Impact of dialysis adequacy on cardiac function in pediatric CAPD patients.

BACKGROUND: Left ventricular hypertrophy is a major cause of morbidity and mortality among patients with chronic renal failure. Uremia-related risk factors play a fundamental role in its occurrence, thus better prognosis and prolonged survival can be attained by successful dialytic therapies. OBJECTIVE: To investigate whether dialysis adequacy has a beneficial effect on cardiac structure and function in children receiving continuous ambulatory peritoneal dialysis (CAPD). DESIGN: Cross-sectional study in the Pediatric Peritoneal Dialysis Unit of a university hospital. PATIENTS: Eighteen children, aged 13.3 +/- 2.8 years, being treated with CAPD, and 20 healthy age- and sex-matched control subjects were enrolled in this study. MAIN OUTCOME MEASURES: Echocardiographic evaluation was performed in all subjects. Dialysis adequacy indices [weekly urea (Kt/V) and creatinine clearance (TCCr)] were calculated in the dialysis group. RESULTS: Interventricular septal thickness, left ventricular (LV) posterior wall thickness, LV mass index (LVMI), and LV end systolic and diastolic dimensions were all found to be significantly higher in the CAPD group compared to the control subjects (p < 0.01). Ejection fraction and fractional shortening of the LV were not significantly different between the two groups. Mean Kt/V was 2.02 +/- 0.71 and mean TCCr was 58 +/- 33 L/wk/1.73 m2. There were significant negative correlations between dialysis adequacy indices and LV end systolic and diastolic dimensions (p < 0.05 and p < 0.001). Ejection fraction and fractional shortening were positively correlated with Kt/V (p < 0.01). Systolic and diastolic blood pressures were positively correlated with LVMI (r= 0.501 and r = 0.523). Significant inverse correlations between mean arterial pressure and both Kt/V and TCCr (r = -0.555 and r = -0.520) were detected. CONCLUSION: These data clearly document that cardiac structure and function are remarkably influenced by the uremic state and dialysis therapy in pediatric CAPD patients. The close relationships between echocardiographic findings and dialysis adequacy indices suggest that adequate dialysis has a beneficial effect on cardiac function via effective removal of toxic substances.     

孤立性房颤与高血压房颤患者左心重塑对比

目的:探讨高血压伴发的房颤和孤立性房颤患者左室质量等重塑状况异同及其意义。方法:房颤和(或)原发性高血压患者,排除对心脏有影响的其他疾病,分为原发性高血压无房颤组(EH组)、原发性高血压伴房颤组(EHAF组)和孤立性房颤组(LAF组)。进行超声心动图检测左房横径、左房前后径、左房长径、左房面积、左室室间隔厚度(IVST)、左室后壁厚度(PWT)和左室舒张末期内径(EDD),计算室间隔/左室后壁厚度比值和左室质量指数(LVMI)。结果: EH组入选446 例,EHAF组78例,LAF组38例。EHAF组IVST和PWT均明显大于EH组和LAF组(p<0.05和p<0.01),EH组IVST和PWT也大于LAF组(p<0.01和p<0.05)。EHAF组左房各内径和面积均明显大于LAF组和LH组(p<0.01),后两组间无明显差异。EHAF组LVMI明显大于LAF组和LH组(p<0.01和p<0.05),LAF组和LH组间无明显差异。结论:原发性高血压伴发房颤者左室肥厚程度明显重于不伴房颤者。左房扩大、左室肥厚性重塑与孤立性房颤的关系不如与高血压房颤密切,孤立性房颤发生的危险因子不同于高血压房颤。     

