维持性血液透析患者左心室舒张功能障碍因素分析

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[摘要] 目的 探讨维持性血液透析患者左心室舒张功能障碍的发生率及相关因素。 方法 对46例维持性血液透析患者进行超声心动图检查，将对象分为阳性组和阴性组，每组各24例，研究其氮、血红蛋白、血浆白蛋白，并进行统计学分析。 结果 46例维持性血液透析患者中，检测两组年龄、透析龄、每周透析时间、血肌酐、血尿素声心动图后发现左心室舒张功能障碍28例，发生率为60.9%，阳性组年龄、血红蛋白与阴性组比较差异有统计学意义（P < 0.05）；患者的年龄与左心室舒张功能障碍的发生有明显相关性（P < 0.05）。 结论 维持性血液透析患者左心室舒张功能障碍不少见，本研究显示患者年龄因素是唯一一个有明显相关性的指标。

[关键词] 血液透析；左心室舒张功能障碍；血红蛋白；年龄

[中图分类号] R541.6；R692 [文献标识码] A [文章编号] 1673-7210（2012）08（c）-0062-02

Factor analysis of left ventricular diastolic dysfunction of patients undergoing maintenance hemodialysis

ZENG Yuran WANG Weihong TAN Fengjiao LIN Tanfa

Department of Blood Purification, the First Affiliated Hospital of Medical College of Shantou University, Guangdong Province, Shantou 515041, China

[Abstract] Objective To investigate the incidence and related factors of left ventricular diastolic dysfunction in patients undergoing maintenance hemodialysis. Methods A total of 46 patients undergoing maintenance hemodialysis were given echocardiography and then they were divided into the positive group and the negative group based on whether they had left ventricular diastolic dysfunction. Age, age of dialysis, weekly duration of dialysis, serum creatinine, blood urea nitrogen, hemoglobin and serum albumin of the two groups were detected. Results In the 46 patients undergoing maintenance hemodialysis, echocardiography discovered 28 patients with left ventricular diastolic dysfunction, with the incidence rate of 60.9%. The results showed that age and hemoglobin were significantly different between the two groups (P < 0.05), but only age was significantly correlated to the left ventricular diastolic dysfunction (P < 0.05). Conclusion Left ventricular diastolic dysfunction is not uncommon in patients undergoing maintenance hemodialysis and patients' age is its only significant indicator.

[Key words] Hemodialysis; Left ventricular diastolic dysfunction; Hemoglobin; Age

维持性血液透析患者发生心血管疾病的风险是健康人群的10～20倍，而死亡原因中的40%～50%是心血管疾病所致，资料显示终末期慢性肾脏病患者舒张功能减退是影响患者存活的独立危险因素[1-2]，本研究旨在探讨维持性血液透析患者左心室舒张功能障碍发生的相关因素，以期能早期防治。

1 资料与方法

1.1 一般资料

收集我院血液净化科行维持性血液透析的患者（透析龄≥12个月）46例，其中，男18例，女28例，年龄18～80岁，平均（60.02±14.46）岁，透析时间12～105个月，平均（27.15±18.24）个月，每周透析时间4～12 h，平均（8.30±1.58） h。原发病慢性肾炎28例，糖尿病肾病 9例，高血压肾病5例，多囊肾3例，梗阻性肾病1例。所选患者均1个月内无急性炎症、无接受外科手术、无严重肝功能受损，无心脑血管事件和肿瘤、创伤、无慢性阻塞性肺病、心房纤颤、先天性心脏病等。

1.2 方法

采用惠普公司SONOS 5500型彩色多普勒超声显像仪对患者进行检查，探头频率2～4 MHz。除常规检测外，左心室收缩功能正常，左心室射血分数＞50%。以舒张早期峰值速度（the early diastolic peak velocities，Ve）与舒张晚期峰值速度（the late diastolic peak velocities，Va）的比值（Ve/Va），作为判断左心室舒张功能标准并分为两组：左心室舒张功能障碍组（阳性组24例，Ve/Va＜1），左心室舒张功能正常组（阴性组24例，Ve/Va≥1）[3]。为避免因容量负荷影响，超声心动图检查均选择在血液透析完成后24 h内进行。