老年慢性肾脏病患者左心室肥厚危险因素分析

摘要

Objective To explore the risk factors of left ventricular hypertrophy (LVH)in elderly patients with chronic kidney disease (CKD)1 -4 stages.Methods 1 98 cases of hospitalized patients over 65 years old with CKD in 1 -4 stages were selected and divided into LVH group and non LVH group according to left ventricular mass index(LVMI).Collecting the 24 hours ambulatory blood pressure and laboratory indices to analyze risk factors of LVH in CKD 1 -2 stages and CKD 3-4 stages.Results (1 )In the 1 98 cases of elderly patients with CKD,58 cases with LVH accounted for 29.3%.The prevalence of LVH in CKD 1 -4 stages were 8.1 %,26.2%,36.8% and 60.0%,respectively(P <0.01 ). (2)Compared with non-LVH group,patients in CKD 1 -2 stages with LVH had higher diurnal and nocturnal systolic blood pressure (SBP),diastolic blood pressure (DBP),mean arterial pressure level (MBP)and nocturnal hypertension incidence.Patients in CKD 3-4 phstages with LVH had higher serum phosphorus, calcium phosphorus product,day and night SBP and non dipper blood pressure rhythm incidence(P <0.05). (3)Diurnal and nocturnal SBP,DBP,MBP and nocturnal hypertension had positive correlation with LVH in CKD 1 -2 stages.Diurnal and nocturnal SBP increasing,non dipper blood pressure rhythm and serum phosphorus,calcium phosphorus product had positively correlation with LVH in patients of CKD 3-4 stages (P <0.05).(4)Women,24h-MBP were the risk factors of LVH in patients with CKD 1 -2 stages.Blood phosphorus and nocturnal SBP were the risk factors of LVH in patients with CKD 3-4 stages.Conclusion LVH in elderly patients with CKD is common.SBP increasing,calcium and phosphorus metabolism,renal function impairment are the significant causes of LVH in the elderly with CKD.%目的：探讨老年慢性肾脏病（CKD）1～4期患者发生左心室肥厚（LVH）的危险因素。方法选取198例 CKD 1～4期年龄≥65岁患者，根据左心室质量指数（LVMI）分为 LVH 组与非 LVH 组。收集动态血压、实验室检查指标，分别分析 CKD 1～2期、CKD 3～4期 LVH 的危险因素。结果（1）198例老年 CKD 患者中 LVH 58例（29．3％），CKD 1～4期 LVH 发生率分别为8．1％、26．2％、36．8％和60．0％（P ＜0．01）；（2）CKD 1～2期患者 LVH 组日间与夜间收缩压（SBP）、舒张压（DBP）、平均动脉压（MBP）水平及夜间高血压发生率高于非 LVH 组（P ＜0．05）；CKD 3～4期患者 LVH 组血磷、钙磷乘积、日间与夜间 SBP 水平及非杓型血压节律发生率高于非LVH 组（P ＜0．05）。（3）单因素相关分析显示，CKD 1～2期患者 LVH 与日间及夜间 SBP、DBP、MBP 水平、夜间高血压呈正相关；CKD 3～4期患者 LVH 与日间及夜间 SBP、非杓型血压节律、血磷、钙磷乘积呈正相关（P 均＜0．05）。（4）多因素 Logistic 回归分析结果显示，女性、24h-MBP 是CKD 1～2期患者 LVH 危险因素；血磷、夜间收缩压是 CKD 3～4期患者 LVH 危险因素。结论老年 CKD1～4期 LVH 发生率高，收缩压升高、钙磷代谢紊乱、肾功能损害是老年 CKD 患者 LVH 的重要原因。