缬沙坦对维持性血液透析患者心脏功能和结构的影响

目的 探讨缬沙坦对维持性血液透析(maintenance hemodialysis,MHD)患者心脏功能和结构的影响.方法 100例MHD患者,随机分为缬沙坦治疗组与对照组,治疗前及治疗后使用超声心动图测定心脏结构指标:左房收缩末期内径(LADs)、左室舒张末期内径(LVEDd)、室间隔舒张末期厚度(IVSTd)、左室后壁舒张末期厚度(LVPWTd),左房内径指数(LAI)、左心室心肌重量指数(LVMI)、相对室壁厚度(RWT);心脏功能指标:左室射血分数(LVEF),左室短轴缩短率(FS),二尖瓣口舒张早期和晚期最大血流速度比(E/A)各项指标测定.结果 治疗组MHD患者心脏结构指标:左房收缩末期内径(LADs)、左室舒张末期内径(LVEDd)、室间隔舒张末期厚度(IVSTd)、左室后壁舒张末期厚度(LVPWTd),左房内径指数(LAD、左心室心肌重量指数(LVMI)值均明显低于对照组,二者差异有统计学意义(P＜0.05),两组相对室壁厚度(RWT)相比没有明显的差异(P＞0.05).心脏功能指标:左室射血分数(LVEF),左室短轴缩短率(FS),二尖瓣口舒张早期和晚期最大血流速度比(E/A)值较对照组明显增高(P＜0.05).结论 缬沙坦可以改善MHD患者的心脏结构和功能.     

Possibilities of Doppler echocardiography application in a patient on program hemodialysis

The aim of the study was to investigate the significance of Doppler echocardiography (echoCG) for assessment of "dry weight" in hemodialysis patients. 43 dialysis patients (20 men and 23 women aged 49 +/- 11 years), receiving 4-hour bicarbonate hemodialysis (HD) 3 times a week, were studied prior to and after HD procedures. M-mode echoCG was performed and left ventricular mass index (LVMI) and ejection fraction (EF) were calculated. Transmitral flow was assessed by Doppler echoCG. Peak velocity of early (E) and late (A) filling, E/A ratio, isovolumic relaxation time (IVRT) and early deceleration time (DT) were detected. Left ventricular hypertrophy (LVH) was detected in 37 (86.0%) patients. EF was lower than 45% in 4 patients. There was significant positive correlation between the amount of ultrafiltration (evaluated in per cents of body mass after HD) and deltaE (r = 0.59; p = 0.001), and there was found no correlation between the amount of ultrafiltration and deltaA. Patients with intradialytic hypotension had substantially higher DT than patients without one (238.7 +/- 64.3 vs. 168.6 +/- 51.2 mc, respectively, p < 0.001). "Dry weight" is associated with increase of early DT over the level normal for the age in hemodialysis patients with left ventricular hypertrophy. Patients with increased early DT are exposed to the high risk of intradialytic hypotension development.     

Serum BNP concentration and left ventricular mass in CAPD and automated peritoneal dialysis patients.

OBJECTIVE: To compare ultrafiltration under continuous ambulatory peritoneal dialysis (CAPD) and automated PD (APD), disclosing potential effects on serum B-type natriuretic peptide (BNP) levels and echocardiographic findings. PATIENTS AND METHODS: This cross-sectional clinical study included 32 patients on CAPD and 30 patients on APD without clinical evidence of heart failure or hemodynamically significant valvular heart disease. Peritoneal equilibration tests, BNP levels, and echocardiographic measurements were performed in each subject. BNP measurements were also performed in 24 healthy control subjects. RESULTS: Patients on APD had lower ultrafiltration and higher values of BNP and left ventricular mass index (LVMI) compared with patients on CAPD (respectively: 775 +/- 160 vs 850 +/- 265 mL, p = 0.01; 253.23 +/- 81.64 vs 109.42 +/- 25.63 pg/mL, p = 0.001; 185.12 +/- 63.50 vs 129.30 +/- 40.95 g/m(2), p = 0.001). This occurred despite higher mean dialysate glucose concentrations and far more extensive use of icodextrin in the APD group. CONCLUSION: Treatment with APD is associated with higher plasma BNP levels and LVMI compared to CAPD. This may be the result of chronic fluid retention caused by lower ultrafiltration in APD patients.     

