患者135例,其中男性66例,女性69例,平均年龄(63.3±15.9)岁。利用OCM监测Kt/V值(Kt/Vocm值),同时透析前、后取全血检测尿素氮浓度,根据单室尿素动力模型DaugirdasⅡ公式计算Kt/V值(Kt/VD值),通过线性相关分析了解二者的相关性并通过多元线性回归分析得出影响Kt/Vocm值的相关临床因素。结果本组135例患者OCM法测得的Kt/V值与采血计算法所得的Kt/V值分别为(1.25±0.33)与(1.44±0.30),直线回归分析相关指数r=0.512,P0.001。身高、体质量、透析血流量是Kt/Vocm值的独立影响因素,体质量、身高与之呈负相关[OR=-0.412,P0.001,95%可信区间(-0.015,-0.006);OR=-0.240,P=0.01,95%可信区间(-0.015,-0.002)],透析血流量与之呈正相关[OR=0.349,P0.001,95%可信区间(0.003,0.008)]。比较Kt/Vocm值达标组(Kt/Vocm值≥1.2)和不达标组(Kt/Vocm值1.2)患者各项临床资料的差异,发现2组患者的性别、尿素下降率(urea reduction ratio,URR)、体质量、空腹血糖、体表面积、透析血流量存在显著差异。结论 OCM监测Kt/V值与采血计算Kt/V值有显著相关性,Kt/Vocm值低于Kt/VD值,身高、体质量和透析血流量是其独立影响因素。OCM能够很好的反映患者单次透析的尿素清除,可以作为临床评价透析充分性的简便、可靠指标。     

老年患者血液透析相关感染的危险因素分析

目的 探讨老年患者血液透析相关感染的原因及特点,为其感染的预防和治疗提供理论依据.方法 选取2012年1月～2014年6月在本院行血液透析治疗的老年患者60例.观察患者的年龄、血透龄、血红蛋白(HGB)、血浆白蛋白(ALB)、C反应蛋白(CRP)、血沉(ESR)、白细胞(WBC)、尿素清除指数(Kt/V)值等指标.使用COX回归分析老年患者透析相关感染的主要类型和相关危险因素,并以Kt/V和CRP水平对老年患者发生透析相关感染的诊断绘制ROC曲线.结果 60例老年患者发生透析相关感染共78例次,其中肺部感染38例次(48.7％)、泌尿系感染20例次(25.6％)、消化道感染8例次(10.3％)、透析导管感染7例次(9.0％)、动静脉内瘘感染5例次(6.4％);COX回归分析示:年龄、透析龄、Kt/V值、HGB、ALB、ESR、CRP水平与老年患者透析相关感染的风险存在显著相关性(P均＜0.05);ROC曲线示:Kt/V和CRP水平与老年患者透析相关感染的关系密切.结论 老年透析患者主要以呼吸系统、泌尿系统感染等最为常见.年龄、透析龄、Kt/V值、HGB、ALB、ESR、CRP等指标可能是引起透析相关感染的重要危险因素,定期监测Kt/V、CRP指标对透析相关感染有着较好的预防作用.     

单中心维持性血液透析患者睡眠质量调查及分析

目的调查维持性血液透析(MHD)患者睡眠质量,并分析影响其睡眠质量的因素,为进一步研究相应的预防措施及干预手段提供思路和依据。方法采用匹茨堡睡眠质量指数(PSQI)量表调查150名MHD患者的睡眠情况,并统计患者的年龄、性别、婚姻状况、透析时间、透析频率、平均超滤量、血红蛋白、甲状旁腺素(PTH)、白蛋白、尿素清除指数(Kt/V)。计算PSQI评分后进行分组,将PSQI评分≤5分者归为睡眠质量好组,PSQI评分5分者归为睡眠质量差组,并进行各因素、各维度的比较。结果结果 150名MHD患者中82名(54.66%)患者PSQI总分大于5分。睡眠质量差组与睡眠质量好组在年龄、透析时间、血红蛋白、PTH、Kt/V等指标方面差异有显著性(P 0.05)。而在白蛋白、平均超滤量指标方面无显著差异(P 0.05)。60岁以上患者与60岁以下患者PSQI量表中PSQI总分、睡眠效率、催眠药物方面比较差异有统计学意义(P 0.05),在睡眠质量、睡眠时间、入睡时间、睡眠障碍及日间功能障碍方面比较差异无统计学意义(P 0.05);透析时间3年以上和透析时间3年以下的患者在PSQI量表中总分及各项评分比较差异均有统计学意义(P 0.05)。结论 MHD患者的睡眠质量普遍较差。高龄、透析时间长、血红蛋白降低、PTH升高、Kt/V降低更易导致睡眠质量差。     

