血液透析患者左心室肥厚相关因素分析

目的探讨血液透析患者左心室肥厚(LVH)发生情况及相关危险因素。 方法横断面调查选取江苏大学附属医院血液净化中心维持性血液透析(MHD)患者84例，采集一般情况、生化指标和同期心脏彩色多普勒超声检查结果，按左室心肌质量指数(LVMI)分为左室肥厚组(n＝50)和左室正常组(n＝34)，比较两组相关指标的差异。应用Spearman秩相关和多元线性回归分析评价影响左室肥厚的危险因素。 结果左室肥厚组尿素清除指数(Kt/V)、血红蛋白、透析龄均低于正常组，收缩压高于左室正常组，差异有统计学意义(P<0.05)。Spearman秩相关提示LVMI与尿素清除指数(Kt /V)呈负相关(r＝－0.342，P<0.05)，与超滤量、收缩压呈正相关(r ＝0.291、0.256，P<0.05)。多元线性回归分析提示Kt /V、收缩压、超滤量与血液透析患者左室肥厚相关(P<0.05)。 结论Kt /V是左室肥厚的保护因素，高收缩压、高超滤量是透析患者左室肥厚的独立危险因素。提高透析充分性，控制收缩压及透析间期入液量可能利于减少左室肥厚的发生。

Analysis of factors related to left ventricular hypertrophy in hemodialysis patients

ObjectiveTo investigate the incidence and related risk factors of left ventricular hypertrophy (LVH) in hemodialysis patients. MethodsA cross-sectional survey was conducted in 84 patients with maintenance hemodialysis (MHD) from the Blood Purification Centre of the Affiliated Hospital of Jiangsu University. All the patients were divided into 2 groups, the group with LVH (n=50) and the group without LVH (n=34), according to the left ventricular myocardial mass index (LVMI). The two groups were compared in the general information, blood biochemical indexes, and the color Doppler ultrasound of the heart. Spearman rank correlation and multiple linear regression analyses were used to evaluate the risk factors of LVH. ResultsThe urea clearance index (Kt/V), hemoglobin, and dialysis age were all lower, and the systolic blood pressure was higher in the group with LVH than in the group without LVH (all P<0.05). Spearman rank correlation analysis showed that the LVMI was negatively correlated with the urea clearance index Kt/V (r=-0.342, P<0.05), and positively correlated with the ultrafiltration volume and systolic pressure (r=0.291, 0.256, respectively, both P<0.05). The multivariate linear regression analysis showed that the urea clearance index Kt/V, systolic blood pressure, and ultrafiltration volume were correlated with the LVH of the hemodialysis patients (P<0.05). ConclusionsThe urea clearance index Kt/V was a protective factor of LVH. High systolic pressure and high ultrafiltration volume were independent risk factors of LVH in the dialysis patients. Improvement of the dialysis adequacy and control of both the systolic blood pressure and dialysis interval fluid intake may be helpful in reducing the incidence of LVH.