血液透析患者脑钠肽水平与左心功能不全及血容量负荷的关系

目的通过对维持性血液透析(maintain hemodialysis,MHD)患者透析前、后血清脑钠肽(brainnatriuretic peptide,BNP)的变化及其与左心室结构和功能以及血压、超滤量的相关性分析,探讨BNP在MHD患者血容量负荷评估中的临床应用价值。方法选择在上海市闸北区中心医院血液净化中心透析龄超过3个月的MHD患者56例,病情稳定,已排除急性心血管事件,分别检测患者一周连续3次治疗的透析前、后血清BNP水平,记录透析前、后血压的变化和透析超滤量(UF),同时应用心脏超声心动图测定患者一周连续3次透析前、后的左心房内径(LAD)、左心室舒张末内径(LVDd)、左心室收缩末内径(LVDs)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室射血分数(LVEF)等,计算左心室心肌重量指数(LVMI),探讨BNP与MHD患者左心室结构、功能和血容量的关系。结果①MHD患者透析前、后血清BNP水平均显著高于健康对照组,二者差异有统计学意义(P0.01),MHD患者透析后BNP水平较透析前下降(P0.01);MHD伴有高血压患者透析前的BNP水平较不伴有高血压患者显著升高(P0.01),伴有高血压的患者透析后BNP水平较透析前显著下降(P0.01);MHD不伴有高血压患者中,UF≥1.0kg的患者透析前BNP水平较UF1.0kg的患者显著升高(P0.01),UF≥1.0kg的患者透析后BNP水平较透析前显著下降(P0.05)。②MHD患者血清BNP分别与LVDd、LVDs、LVPWT、LVMI呈正相关(P0.05)、与LVEF呈负相关(P0.05)、与LAD、IVST无相关性,与血压、UF呈正相关(P0.05)。多因素回归分析显示,BNP、血压和年龄是MHD患者左心功能不全的独立危险因素。结论 MHD患者BNP水平普遍升高,并且与左心室功能及血容量负荷密切相关,是一个无创和灵敏的指标。测定血清BNP水平可有助于及时调整干体质量,减轻心脏负荷,减少心血管并发症,具有临床应用价值。     

The influence of dialytic modality on arterial stiffness, pulse wave reflections, and vasomotor function.

BACKGROUND: Measurements of aortic stiffness [aortic pulse wave velocity (PWV) and augmentation index (Alx)] have been established as powerful predictors of survival on hemodialysis (HD). Abnormal endothelial-dependent and endothelial-independent vascular reactivity and increased arterial stiffness are commonly described in HD patients. There is, however, a lack of information on the comparative impact of different renal replacement therapies (RRTs) on PWV and Alx, and how these different methods might influence endothelial-dependent abnormal vasodilatation. OBJECTIVE: To describe in a cross-sectional design arterial compliance and distensibility in continuous ambulatory peritoneal dialysis (CAPD) versus HD versus renal transplant (RTx) patients, compared with age- and blood pressure-matched essential hypertensive controls. The PWV and aortic Alx were determined from contour analysis of arterial waveforms recorded by applanation tonometry in 40 CAPD, 41 HD, 20 RTx patients (with normal serum creatinine), and 20 controls with essential hypertension (all normotensive under treatment). Endothelial-dependent and endothelial-independent vascular reactivities were assessed by changes in Alx following challenges with inhaled salbutamol and sublingual nitroglycerin respectively. RESULTS: CAPD patients had significantly stiffer arteries than all other categories. The PWV was 8.29 +/- 1.09 m/ second in CAPD patients, significantly higher (p < 0.05) compared to HD subjects (7.19 +/- 1.87 m/s). Both dialysis subgroups had significantly higher PWV values compared to RTx patients (6.59 +/- 1.62 m/s) and essential hypertensive controls (6.34 +/- 1.32 m/s), p < 0.05. The Alx had a profile similar to PWV in different RRTs. All groups with the exception of CAPD subjects had a significant decrease in Alx following salbutamol. Moreover, the vasodilatation induced by either nitroglycerin or salbutamol was significantly blunted compared to HD. Overall, both dialysis categories had more abnormal responses compared to RTx patients and essential hypertensive controls. CONCLUSION: CAPD is associated with stiffer arteries and more profoundly abnormal endothelial-dependent vasomotor function, compared to matched HD subjects. These differences in arterial physical properties might explain differences seen in cardiac structure and function between the RRTs.     

Association between serum n-terminal pro-brain natriuretic peptide concentration and left ventricular dysfunction and extracellular water in continuous ambulatory peritoneal dialysis patients.

