血红蛋白浓度对维持性血液透析患者心脏结构的影响

目的回顾性分析血红蛋白不同浓度对改善维持性血液透析患者心脏结构的影响。方法选择2007-2010年间武警总医院和解放军第九四医院维持性血液透析患者60例,均无原发性心脏病和心肌肥厚。根据最近2年的血红蛋白浓度分为高血红蛋白组和低血红蛋白组,比较两组的左心室容量指数（left ventricular volume index,LVVI）、左心室重量指数（leftventricular mass index,LVMI）。结果两组平均年龄、接受透析时间、基线血红蛋白水平和LVVI无差异;15%的患者为糖尿病肾病。两组间血红蛋白浓度、每周促红素用量有明显差异,分别为（12.1±2.7）vs（10.2±1.7）]g/dl和（117±25.6）vs（83.5±22.6）]U/（kg.周）。LVVI、LVMI无差异。但高血红蛋白组的收缩压较低血红蛋白组高（137±9.3）vs（132±8.7）]mmHg（1mmHg=0.133kPa）（P=0.046）。结论高血红蛋白未能改善维持性血液透析患者的心脏结构,却增加了促红素的用量和高血压的发生率。结论有待随机双盲的大样本实验进一步证实。

Effect of hemoglobin level on heart structure of patients on hemodialysis

Objective To retrospectively analyze the effect of hemoglobin level on heart structure in patients on hemodialysis.Methods Sixty patients without primary heart disease and myocardial hypertrophy who underwent hemodialysis from 2007-2010 were divided into high hemoglobin group and low hemoglobin group.Their left ventricular volume index（LVVI）and left ventricular mass index（LVMI） were compared.Results No significant difference was found in the mean age,hemodialysis time,baseline hemoglobin level,and LVVI between the two groups.Diabetic nephropathy was diagnosed in 15% of the patients.The hemoglobin level and epoetin used per week were significantly lower in low hemoglobin group than in high hemoglobin group（12.1±2.7）g/dl and（0.2±1.7）g/dl vs（117±25.6）U/（kg·w） and（83.5±22.6）U/（kg·w）,P=0.00].No difference was observed in LVVI and LVMI between the two groups.However,the systolic pressure was higher in high hemoglobin group than in low hemoglobin group（137±9.3）mmHg vs（132±8.7）mmHg,P=0.046].Conclusion High hemoglobin level cannot improve the heart structure of patients on hemodialysis,but increases the epoetin used per week and the incidence of systolic pressure,which should be further confirmed in double-blind study with a large sample.