非透析慢性肾脏病患者肺动脉压变化及其与心脏形态功能的相关性研究

目的探讨非透析慢性肾脏病（CKD）患者肺动脉压变化及其与心脏形态、功能的相关性。方法回顾性分析2008年1月至2010年12月新诊断非透析CKD患者397例（CKD组）,同期健康体检者51例为对照组。比较两组肺动脉压（PAP）、血浆脑钠肽（BNP）及左房内径（LA）、室间隔厚度（IVST）、左室舒张末期内径（LVDd）、左室收缩末期内径（LVDs）、左室射血分数（LVEF）、左室质量指数（LVMI）等参数的差异,探讨非透析CKD患者肺动脉压变化及其与心脏形态、功能之间的相关性。结果非透析CKD组肺动脉压明显高于对照组（33.13±9.00）mm Hg比（29.43±3.71）mm Hg,P〈0.01],CKD组总的肺动脉高压发生率为18.9%。CKD（4～5期）组肺动脉压较CKD（1～3期）组显著增高（35.90±9.34）mm Hg比（32.08±8.62）mm Hg,P〈0.01）],肺动脉高压发生率明显升高（21.60%比13.47%,P〈0.01）。与对照组比较,CKD组BNP的自然对数值（lnBNP）（3.59±1.63）pg/mL比（2.88±1.51）pg/mL,P〈0.01]、LA（40.42±6.77）mm比（36.75±4.94）mm,P〈0.01）]、左室后壁厚度（LVPW）（9.55±1.96）mm比（8.54±0.88）mm,P〈0.01）]、IVST（9.76±1.75）mm比（8.71±0.90）mm,P〈0.01）]、LVMI（105.61±36.47）g/m2比（87.41±17.08）g/m2,P〈0.01）]均显著升高。单因素相关分析显示PAP与肾小球滤过率（GFR）呈负相关（r=-0.461,P〈0.01）,与LA（r=0.491,P〈0.01）、LVPW（r=0.298,P〈0.01）、IVST（r=0.613,P〈0.01）、lnBNP（r=0.536,P〈0.01）、LVMI（r=0.382,P〈0.01）呈正相关。多元线性回归分析结果显示LVMI和lnBNP是PAP的独立危险因素,其回归方程为：y=16.447＋0.105x1＋1.724x2（F=23.482,P=0.000）,y代表PAP（mm Hg）,x1为LVMI（g/m2）,x2为lnBNP（pg/mL）。结论非透析CKD患者普遍存在肺动脉高压,并随肾功能恶化而加剧。肺动脉压与lnBNP、LVMI、LA、LVPW、IVST等心脏功能和形态指标有关,lnBNP和LVMI是影响肺动脉压的独立危险因素。

Pulmonary Arterial Pressure in Patients with Predialysis Chronic Kidney Disease and Its Relationship to Cardiac Structure and Function

Objective To explore the pulmonary arterial pressure level in patients with predialysis chronic kidney disease(CKD) and its relationship to cardiac structure and function.Methods 397 patients with predialysis CKD and 50 healthy subjects were enrolled.Cardiac structure was evaluated by Doppler echocardiography.Glomerular filtration rate(GFR) were assessed by radiant 99mTc-DTPA.Differences of PAP,BNP,LA,IVST,LVDd,LVDs,LVEF,LVMI and the correlation of PAP with cardiac structure and function were examined. Results The PAP level in the predialysis CKD patients was much higher than that in the healthy subjects (33.13±9.00) mm Hg vs.(29.43±3.71) mm Hg,P<0.01].18.9% of the CKD patients were complicated with pulmonary hypertension.PAP was higher in the CKD patients in stages 45 than those CKD patients in stages 1-3 (35.90±9.34) mm Hg vs.(32.08±8.62) mm Hg,P<0.01)],so as to the prevalene of pulmonary hypertension(21.60% vs.13.47%,P<0.01).Compared with the healthy,the level of lnBNP (3.59±1.63) pg/mL vs.(2.88±1.51) pg/mL,P<0.01],LA (40.42±6.77) mm vs.(36.75±4.94) mm,P<0.01)],LVPW (9.55±1.96) mm vs.(8.54±0.88) mm,P<0.01)],IVST (9.76±1.75) mm vs.(8.71±0.90) mm,P<0.01)],LVMI (105.61±36.47) g/m2 vs.(87.41±17.08) g/m2,P<0.01)] were all much higher.There was a negative correlation between PAP and GFR(r=-0.461,P<0.01),and positive correlations between PAP and LA(r=0.491,P<0.01),LVPW(r=0.298,P<0.01),IVST (r=0.613,P<0.01),lnBNP(r=0.536,P<0.01),LVMI(r=0.382,P<0.01).LVMI and lnBNP were both independent risk factors of PAP.The regression equation:y=16.447+0.105x1+1.724x2(F=23.482,P=0.000),y:PAP(mm Hg),x1:LVMI(g/m2),x2:lnBNP(pg/mL).Conclusions Pulmonary hypertension is a common morbidity of predialysis CKD patients,and deteriorates with degression of renal function.PAP is related to indexes of cardiac structure(LVMI,LA,LVPW,IVST) and index of cardiac function(lnBNP).LnBNP and LVMI are independent risk factors of PAP.