BACKGROUND: This study investigated the association between serum N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels and extracellular water (ECW%) and left ventricular (LV) dysfunction in continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS: The study involved 30 stable CAPD patients: 14 males, 16 females; mean age 52 +/- 14 years; mean CAPD duration 34 +/- 12 months; 12 with diabetes mellitus (DM) and 18 non-DM. Serum NT-pro-BNP levels were determined using electrochemiluminescence immunoassay. Baseline echocardiography was performed using a Hewlett-Packard Sonos 1000 (Andover, Massachusetts, USA) device equipped with a 2.25-MHz probe, allowing M-mode, two-dimensional, and pulsed Doppler measurements. Left ventricular mass index (LVMI) was calculated according to the Penn formula. A multifrequency bioimpedance analyzer was used; ECW% was calculated as a percentage of total body water and was considered the index of volume load. RESULTS: (1) Serum NT-pro-BNP level, ECW%, LVMI, and LV ejection fraction in CAPD patients were 3924 (240 - 74460) pg/mL, 36.7% +/- 2.2%, 158 +/- 48 g/m2, and 60.5% +/-11.2%, respectively. (2) Patients were divided into three tertiles (10 patients each) according to their serum NT-proBNP concentration [1st tertile 1168 (240 - 2096), 2nd tertile 4856 (2295 - 20088), 3rd tertile 35012 (20539 -74460) pg/mL]. The tertiles did not differ significantly in terms of age, sex, presence of DM, body mass index, or PD duration. Patients in the 3rd tertile (highest serum NT-proBNP concentration) had the highest LVMI (126 +/- 45 vs 160 +/-41 vs 200 +/- 23 g/m2 for 1st, 2nd, 3rd tertiles, respectively) and the lowest LV ejection fraction (66% +/- 11% vs 62% +/-6% vs 55% +/- 9%). ECW% did not differ significantly between tertiles (35.5% +/- 2.0% vs 37.5% +/- 2.0% vs 36.5% +/-2.0%). (3) In CAPD patients, serum NT-pro-BNP levels correlated positively with LVMI (r = 0.628, p = 0.003) and negatively with LV ejection fraction (r = -0.479, p = 0.033). Serum NT-pro-BNP levels did not correlate with ECW% (r = 0.227, p = 0.25). (4) Stepwise regression analysis showed that LV ejection fraction (beta = -0.610, p = 0.015) and LVMI (beta = 0.415, p = 0.007) were independently associated with the serum NT-pro-BNP concentration. CONCLUSIONS: There was no link between ECW% and serum NT-pro-BNP concentration. Thus, serum NT-pro-BNP levels may not provide objective information with respect to pure hydration status in CAPD patients. In contrast, serum NT-pro-BNP levels were linked to LVMI and LV ejection fraction in CAPD patients. Therefore, while the serum NT-proBNP concentration might not be a useful clinical marker for extracellular fluid volume load, it appears useful for evaluating LV hypertrophy and LV dysfunction in CAPD patients.     

Blood pressure and left ventricular hypertrophy in patients on different peritoneal dialysis regimens.

