腹膜透析患者肺淤血危险因素分析及肺超声对其容量状态的评估价值

摘要

目的 调查肺淤血在腹膜透析(腹透)患者的发生率及分析其发病的危险因素,探讨肺超声在腹透患者容量评估中的应用价值.方法 将98例腹透患者按B线数目分两组,无或轻度肺淤血组(B线≤15)和中重度肺淤血组(B线＞15),比较两组间临床指标的差异,二分类logistic回归分析影响肺淤血发生的危险因素.x2检验比较以肺超声及下肢水肿评估容量的一致性.Spearman相关分析B线数目和血B型尿钠肽水平的相关性.结果 肺淤血发生率52.0％,中重度者达37.8％.与无或轻度肺淤血组相比,中重度肺淤血组糖尿病、肺动脉高压和NYHAⅢ～Ⅳ级者较多,而血白蛋白、钙磷乘积较低(P均＜0.01).多因素分析显示糖尿病、低白蛋白血症及肺动脉高压是肺淤血发生的独立危险因素(P均＜0.05).下肢水肿者83.3％存在肺淤血,而肺淤血者仅39.2％存在下肢水肿(Kappa＜0.4,P＜0.01).B线数目和血B型尿钠肽水平显著相关(r=0.692,P＜0.01).结论 腹透患者肺淤血发生率高.肺淤血的发生与糖尿病、低白蛋白血症及肺动脉高压有关.下肢水肿预测肺淤血准确度低.肺超声或有助指导容量超负荷的早期诊断与干预.%Objective To investigate the prevalence of pulmonary congestion (PC) and its risk factors in peritoneal dialysis patients,and to appraise the value of lung ultrasonography (LUS) in volume assessment in this population.Methods Ninety-eight peritoneal dialysis patients were divided into two groups according to B lines number,the no or mild PC group (B lineses ≤ 15) and the moderate to severe PC group (B lines ＞ 15).The differences in clinical parameters were compared between the two groups,and risk factors of PC were analyzed by binary logistic regression analysis.The consistency of volume assessment between LUS and lower extremity edema (LEE) was analyzed,and the correlation between B lines number and serum B-type natriuretic peptide (BNP) level was explored.Results Prevalence of PC was 52.0％,while that of moderate to severe PC was up to 37.8％.Compared with no or mild PC,pulmonary arterial hypertension (PAH),diabetes and NYHA class Ⅲ-Ⅳ were more common,while serum albumin,serum calcium and phosphorus product were lower in the moderate to severe PC group (P ＜ 0.01).Multivariate analysis showed that diabetes,hypoalbuminemia and PAH were independent risk factors of PC.Among those with LEE,83.3％ exhibited PC in LUS.However,only 39.2％ presented LEE among those with PC (Kappa ＜0.4,P ＜0.01).The number of B lines was significantly correlated with the level of BNP (r--0.692,P ＜ 0.01).Conclusion Prevalence of PC in peritoneal dialysis patients is high.Diabetes,hypoalbuminemia and PAH are associated with the occurrence of PC.LEE poorly predicts PC.LUS could serve as a novel useful tool in guiding early diagnosis and intervention of volume overload.