目的 探讨维持性血液透析(MHD)患者肺动脉高压(PHT)的发生率及相关影响因素,以早期诊断并进行干预.方法 选取我科2008-2012年收治的以动静脉内瘘作为透析血管通路、透析时间在1年以上的资料完整的MHD患者84例,根据超声心动图检测的肺动脉收缩压(PASP)＞35 mm Hg诊断PHT.比较MHD合并PHT组(PHT组)和MHD不合并PHT组(非PHT组)患者的临床资料、实验室检查指标及心脏超声检查指标;比较不同透析龄、原发病、临床表现的患者PHT发生率及PASP;采用多因素Logistic回归分析MHD患者发生PHT的相关因素.结果 (1)84例患者中,36例(42.9%)并发PHT,PASP(53.1±11.8)mm Hg.与非PHT组比较,PHT组患者透析龄长,血红蛋白(Hb)水平降低,左房内径、左室舒张末内径、主肺动脉内径、右房内径及左室射血分数(LVEF)＜50%、舒张早期和舒张晚期最大血流速度之比(E/A)、瓣膜钙化者比例均增高,LVEF下降,差异均有统计学意义(P＜0.05).(2)透析龄＞5年组MHD患者PHT发生率及PASP高于透析龄＜2年组,有呼吸困难的MHD患者PHT发生率及PASP高于无症状者,差异有统计学意义(P＜0.05);而原发病为糖尿病的MHD患者PHT发生率及PASP与非糖尿病患者比较,差异无统计学意义(P＞0.05).(3)Logistic回归分析显示,Hb、瓣膜钙化、E/A与MHD并发PHT存在回归关系(P＜0.05).结论 MHD患者PHT的发生率为42.9%;透析龄＞5年者PHT发生率显著升高.贫血、转移性钙化、左室舒张功能减退可能参与了MHD患者PHT的发生.%Objective To investigate the incidence of pulmonary hypertension ( PHT ) and its correlative influential factors in patients receiving long - term maintenance hemodialysis ( MHD ), to give early diagnoses and intervention. Methods A retrospective analysis was performed on complete clinical data of 84 patients admitted for over - 1 - year MHD with internal arteriovenous fistula as hemodialysis vascular access and with echocardiography pulmonary artery systolic pressure ( PASP ) > 35 mm Hg for PHT diagnosis. The clinical data, laboratory parameters, cardiac ultrasound parameters were compared between groups PHT, non -PHT, and PHT incidence, PASP between patients with and without dialysis ages ( DA ), primary diseases, clinical manifestations. Multifactor Logistic regression analysis was used to find related factors of PHT. Results ( 1 ) Thirty -six ( 42. 9% ) patients were diagnosed as PHT with mean PASP ( 53. 1 ±11.8 ) mm Hg. DA was longer, hemoglobin ( Hb ) lower, left atrial diameter, left ventricular end - diastolic diameter, main pulmonary artery, right atrial diameter, left ventricular ejection fraction ( LVEF ) < 50% , diastolic early and late diastolic peak velocity ratio ( E/A ) and proportion of valvular calcification higher, LVEF lower in PHT group than in non -PHT group, the differences were significant ( P <0. 05 ). ( 2 ) PHT incidence and PASP were higher in DA > 5 - year group than in < 2 - year group, higher in patients with dyspnea than in those without, the difference was significant ( P <0. 05 ). There was no difference in PHT incidence or PASP between MHD patients with diabetes as primary disease and those without diabetes. Logistic regression analysis showed that Hb, valvular calcification, E/A had regressive relationship to MHD combined with PHT ( P < 0. 05 ). Conclusion The incidence of PHT is 42. 9% in MHD patients, and remarkably higher in DA > 5 - year patients. Anemia, metastatic calcification, left ventricular diastolic dysfunction may be involved in the occurrence of PHT in MHD patients.
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