OBJECTIVE: To examine the relation between the results of ambulatory 24-hour blood pressure monitoring (ABPM) and left ventricular mass index (LVMI), then to find the independent determinant for left ventricular hypertrophy (LVH) in peritoneal dialysis (PD) patients. Finally, to evaluate the differences in the clinical and cardiovascular characteristics between patients on continuous ambulatory PD (CAPD) and continuous cyclic PD (CCPD). DESIGN: An open, nonrandomized, cross-sectional study. SETTING: Divisions of nephrology and cardiology in a medical center. PATIENTS: Thirty-two uremic patients on maintenance PD therapy (22 patients on CAPD, and 10 on CCPD) without anatomical heart disease or history of receiving long-term hemodialysis. INTERVENTIONS: Home blood pressure (BP) and office BP were measured using the Korotkoff sound technique by sphygmomanometer. ABPM was employed for continuous measurement of BP. Echocardiography was performed for measurement of cardiac parameters and calculation of LVMI. MAIN OUTCOME MEASURES: Multivariate logistic regression analysis was performed for independent determinant of LVH in PD patients. The differences in clinical and cardiovascular characteristics between CAPD and CCPD patients were compared. RESULTS: Simple regression analysis showed positive correlations between LVMI and the duration of hypertension, ambulatory nighttime BP/BP load/BP load > 30%, serum phosphate, calcium-phosphate product, ultrafiltration (UF) volume, and percentage of UF volume during the nighttime. A negative correlation was noted between LVMI and dipping. In multiple regression analysis, the duration of hypertension was the only variable linked to LVMI. In multivariate logistic regression analysis, only ambulatory nighttime systolic BP load > 30% had an independent association with LVH.There were correlations between office/home BP and ambulatory 24-hour BP. In addition, CCPD patients had higher LVMI, UF volume during the nighttime, and percentage of UF volume during the nighttime than those of CAPD patients. CONCLUSIONS: In this study, ambulatory nighttime systolic BP load > 30% had an independent association with LVH. Office and home BP measurements were correlated with ABPM in PD patients. The result that CCPD patients had a higher LVMI than CAPD patients may be due to a relative volume overload during the daytime in CCPD patients.     

Effect of preload reduction on sonographic myocardial integrated backscatter

PURPOSE: Sonographic myocardial tissue characterization with integrated backscatter (IBS) is affected by both structural and functional properties of the myocardium. The aim of the present study was to investigate the effect of preload reduction by hemodialysis (HD) on IBS measurements. METHODS: Fifty-two patients on maintenance HD underwent echocardiography before and after a routine HD session. Measurements included the variation of IBS during the cardiac cycle (CV-IBS) and calibrated IBS (cal-IBS). RESULTS: After HD, there were significant reductions in left ventricular end-diastolic and end-systolic dimensions and left atrial diameter. There was a reduction in stroke volume and LV ejection fraction consistent with a reduction in preload. Furthermore, CV-IBS was significantly lower after HD (7.9 +/- 2.2 versus 6.9 +/- 1.8 dB, 7.0 +/- 2.1 versus 6.2 +/- 1.9 dB, and 9.0 +/- 2.6 versus 8.1 +/- 2.0 dB [p < 0.01], respectively, in the left anterior, lateral, and inferior wall of the ventricle). Cal-IBS remained unchanged after dialysis compared with baseline. CV-IBS and ultrafiltration volume were significantly correlated. CONCLUSION: HD leads to a decrease in CV-IBS that appears to be preload-dependent. This finding is in concordance with diminished left ventricular performance during HD.     

脉压与冠心病患者左室肥厚的关系探讨

目的 探讨冠心病患者左室肥厚与脉压的关系.方法 将本院收治的96例冠心病患者根据脉压大小分为3组:A组30例,脉压≤45 mmHg;B组35例,55 mmHg≥脉压＞45 mmHg;C组31例,脉压＞55 mmHg.采用彩色超声心脏诊断仪测定舒张期室间隔厚度(IVST)、左室后壁厚度(PWT)、左室舒张末期内径(LVD...     

Low calcium dialysate increases cardiac relaxation in CAPD patients.

OBJECTIVE: To establish whether changes in serum calcium affect left ventricular (LV) function in continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS: This study was conducted on 28 clinically stable CAPD patients (11 females, 17 males). Left ventricular relaxation and systolic function were echocardiographically examined in all patients during standard dialysate (containing 1.75 mmol/L calcium) treatment. All patients were then changed to low calcium dialysate (1.25 mmol/L calcium) for 1 month and all patients were re-examined echocardiographically. Decrement in isovolumic relaxation time (IVRT) and deceleration time (DT), and increment in the ratio of peak early to peak late diastolic velocities (E/Amax) were admitted as indexes showing improvement in LV relaxation. 17 age- and sex-matched controls were also echocardiographically examined. RESULTS: Deceleration time, interventricular septal thickness at systole (IVSTS) and diastole (IVSTD), and posterior wall thickness at systole (PWS) and diastole (PWD) were higher in CAPD patients using standard dialysate than in normal controls. With the use of low calcium dialysate, DTs were similar but IVSTS, IVSTD, PWS, and PWD values remained higher. In normal controls, E/Amax values were higher than those in CAPD patients using standard dialysate (p < 0.001) and low calcium dialysate (p = 0.009). Serum intact parathyroid hormone level, weight, clinical volume status, and blood pressure were similar throughout the study period. Serum ionized calcium levels were decreased significantly during low calcium dialysate treatment. The changes in IVRT, DT, and E/Amax suggest improvement in LV relaxation during low calcium dialysate treatment. CONCLUSION: Left ventricular relaxation is increased with the use of low calcium dialysate compared with standard dialysate treatment.The idea of possible beneficial effects of increment in LV relaxation on cardiovascular morbidity and mortality deserves further studies.     

