慢性肾衰患者甲状旁腺激素与左心室结构和功能的关系

目的：心血管并发症是慢性肾衰（CRF）一个常见而严重并发症。CRF患者常伴继发性甲旁亢（SHPT），有甲状旁腺激素（PTH）的增高，为了解PTH的增高与左室结构与功能的关系特作此研究。方法：通过对60例维持性血透患者心超与心功能检测及与血PTH的相关分析，了解CRF患者心脏结构与功能改变特征及PTH的关系。结果：76．6％ CRF患者有左室肥厚（LVH），其中52．2％为偏心性肥厚，43．5％为向心性肥厚，4．3％为单纯扩张，心功能损害以左心舒张功能受累为主，占81．7％，并出现早。54／60例（90％）血PTH增高，且与左室后壁厚度（LVPWT），室间隔厚度（IVST），左室心肌重量指数（LVMI）正相关，与左室舒张功能E／A负相关。结论：CRF时血PTH增高是影响左结构与功能的重要因素之一。

Increased serum parathyroid hormone level is associated with left ventricular hypertrophy and dysfunction in chronic hemodialysis patients

Objective:Cardiovascular problem happens usualy as one of the severe complications of chronic renal failure.The patients may show the signs of secondary hyperparathyroidism.The expression of receptors for parathyroid hormone(PTH)has been discovered in cardiovascular smooth muscle cells.Cardiovascular effects of increased serum PTH are reported in primary parathyroidism. Methodology:In this study,echocardiography was performed and serum PTH level determined in 60 patients with maintenance hemodialysis.The investigations for discovery of the association between increased serum PTH and left ventricular hypertrophy(LVH)and dysfunction in this group of patients were carried out. Results:The overall prevalence of LVH was 76 6%,with eccentric LVH found in 52 5%,endocentric LVH in 43 5% and simple left ventricular dilation in 4 3% of these patients.In this patient group left ventricular diastolic dysfunction occurred in 81 7% and systolic dysfunction in 6 3%.Increased serum levels of PTH were found in 90% of these patients,and PTH level was found significantly positively correlated to LVPW,IVST and LVMI and negatively correlated to left ventricular diastolic function(E/A). Conclusion:This study supports that the increasing serum PTH in uremia is a systemic toxin and it contributes to the cardiovascular complications(as LVH and left ventricular dysfunction)in patients with hemodialysis.