透析治疗对终末期肾病患者左心室肥厚的影响

目的 探讨不同透析方式-血液透析(HD)和腹膜透析(PD)对终末期肾病患者左心室肥厚(LVH)的影响及相关因素.方法入选透析中心透析龄大于3月的HD患者48例和PD惠者62例,并选取慢性肾脏病(CKD)3～5期患者43例作为对照.所有患者均测量血压、血容量、生化指标,行超声心动图检查,获得左心室质量指数(LVMI);HD患者于透后1小时内检查.PD和CKD患者于每月门诊复诊时空腹状态下检查.结果 3组患者的基线资料差异无统计学意义.HD患者的收缩(SBP)(156.7±28.4)mmHg明显高于PD(147.7±20.6)mmHg(P<0.05)和CKD患者(143.4±21.9)mmHg(P<0.01);HD患者透后的细胞外液(ECW)(14.51±2.51)L低于PD(15.67±3.26)L和CKD患者(15.84±3.27)L(P均<0.05);HD患者的LVMI 137.6±38.5显著高于PD 116.2±34.5和CKD患者104.5±30.0(均P<0.01),而PD和CKD患者的LVMI比较差异无统计学意义.根据Framingham标准HD、PD、CKD患者LVH发生率分别为68.8%、45.2%、32.6%.多元逐步回归分析显示SBP、透析方式(HD)、ECW均为LVMI的独立预测因素(r2=0.364,P<0.01).结论HD较PD患者展现出更高更严重的LVH.LVH与高血压、容量超负荷等有关.

Effect of dialysis modality on left ventricular hypertrophy in patients with end-stage renal disease

Objective To investigate the effect of hemodialysis（HD） and peritoneal dialysis（PD） on left ventricular hypertrophy（LVH） in patients with end-stage renal disease,and analyze the associated factors.Methods 48 HD and 62 PD patients receiving treatment for at least 3 months in dialysis center were enrolled.In addition,43 patients with the stage from 3 to 5 chronic kidney diseases（CKD） were also included.All patients underwent blood pressure measurements and echocardiographic examinations.The left ventricular mass index（LVMI） was calculated.Volume status was assessed by bioelectrical impedance analysis.At the same time,biochemistry parameters were also measured.For HD patients,all the following measurements were performed within one hour post-dialysis.In PD and CKD patients,the measurements were performed at a monthly scheduled visit,during the time the abdominal cavity was empty.Results There was no baseline difference in demographics among the three groups.As expected,systolic blood pressure（SBP） in HD patients（156.7±28.4） mmHg was significantly higher than that in PD（147.7±20.6） mmHg（P0.05） and CKD patients（143.4±21.9） mmHg（P0.01）.Extracellular water（ECW） was lower in HD（14.51±2.51） L than PD（15.67±3.26） L（P0.05） and CKD patients（15.84±3.27） L（P0.05）.The LVMI was markedly higher in HD patients 137.6±38.5 as compared to PD 116.2±34.5（P0.01） and CKD patients 104.5±30.0（P0.01）,while there was no significant difference in LVMI between PD and CKD patients.Thus,the prevalence of LVH according to the Framingham criteria was 68.8% in HD patients,45.2% in PD patients,and 32.6% in CKD patients.Finally,in a linear stepwise regression model（r2=0.364,P0.01）,SBP,treatment modality（to be in HD）,and ECW were all independent predictors of LVMI.Conclusion In a cross-sectional analysis of patients in dialysis center,HD patients showed a higher LVMI and a higher prevalence of LVH than PD patients.The LVMI was associated with high blood pressure,volume overload and others.