高血压病患者心脏结构及功能变化与心房颤动关系的研究

目的:评价高血压病患者合并不同类型心房颤动(房颤)时心脏结构及功能变化特点。方法:入选高血压病不伴房颤75例(A组)、伴阵发性房颤30例(B组)、伴持续或永久性房颤20例(C组)。所有患者均行24h动态心电图检查判定心律失常情况,多普勒超声心动图检查评价心脏结构和功能,同时用干式快速免疫荧光法定量测定血浆B型钠尿肽(BNP)浓度,协助评估心功能。结果:(1)3组间,C组的左心房内径(LAD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左室收缩末期内径(LVESd)、左室舒张末期内径(LVEDd)、左室质量指数(LVMI)、左心室室壁相对厚度(RWT)、血浆BNP浓度最大,左室射血分数(LVEF)最低,且均与其他2组有统计学差异(P<0.05);(2)B组的LAD、IVST、LVPWT、LVESd、LVEDd、LVMI、RWT、LVEF、血浆BNP浓度大于A组,但仅LAD、LVMI、血浆BNP浓度达统计学差异(P<0.05)。结论:高血压病患者合并房颤时左心结构及功能发生明显变化,且以合并持续或永久性房颤时最显著。     

家族史对原发性高血压患者左室形态及功能的影响

目的：观察家族史对原发性高血压患者左心形态及功能的影响。方法：选择高血压患者189例,其中有家族史92例,无家族史97例,血压正常者100例。分别测量左室舒张末期内径（LVIDed）、室间隔厚度（LVST）、左室后壁厚度（LPWT）,并计算左室重量指数（LVMI）、相对室壁厚度（RWT）,测量射血分数（EF）、短轴缩短率（FS）。应用组织多普勒测量二尖瓣环舒张早期峰值速度e（cm/s）及心房收缩期峰值速度a（cm/s）,计算e/a的值。再根据LVMI、RWT划分高血压患者左室几何构型,对各几何构型中有家族史及无家族史者的左心形态及功能变化进行分析。结果：有家族史者不同构型的LVIDed、LVST、LPWT均大于无家族史者。有家族史组舒张功能明显降低,在向心性肥厚型中较为显著。有家族史组收缩功能下降,在离心性肥厚性中较为明显。结论：家族史对原发性高血压患者左心形态、功能具有一定影响,在向心性肥厚及离心性肥厚型中表现明显。     