清晨血压波动与血液透析患者全因死亡的相关性

目的探究并分析清晨血压波动与血液透析患者全因死亡的相关性。方法选取2014年1月至2019年1月于我院血液净化中心进行维持性血液透析的234例患者作为研究对象, 根据清晨血压波动情况将患者分为观察组和对照组, 测量并记录清晨6:30、8:00、9:00及透析结束后5 min的血压, 计算平均血压, 并于血液透析治疗前抽取患者空腹静脉血, 比较两组患者临床资料。采用多变量Cox回归分析模型分析血液透析患者全因死亡的危险因素, 分析清晨血压与全因死亡其他危险因素的相关性。所有患者随访5年, 记录生存时间, 利用Kaplan-Meier方法计算患者生存函数。结果观察组患者清晨收缩压、总胆固醇、甘油三酯、低密度脂蛋白、肌酐和高敏C反应蛋白水平明显高于对照组(P<0.05), 高密度脂蛋白、白蛋白、血红蛋白、尿素清除指数(Kt/V)水平明显低于对照组(P<0.05), 两组患者年龄、清晨舒张压、体质指数、谷丙转氨酶、谷草转氨酶、前白蛋白、血磷、血钙和透析时长差异无统计学意义(P>0.05)。多变量Cox回归分析模型显示, 清晨收缩压、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋...     

影响腹膜透析患者血清白蛋白的相关因素及中医证型分布规律

目的:研究影响腹膜透析(PD)患者血清白蛋白(Alb)的相关因素和中医证型分布规律,为中西医结合治疗低蛋白血症提供依据。方法:收集2017年7月—2018年7月于温州市中医院、温州市中心医院规律腹膜透析的患者177例,分为正常组93例和低白蛋白组84例,采集每位患者的各项临床指标并进行中医辨证分型,探讨影响PD患者Alb的相关因素和中医证型分布规律。结果:两组血肌酐、血清尿素、C-反应蛋白、腹膜尿素清除指数(腹膜Kt/v)、腹膜肌酐清除率(腹膜Ccr)比较,差异无统计学意义(P0.05);两组透析时间、中医症状积分、超滤量、Alb、血红蛋白、尿量、残肾尿素清除指数(残肾Kt/v)、总尿素清除指数(总Kt/v)、残肾肌酐清除率(残肾Ccr)、总肌酐清除率(总Ccr)比较,差异有统计学意义(P0.01)。逐步回归分析发现,残肾Kt/v、总Kt/v是Alb的独立影响因素。本虚证为脾肾阳虚证和阴阳俱虚证的患者Alb水平最低。结论:腹膜透析患者的血清白蛋白水平和残余肾功能、中医证型有着相关性。     

早期慢性肾病患者动态血压变化与左心室肥厚的关系

目的：分析早期慢性肾脏病（CKD1期）患者24h动态血压变化与左心室肥厚（LVH）的关系。方法：以25例正常人作为对照组（N组）,71例肾功能稳定的CKD1期患者作为疾病组（D组）。收集肾功能、血脂、24h动态血压监测（ABPM）等临床资料;采用超声心动图检测早期CKD患者LVH有关指标,分析ABPM指标与LVH的关系。结果：（1）与N组相比,D组夜间收缩压,昼、夜及24h平均舒张压均升高（P均〈0.05）;夜间收缩压下降率（nDRS）及舒张压下降率（nDRD）均明显下降（P均〈0.05）;舒张末期左室内径（LVDd）及左心室质量指数（LVMI）均升高（P均〈0.05）。（2）D组高血压及非杓型血压发生率分别达47.9%、62.0%。（3）与杓型血压组（Dip组）相比,非杓型血压组（non-Dip组）LVMI值及LVH发生率均显著增高（P均〈0.05）。（4）与非高血压组（non-LVH组）相比,高血压组（LVH组）nDRS和nDRD均明显下降,血红蛋白（Hb）显著降低（P均〈0.05）。（5）相关性分析显示LVMI值与nDRS、nDRD和Hb均呈负相关（P均〈0.01）,昼间平均收缩压（dSBP）、夜间平均收缩压（nSBP）、夜间平均舒张压（nDBP）和24h平均舒张压（mSBP）均呈正相关（P均〈0.05）。多因素逐步回归分析显示：nDRS、Hb、nDRD和血肌酐（Scr）进入回归方程：y=123.429-2.290x1-0.47x2-0.768x3＋0.178x4（y=LVMI;123.429=常数,t=8.41,P=0.000;x1=nDRS,t=-5.43,P=0.000;x2=Hb,t=-4.77,P=0.000;x3=NDRD,t=-3.47,P=0.001;x4=Scr,t=2.08,P=0.041）。结论：早期CKD患者即已出现血压升高及血压节律改变;LVH发生与早期CKD患者夜间高血压及非杓型血压关系更为密切;贫血和肾功能减退本身也与早期CKD患者LVH发生有关。     

