维持性血液透析患者左心室肥厚进展情况和相关危险因素分析

摘要

Objective· To observe the progression of left ventricular hypertrophy (LVH) in maintenance hemodialysis (MHD) patients,and to analyse risk factors of the progression of LVH.Methods· Stable MHD patients of Ruijin Hospital,Shanghai Jiao Tong University School of Medicine were enrolled in July 2012.These patients were followed for 1 year.Clinical characteristics and laboratory indices were collected at baseline and 1-year followup.Left ventricular mass (LVM) was evaluated by ultrasonic cardiogram.Left ventricular mass index (LVMI) increased more than 5％ was defined as LVH progression.Results · Totally 71 MHD patients were enrolled in this study.44 patients were males,with median age 55.9 years old,median dialysis vintage 152.1 months.22 (30.99％) patients had LVH at enrollment.A significant higher percentage of MHD patients used calcium-channel binder (CCB) and angiotensin-converting-enzyme inhibitor (ACEI) in LVH group,while a significant higher NT-proBNP level was also showed in LVH group.31 patients had LVH progression while 40 patients didn't after 1 year.Patients in progression group had significant higher levels of total cholesterol and low-density lipoprotein cholesterol (LDL-C).In univariable and multivariable Logistic regression,total cholesterol and LDL-C were independent risk factors of LVH progression (OR=2.515,95％ CI 1.219-5.910,P=0.013;OR=1.950,95％ CI 1.127-3.375,P=0.017).Conclusion · LVH is one of the common cardiovascular complications in MHD patients.The proportion of use of antihypertensive drugs is higher in the patients with LVH.Higher LDL-C and total cholesterol levels are risk factors for the progression of LVH.%目的·观察维持性血液透析(maintenance hemodialysis,MHD)患者左心室肥厚(left ventricular hypertrophy,LVH)的进展情况,分析影响LVH进展的危险因素.方法·选取2012年7月上海交通大学医学院附属瑞金医院血液净化中心病情稳定的MHD患者为研究对象,随访1年;收集入组时和1年后患者的临床资料和实验室指标,通过超声心动图评估左心室质量.定义1午后左心室心肌质量指数进展超过5％为LVH进展.结果·共71例MHD患者纳入研究,男性44例,中位年龄55.9岁,中位透析龄152.1个月.入组时,22例(30.99％)患者合并LVH.LVH组患者服用钙离子拮抗剂、血管紧张素酶抑制剂的比例较高,氨基末端B型脑钠肽前体(NT-proBNP)水平较高,组间差异均有统计学意义(P＜0.05).随访1年,31例患者出现LVH进展,40例患者LVH好转或稳定;LVH进展组患者总胆固醇和低密度脂蛋白胆固醇(LDL-C)均较LVH无进展组显著增加(P＜0.05).单因素和多因素Logistic回归结果显示,LDL-C和总胆固醇是LVH进展的危险因素(OR=2.515,95％ CI为1.219 ～ 5.910,P=0.013;OR=1.950,95％ CI为1.127 ～ 3.375,P=0.017).结论·LVH是MHD患者常见的心血管并发症之一;LVH患者使用高血压药物治疗的比例更高;LDL-C和总胆固醇是LVH进展的危险因素.