非透析慢性肾脏病患者sST2、NT-proBNP、hs-cTnT与左心室构型的相关性

目的 左室重构和肥厚在慢性肾脏病（Chronic Kidney Disease, CKD）患者中十分常见,并与其不良预后相关。可溶性生长刺激表达基因2蛋白（soluble growth Stimulation expressed gene 2, sST2）是一种与心脏重构相关的新型循环标志物。本研究探讨了CKD患者sST2和传统心脏标志物与左心构型的相关性。 方法 纳入2019年8月至2020年12月在上海复旦大学附属中山医院肾病科诊治的CKD患者。收集患者临床资料,检测心脏标志物sST2、N端脑钠肽前体（N-terminal pro-B-type natriuretic peptide, NT-proBNP）、高敏肌钙蛋白T（high-sensitivity cardiac troponin , hs-cTnT）。采用经胸超声心动图评估左心室结构,根据左心室质量指数（Left Ventricular Mass Index, LVMI）和相对室壁厚度（Relative Wall Thickness, RWT）定义左心室几何构型。采用受试者工作特征（Receiver operating characteristic , ROC）曲线分析各心脏标志物对左心室肥厚（Left Ventricular Hypertension, LVH）的预测效能。采用事后检验分析各左心构型间心脏标志物的组间差异。采用多元线性回归分析心脏标志物与心脏结构参数之间的相关性。 结果 共纳入CKD患者652例。LVH的检出率为33.4%,检出率随着肾功能的恶化而增加,在CKD5期患者为64.3%。与正常构型患者相比,NT-proBNP和cTNT水平在向心性或离心性肥厚组中均显著升高,而sST2水平仅在向心性肥厚组中显著升高。多元线性回归分析示NT-proBNP与左房内径、左心室舒张末期内径、左心室收缩末期内径、后壁厚度、室间隔厚度、左心室射血分数、左心质量和LVMI相关,hs-cTNT与左房内径、后壁厚度、室间隔厚度、左心质量、RWT和LVMI相关,sST2与左房内径、LVMI相关。 结论 sST2在向心性肥厚的CKD患者中明显升高,这一特征不同于传统心脏标志物。ST2/白细胞介素-33通路在CKD患者心脏重构过程中的作用机制有待进一步研究。     

Circulating natriuretic peptide concentrations in patients with end-stage renal disease: role of brain natriuretic peptide as a biomarker for ventricular remodeling.

OBJECTIVES: To determine levels of natriuretic peptides (NPs) in patients with end-stage renal disease (ESRD) and to examine the relationship of these cardiovascular peptides to left ventricular hypertrophy (LVH) and to cardiac mortality. PATIENTS AND METHODS: One hundred twelve dialysis patients without clinical evidence of congestive heart failure underwent plasma measurement of NP concentrations and echocardiographic investigation for left ventricular mass index (LVMI). RESULTS: Plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) concentrations correlated positively with LVMI and inversely with left ventricular ejection fraction, whereas C-type NP and Dendroaspis NP levels did not correlate with LVMI. In dialysis patients with LVH (LVMI >125 g/m2), plasma ANP and BNP concentrations were increased compared with those in dialysis patients without LVH (both P<001). In a subset of 15 dialysis patients without LVH or other concomitant diseases, plasma BNP concentrations were not significantly increased compared with those in 35 controls (mean +/- SD, 20.1+/-13.4 vs 13.5+/-9.6 pg/mL; P=.06), demonstrating that the BNP concentration was not increased by renal dysfunction alone. Furthermore, the BNP level was significantly higher in the 16 patients who died from cardiovascular causes compared with survivors (mean +/- SD, 129+/-13 vs 57+/-7 pg/mL; P<.003) and was significantly associated with greater risk of cardiovascular death in Cox regression analysis (P<.001), as was the ANP level (P=.002). CONCLUSIONS: Elevation of the plasma BNP concentration is more specifically related to LVH compared with the other NP levels in patients with ESRD independent of congestive heart failure. Thus, BNP serves as an important plasma biomarker for ventricular hypertrophy in dialysis patients with ESRD.     

终末期糖尿病肾病患者的心脏结构与功能

目的 观察终末期糖尿病肾病(DN)患者的心脏结构和功能,并分析其相关因素.方法 采用超声心动图检测36例DN患者(DN组)的心脏结构和功能,同时测定血压及生化指标,并与38例非DN的终末期肾病患者(non-DN组)比较.结果 (1)DN组的总胆固醇、低密度脂蛋白胆固醇显著高于non-DN组(P<0.05),而舒张压(DBP)、血白蛋白、肌酐明显低于non-DN组(P<0.05),脉压(PP)在数值上高于non-DN组,但未达统计学意义(P＝0.080).(2)DN组在左心房内径(LAD)、室间隔舒张期厚度(IVSDT)、左心室质量指数(LVMI)、左心室肥厚(LVH)的发生率显著高于non-DN组(P<0.05),两组在左心室射血分数和E/A无明显差异.(3)LVMI与PP(r＝0.346,P＝0.003)、LAD(r＝0.365,P＝0.002)、IVSDT(r＝0.581,P<0.001)、左心室后壁舒张期厚度(r＝0.678,P<0.001)、左心室舒张末期内径(r＝0.556,P<0.001)明显正相关,与DBP(r＝-0.237,P＝0.048)、血红蛋白(r＝-0.309,P＝0.023)、白蛋白(r＝-0.465,P<0.001)呈负相关.结论 终末期DN患者展现出明显的左心房扩大和LVH.对于DN患者,应积极控制心血管疾病的危险因素,逆转LVH.     