Impact of volume status on blood pressure and left ventricle structure in patients undergoing chronic hemodialysis

In this study, we aimed to examine the impact of volume status on blood pressure (BP) and on left ventricular mass index (LVMI) in chronic hemodialysis (HD) patients. This study enrolled 74 patients (F/M: 36/38, mean age 53.5 ± 15.3 years, mean HD time 41.5 ± 41 months) that were on HD treatment for at least 3 months. Demographics, biochemical tests, hemogram and C-reactive protein levels, mean interdialytic weight gain (IDWG), mean percentage of ultrafiltration (UF), and intradialytic complications such as hypotension and cramps were determined. Mean values of predialysis and postdialysis BP measurements were recorded a month before echocardiographic examination. On the day after a midweek dialysis session, 24 h ambulatory BP monitoring (ABPM) and echocardiographic examination were made concurrently. The patients were classified into two groups according to volume status: normovolemic (group 1; 14F/24M, mean age 50 ± 16.7 years, mean dialysis time 47.7 ± 47.7 months) and hypervolemic (group 2; 15F/21M, mean age 57.3 ± 12.7 years, mean dialysis time 34.9 ± 32 months). HD duration, IDWG, UF, and interdialytic complication rates were similar between the two groups (p < 0.05). Eleven patients (28.9%) of group 1 and 8 patients (22.2%) of group 2 showed dipper (p?=?0.50). Valvular damage was more common in group 2 (p?=?0.002). Whereas 33 patients (91.7%) had left ventricular hypertrophy (LVH) in group 2, 21 patients of the group 1 (55.3%) had LVH (p < 0.001). Although LVMI showed a significant positive correlation with cardiothoracic index, predialysis and postdialysis BP, IDWG, UF, daytime and nighttime BP measurements of 24 h ABPM, a significant negative correlation was seen with Kt/V urea and serum albumin levels. In conclusion, increased IDWG and UF and elevated BP are independent predictors of LVH for HD patients. Increased volume status leads to IDWG and elevated BP and eventually causes severe LVMI increases.     

Blood pressure measurements and left ventricular mass index in hemodialysis patients

Left ventricular hypertrophy (LVH) is the most frequent cardiac abnormality in hemodialysis (HD) patients. It is related to cardiovascular diseases and is an important risk factor for mortality in HD patients. Arterial hypertension is an established risk factor for LVH in HD patients. Inferior vena cava (IVC) diameter is a good indicator of circulating fluid volume; hypervolemia is an important pathogenetic factor of hypertension in HD patients. The purpose of our study was to evaluate possible association between LVH, IVC diameter, and different blood pressure (BP) measurements in HD patients. In the present study, 85 HD patients were included. BP was measured with a standard mercury sphygmomanometer before and after the HD session; the average 1‐monthly values of the routine BP measurements were also analyzed. 24‐ and 48‐h ambulatory blood pressure measurements (ABPMs) were performed after the end of HD sessions using a noninvasive ABPM. Average values of systolic and diastolic BP were analyzed separately for the first (HD) and second (interdialytic) day ABPM and for both days together. Using echocardiography, left ventricular mass was measured and left ventricular mass index (LVMI) was calculated. Using ultrasonography, IVC diameter was measured on the interdialytic day. Using multiple regression analysis, we found statistically significant correlations between LVMI and mean monthly postdialysis systolic BP (P < 0.05) and mean 48‐h diastolic BP (P < 0.05). Only longer BP measurements (average 1‐month post‐HD and 48‐h ABPM) were associated with LVMI in HD patients.     

