维持性血液透析136例患者超声心动参数与肺动脉压的相关性分析

目的通过心脏彩色多普勒检查对136例维持性血液透析(MHD)患者心脏结构、功能的各项参数进行评估,并通过各项参数与肺动脉压力的相关性分析,了解引发肺动脉高压的相关因素。方法对中山大学附属第五医院血液净化中心符合研究入选标准的136例MHD患者做横断面研究。根据超声心动图的检查结果将患者分为肺动脉高压组(PH组,PASP>35 mmHg)、肺动脉压力正常组(nPH组,PASP≤35 mmHg),并将超声心动图检测指标与肺动脉压力做相关性分析。结果 PH组较nPH组患者的左、右心房及心室明显增大、心肌肥厚程度较重;PH组较nPH组患者心脏收缩及舒张功能下降;PH组较nPH组患者心脏处于高循环动力状态(均P<0.05)。肺动脉压力与肺动脉内径、肺动脉最高流速、右心房内径、左心房内径、右心室内径、左心室收缩末期内径、左心室舒张末期内径、室间隔厚度、左心室质量、左心室质量指数、心输出量呈正相关(均P<0.001);与左心室舒张早期和舒张晚期最大血流速度之比(E/A)、左心室射血分数、左心室短轴缩短率呈负相关(均P<0.001)。结论 MHD患者心脏的结构和功能的病变是引起肺动脉高压的重要原因之一,同时肺动脉压的升高可能进一步加重MHD患者的心脏病变;其中心脏舒张功能下降是引起肺动脉压升高重要因素。左心室收缩功能减低,可导致肺动脉压升高。

The correlation analysis between echocardiographic parameters and pulmonary arterial pressure for a total of 136 maintenance hemodialysis patients

Objective To assess the parameters of cardiac structure and function by Doppler echocardiographic examinations in a total of 136 maintenance hemodialysis（MHD） patients and assess relationship between these parameters and pulmonary artery pressure, we explorer related factors causing pulmonary hypertension in MHD patients. Methods A total of 136 MHD patients from the fifth affiliated hospital of Sun Yat-Sen University were included the cross-sectional study, they were divided into PH and nPH groups according to the echocardiographic results. We make a correction analysis for these results and pulmonary artery pressure. Results The values of left, right atrium and ventricle were statistic significantly higher in PH group than those in nPH group;the degree of cardiac hypertrophy in PH group was greater than nPH group; cardiac systolic and diastolic function in PH group was significantly lower than nPH group;the cardiac output in PH group was significantly higher than nPH group（all P＆lt;0.05）. As the same time, the value of PH was positively correlated with diameter of pulmonary artery, maximum flow rate of pulmonary artery, diameter of right atrium, diameter of left atrium, diameter of right ventricular, diameter of left end-systolic ventricular, diameter of left end-diastolic ventricular, septal thickness, left ventricular mass, left ventricular mass index, cardiac output（all P＆lt;0.001）;was negatively correlated with E/A, left ventricular ejection fraction, fractional shortening（all P＆lt;0.001）. Conclusions The change of cardiac structure and function in MHD patients is one of possible causative factors of PH. And elevated pulmonary blood pressure may further aggravate MHD. The decline of cardiac diastolic function is an important cause of PH. A decline of left ventricular systolic function also cause PH in MHD patients.