QT dispersion and signal-averaged electrocardiogram in hemodialysis and CAPD patients.

OBJECTIVE: The aim of this study was to compare QT dispersion (QTd) and signal-averaged electrocardiogram (SA-ECG) parameters that may predict risk of malignant arrhythmias in patients on hemodialysis (HD), on continuous ambulatory peritoneal dialysis (CAPD), and in controls. SETTING: Controlled cross-sectional study in a tertiary-care setting. PATIENTS: 28 HD (M/F 18/10; mean age 32 +/- 9 years), 29 CAPD (M/F 17/12; mean age 34 +/- 10 years), and 29 healthy controls (M/F 17/12; mean age 32 +/- 8 years) were included. INTERVENTIONS: On ECG, minimum (QTmin) and maximum (QTmax) QT duration and their difference (QTd) were measured. In SA-ECG, duration of filtered QRS, HFLA signals less than 40 microV, and RMS voltage (40 ms) were also measured. RESULTS: Higher serum Ca2+ and lower K+ levels were found in CAPD compared to HD. All QT parameters were increased in HD and CAPD compared to controls. QT dispersion was significantly prolonged in HD compared to CAPD. In HD, QTd was correlated with left ventricular (LV) mass index (r = 0.53, p = 0.004), but not in CAPD (r = -0.09, p = 0.63). QT dispersion was significantly prolonged in patients with LV hypertrophy compared to patients without hypertrophy on HD (68 +/- 18 ms vs 49 +/- 18 ms, p = 0.008). In the analysis of SA-ECG, 3 of the 28 (11%) HD and 2 of the 29 (7%) CAPD patients had abnormal late potentials. Patients on HD and CAPD had significantly higher filtered-QRS duration compared to controls (105 +/- 15 ms and 104 +/- 12 ms vs 95 +/- 5 ms, respectively, p = 0.04). Patients with LV hypertrophy had higher filtered-QRS duration compared to patients without hypertrophy (109 +/- 12 ms vs 95 +/- 8 ms, p < 0.001). CONCLUSION: Dialysis patients had prolonged QTd and increased filtered-QRS duration in SA-ECG compared to controls. Patients on HD had longer QTd than patients on CAPD. QTd has been correlated to LV mass index in HD, but not in CAPD. This difference might be due to the effect of different dialysis modalities on electrolytes, especially the higher serum Ca2+ levels.     

原发性高血压患者颈动脉内-中膜厚度与左室重构的相关性

目的：探讨原发性高血压（EH）患者颈动脉内-中膜厚度（IMT）与左心室重构的关系。方法：筛选本院EH患者78例（EH组）,并选取30例健康人为对照组,进行心脏及颈动脉超声检查。分别测量室间隔厚度（IVST）、左心室后壁厚度（LVPWT）、左心室舒张末期内径（LVDd）,计算左心室心肌重量指数（LVMI）;测量颈总动脉内-中膜厚度（CCA-IMT）、分叉处内-中膜厚度（BIMT）、斑块以及两侧颈总动脉的血流动力学参数。EH组依据LVMI又分为左心室肥厚（LVH）组和非左心室肥厚（NLVH）组。对所测得的各组数据进行统计分析。结果：EH组CCA-IMT、BIMT高于对照组,其中LVH组最高,颈动脉粥样硬化斑块检出率及严重程度在LVH组最高,NLVH组次之,两者均明显高于正常对照组。EH组颈动脉收缩期峰值流速（PSV）降低,阻力指数（RI）和搏动指数（PI）增高,LVMI与IMT,BIMT,RI和PI成正相关,与PSV成负相关。结论：彩色多普勒超声是检测EH患者颈动脉血管重构与左心室重构的一种可靠方法,颈动脉IMT与左心室重构的发生密切相关,且颈动脉重构的发生早于左心室心肌重构。