腹膜透析初透剂量对患者残余肾功能的影响

目的 探讨腹膜透析（腹透）初透剂量对患者残余肾功能的影响。 方法 追踪观察我院3个月内连续门诊随访的178例开始腹透的患者,测定24 h尿量。根据透析第1、3个月尿量的变化分为少尿组（LU,97例）、尿量减少组（DU,19例）、尿量正常组（NU,62例）,记录并分析其透析剂量、腹透液葡萄糖含量、超滤量、尿素清除指数（Kt/V）、体质量、水肿程度及尿量变化等的相关性。 结果 3组患者的年龄和性别比例差异无统计学意义。透析1个月后,DU组的体质量和水肿程度大于LU和NU组（P < 0.05）;腹透液总入量、腹透液葡萄糖含量、超滤量、残余肾尿素清除指数Kt/V（rKt/V）高于LU组,与NU组差异无统计学意义。透析3个月后,DU组的体质量和水肿程度有所下降（P < 0.05）,但仍高于LU和NU组（P < 0.05）;腹透液总入量、超滤量、尿量下降速度比LU组和NU组高（P < 0.05）;rKt/V 比腹透前显著下降（P < 0.05）。3组的血清白蛋白和tKt/V差异无统计学意义。 结论 开始腹透患者过度超滤可引起残余肾功能下降。对于有一定残余肾功能的患者要注意避免快速或过多超滤。     

Improved left ventricular mass index in children after renal transplantation

Left ventricular hypertrophy (LVH) is a risk factor for cardiovascular disease, and it is prevalent in children with end-stage renal disease (ESRD) and after renal transplantation (RTx) on cross-sectional studies. Our aim was to compare prospectively left ventricular mass index (LVMI) in children with ESRD, before and after RTx. Thirteen patients aged 1.5-15 years underwent echocardiogram prior to and at least 3 months after RTx, and again in the second year after transplantation. A control group consisted of children with ESRD who remained on dialysis. Systolic and diastolic blood pressure index decreased significantly over the study period only in the children who had undergone RTx. Mean LVMI in children with ESRD decreased from 45.4 +/- 12.6 g/m(2.7) to 34.9 +/- 10.4 g/m(2.7) after RTx (P = 0.001), but it remained unchanged in patients who remained on dialysis. The prevalence of LVH decreased from 54% to 8% (P = 0.03) after RTx. Systolic and diastolic blood pressure index were correlated with LVMI. Mean body mass index increased during the study period from 17.3 +/- 2.5 to 20 +/- 4.6 (P = 0.05); however, no correlation was found with LVMI. LVH in children with ESRD is potentially reversible after RTx, especially with good control of hypertension.     

控液手册联合补偿策略对腹膜透析患者容量状态及残余肾功能的影响

目的探讨控液手册联合补偿策略对腹膜透析患者容量状态及残余肾功能的影响。方法将120例腹膜透析患者按照随机数字表法分为对照组和观察组各60例。对照组给予常规护理,观察组在常规护理基础上应用控液手册联合补偿策略。比较两组干预前、干预6个月后的收缩压、舒张压、体质量、24 h尿量、超滤量、水肿程度、血尿素氮、血肌酐、尿素清除指数、肌酐清除率、肾小球滤过率(eGFR)。结果干预后,观察组收缩压、舒张压、体质量显著低于对照组,尿量显著多于对照组,水肿程度显著轻于对照组,血尿素氮、血肌酐检测值显著低于对照组,尿素清除指数及肾小球滤过率显著高于对照组(P0.05,P0.01)。结论控液手册联合补偿策略有利于改善患者的容量超负荷状况,延缓残余肾功能下降。     

Aortic valve calcification is an independent factor of left ventricular hypertrophy in patients on maintenance haemodialysis.

BACKGROUND: Calcification and dysfunction of aortic and mitral valves are frequently found in chronic dialysis patients, but their influence on the development of left ventricular hypertrophy (LVH) is not well defined. METHODS: Conventional echocardiography and Doppler measurement of trans-aortic flow velocity were performed in 135 chronic haemodialysis patients, and left ventricular mass index (LVMI) and trans-valve pressure gradients were calculated. Average values of systolic, diastolic and pulse pressure (PP), interdialytic weight gain, chronic overhydration (difference between mean post-dialysis and dry weights), plasma calcium, phosphate, haemoglobin, and urea reduction ratio over the year preceding this study were obtained in every patient. RESULTS: Aortic valve calcification was present in 105 patients (78%), associated with stenosis in eight (6%); 39 patients (29%) had aortic regurgitation. Mitral annular calcification occurred in 35 (26%) cases and mitral regurgitation in 45 (33%). LVH was observed in 104 patients (77%). Logistic analysis revealed that only aortic valve calcification predicted LVH. LVMI was higher in patients with aortic valve calcification than in those without calcification: (mean+/-SD) 241+/-52 vs 154+/-64 g/m(2), P=0.001. LVMI was not different between patients with normal, calcified, or regurgitating mitral valves. Patients with aortic valve calcification had higher trans-valve peak flow velocities and pressure gradients than those with non-calcified valves: 1.65+/-0.53 vs 1.37+/-0.33 m/s, P=0.01, and 12.1+/-8.9 vs 7.9+/-3.6 mmHg, P=0.01, respectively. The LVMI correlated directly with both variables (r=0.27 and r=0.24, P<0.005). Stepwise linear regression on nine covariates potentially influencing LVMI (age, body mass index, time on dialysis, systolic blood pressure, PP, chronic overhydration, haemoglobin concentration, trans-aortic flow velocity, and urea reduction ratio) showed that LVMI was independently associated with (i) PP, (ii) haemoglobin (inverse correlation), (iii) peak aortic flow velocity, and (iv) chronic overhydration (r=0.502, R(2)=0.252, ANOVA F-ratio=10.19, P<0.0005). CONCLUSION: Our findings show that aortic valve calcification is associated with LVH in chronic haemodialysis patients, probably because valve resistance to ventricular outflow is increased as shown by trans-aortic flow velocities and pressure gradients. The effect on LVMI is independent of PP, anaemia, and overhydration.     

