维持性血液透析甲状旁腺激素水平对心脏结构与功能的影响

目的探讨维持性血液透析(MHD)患者甲状旁腺激素(PTH)水平对心脏结构和功能的影响。方法106例MHD患者进行PTH水平测定,根据PTH值将MHD患者分为L-PTH组(PTH<500pg/ml),M-PTH组(PTH500～800pg/ml)和H-PTH组(PTH>800pg/ml),并进行心脏彩色多普勒超声检查,测量心脏室间隔厚度(IVST)、左心室后壁厚度(LVPWT),计算左室心肌质量指数(LVMI),射血分数(EF)、E峰与A峰流速比值(E/A),比较3组心脏超声检查结果。结果106例MHD患者均符合继发性甲状旁腺功能亢进(SHPT)诊断标准,L-PTH组39例,M-PTH组36例,H-PTH组31例。3组透析时间比较,H-PHT组>M-PHT组>L-PHT组,差异均有统计学意义(P<0.05或P<0.01)。M-PTH组和H-PTH组IVST、LVPWT、LVMI明显高于L-PTH组,EF、E/A明显低于L-PTH组,差异具统计学意义(P<0.01);而H-PTH组IVST、LVPWT、LVMI明显高于M-PTH组,EF、E/A明显低于M-PTH组(P<0.01)。结论PTH水平随透析时间延长而升高,能够影响MHD患者的心脏结构和功能。

Effect of parathyroid hormone on cardiac structure and function in maintenance hemodialysis patients

Objective To explore the effect of parathyroid hormone(PTH)on cardiac structure and function in maintenance hemodialysis(MHD)patients.Methods One hundred and six MHD patients were divided into L-PTH group(PTH<500 pg/ml),M-PTH group(PTH range from 500 pg/ml to 800 pg/ml)and H-PTH group(PTH>800 pg/ml).All cases underwent echocardiography examination.The ventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT)and left ventricle mass index(LVMI),ejection fraction(EF)and the E/A peak ratio were calculated for assessing cardiac function.The results were compared among three groups.Results All patients were proved to be secondary hyperparathyroidism(SHPT).39,36 and 31 cases were respectively ranked in L-PTH group,M-PTH group and H-PTH group.The hemodialysis lasted longer in H-PTH group than M-PTH group and L-PTH group(P<0.05 or P<0.01).The values of IVST,LVPWT and LVMI in H-PTH and M-PTH group were significantly higher than L-PTH group,while the EF and the value of E/A ratio were significantly lower than L-PTH group(P<0.01).Furthermore,the values of IVST,LVPWT and LVMI were obviously higher than M-PTH group,while EF and value of E/A peak ratio were lower(P<0.01).Conclusion It proved that the level of PTH increased with hemodialysis time,and the cardiac Stracture and function were effected in MHD patients.