No association between deletion-type angiotensin-converting enzyme gene polymorphism and left-ventricular hypertrophy in hemodialysis patients

Left-ventricular hypertrophy (LVH), a bad prognostic sign, is a common finding in hemodialysis patients. The aim of the study was to analyze factors, including angiotensin-converting enzyme (ACE) genotype that may have an effect on the development of LVH in hemodialysis patients. Seventy-nine hemodialysis patients (42 males, 37 females, mean age 37.7 +/- 13.1 years) and 82 age- and sex-matched normotensive healthy controls (40 males, 42 females, mean age 35.6 +/- 5.7 years) were included. Left-ventricular mass index (LVMI) was higher in the hemodialysis group compared to controls (170.1 +/- 69.3 versus 84.9 +/- 15.7 g/m(2), p < 0.001). Fourty-three hypertensive patients in the hemodialysis group had an increased LVMI compared to 36 normotensive hemodialysis patients (194.2 +/- 75.5 versus 141.2 +/- 48.0 g/m(2), p < 0.001). On univariate analysis, LVMI was found to be correlated with blood pressure (r = 0.38, p < 0.001), time spent on dialysis (r = 0.22, p = 0.02) and hemoglobin levels (r = -0.21, p = 0.03). No correlation was found between LVMI and age (r = 0.09, p = 0.22), predialytic creatinine (r = 0.09, p = 0.21) and albumin (r = -0.10, p = 0.18). On multivariate analysis for the predictors of LVMI, blood pressure, time spent on dialysis and hemoglobin levels were also found to be significant. LVMI in DD, ID and II genotypes were 155.0 +/- 71.2, 181.6 +/- 60.6, and 163.6 +/- 83.4 g/m(2), respectively (p > 0.05). No association between LVMI and DD genotype was found. ACE genotype distribution was similar in hemodialysis patients and healthy controls. It was concluded that LVH in hemodialysis patients was mainly related to hypertension, anemia and time spent on dialysis and the DD genotype had no effect on LVMI in hemodialysis patients.     

华法令对于带涤纶套中央静脉导管功能不良的改善及临床分析

目的 观察口服华法令对于因血栓及纤维蛋白鞘而至涤纶套中央静脉导管置入后功能不良的改善并行临床分析.方法 59例带卡夫隧道导管患者,分为A组(28例)口服华法令1.5～3mg/d抗凝,对照组B组(31例)口服阿司匹林100mg/d抗凝,两组常规普通肝素封管.记录导管透析中血流量、回血静脉压,记录透析前后尿素氮、肌酐、超滤等,计算透析尿素清除指数,评估透析效果,定期检测非透析状态下国际标准化比值.比较导管留存时间、导管中位留存时间,并观察两组出血、导管相关性血流感染等并发症.观察一年时间.结果 A、B两组透析前后肌酐、尿素氮水平变化存在统计学差异,A组尿素清除指数均达标,A、B两组透析中血流量、回血静脉压比较存在统计学差异.A、B两组透析后比较肌酐、尿素氮水平、尿素清除指数以及国际标准化比值也存在统计学差异,且两组导管留存时间亦存在统计学差异.A组国际标准化比值维持在(2.00±0.93)之间,A、B两组未见出血、导管相关性血流感染并发症.结论 带卡夫中央静脉导管置后常规口服中等剂量华法令抗凝配合肝素封管较口服阿司匹林更能改善因血栓及纤维蛋白鞘而至导管功能不良,延长导管留存时间,且并发症少.但本研究样本量偏少,观察时间偏短,仍需进一步临床验证以证实口服华法令在带卡夫隧道导管置入后临床安全性及有效性.