MHD患者LVH危险因素分析及Hb达标对其逆转作用

发布时间：2018-07-23 17:04

【摘要】：目的:观察维持性血液透析患者发生左心室肥厚的情况,评估目前常用的三种心电图诊断标准对左心室肥厚的诊断价值,分析维持性血液透析患者左心室肥厚的危险因素。探讨维持血液透析患者血红蛋白达标对左心室肥厚的逆转作用。方法:选取224例维持性血液透析患者,进行超声心动图及心电图检查,以超声心动图检查结果计算的左室质量指数作为左心室肥厚诊断标准,比较三种心电图标准诊断左心室肥厚的敏感度、特异度。根据患者是否存在左心室肥厚分为左心室肥厚组(183例)与非左心室肥厚组(41例),比较两组患者的临床资料,进行单因素分析,单因素分析有意义的临床资料进行Logistic多因素回归分析,分析维持性血液透析患者左心室肥厚的相关危险因素。根据左心室肥厚组患者是否存在血红蛋白110g/L分为血红蛋白达标组和血红蛋白未达标组,随访6个月,随访结束时接受超声心动图检测。随访期间患者血压控制平稳,透析方案无改变。血红蛋白未达标组患者调整促红细胞生成素、静脉铁剂后部分患者血红蛋白上升至目标值;血红蛋白达标组患者血红蛋白水平保持稳定。结果:224例维持性血液透析患者中,符合左心室肥厚患者为183例(81.7%)。使用心电图对左心室肥厚进行诊断,在第七版人民卫生出版社诊断学标准(国内标准),Cornall标准,欧洲2013高血压管理指南标准三者中,敏感度最高者为欧洲2013高血压管理指南(37.16%),特异度最高者为国内标准(88.80%)。单因素分析发现高收缩压、女性、透析期间体重增加、合并糖尿病、血红蛋白未达标、尿素氮清除率65%、未服用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂类药物是维持性血液透析患者左心室肥厚的危险因素。多因素Logestic分析发现女性、高收缩压、透析期间体重增加、血红蛋白未达标、合并糖尿病、未服用ACEI/ARB类药物是左心室肥厚发生的独立危险因素。左心室肥厚组共118名患者血红蛋白未达标。随访6月后50名血红蛋白未达标患者血红蛋白水平显著升高并达到目标值,62名患者血红蛋白水平仍低于110g/L。超声心动图提示血红蛋白纠正达标后患者左室质量指数、室间隔厚度及左心室后壁厚度显著下降(P0.05)。结论:维持性血液透析患者普遍存在左心室肥厚,维持性血液透析患者左心室肥厚与性别、血红蛋白水平、收缩压、透析期间体重、是否合并糖尿病、是否服用ACEI/ARB类药物密切相关。对于存在上述临床特征的患者,应进行早期左心室肥厚干预治疗以改善维持性血液透析患者的预后。同时定期行EKG检查,有助于早期发现左心室肥厚。血红蛋白未达标是维持性血液透析患者发生左心室肥厚的独立危险因素之一,合并左心室肥厚的维持性血液透析患者血红蛋白达标后可部分逆转其左心室肥厚。
[Abstract]:Objective: to observe the incidence of left ventricular hypertrophy in maintenance hemodialysis patients, to evaluate the diagnostic value of three kinds of ECG diagnostic criteria for left ventricular hypertrophy, and to analyze the risk factors of left ventricular hypertrophy in maintenance hemodialysis patients. To investigate the reversal effect of hemoglobin on left ventricular hypertrophy in hemodialysis patients. Methods: 224 patients with maintenance hemodialysis were examined by echocardiography and electrocardiogram. The left ventricular mass index calculated by echocardiography was used as the diagnostic criterion of left ventricular hypertrophy. To compare the sensitivity and specificity of three ECG criteria in the diagnosis of left ventricular hypertrophy. According to whether the patients had left ventricular hypertrophy, they were divided into left ventricular hypertrophy group (183 cases) and non-left ventricular hypertrophy group (41 cases). Logistic multivariate regression analysis was performed to analyze the risk factors of left ventricular hypertrophy in maintenance hemodialysis patients. Patients with left ventricular hypertrophy (LVH) were divided into two groups: hemoglobin 110g/L group and hemoglobin substandard group. The patients were followed up for 6 months and examined by echocardiography at the end of follow-up. During the follow-up period, the blood pressure was stable and the dialysis program was unchanged. Erythropoietin was adjusted in patients with substandard hemoglobin, hemoglobin increased to target value in some patients after intravenous iron, and hemoglobin level remained stable in patients with hemoglobin standard. Results of 224 patients with maintenance hemodialysis, 183 (81.7%) were consistent with left ventricular hypertrophy. Using electrocardiogram to diagnose left ventricular hypertrophy, in the seventh edition of the people's Health Publishing House Diagnostics Standard (domestic standard), Cornall standard, European 2013 hypertension management guidelines, European 2013 guidelines for hypertension management (37.16%) and the highest specificity for domestic standards (88.80%) were the most sensitive. Univariate analysis showed high systolic blood pressure (SBP), female weight gain during dialysis, diabetes mellitus, substandard hemoglobin, No angiotensin converting enzyme inhibitor / angiotensin receptor blocker is a risk factor for left ventricular hypertrophy in maintenance hemodialysis patients. Multivariate Logestic analysis showed that women, high systolic blood pressure, weight gain during dialysis, substandard hemoglobin, diabetes mellitus and no ACEI/ARB drugs were independent risk factors for left ventricular hypertrophy. A total of 118 patients in left ventricular hypertrophy group did not meet the standard of hemoglobin. Hemoglobin levels in 50 patients with substandard hemoglobin increased significantly and reached the target value after 6 months follow-up. The hemoglobin level of 62 patients was still below 110 g / L. Echocardiography showed that left ventricular mass index (LVMI), interventricular septal thickness and left ventricular posterior wall thickness decreased significantly after hemoglobin correction (P0.05). Conclusion: left ventricular hypertrophy and sex, hemoglobin level, systolic blood pressure, body weight during hemodialysis, diabetes mellitus are common in maintenance hemodialysis patients. Whether or not to take ACEI/ARB drugs is closely related. Patients with these clinical characteristics should be treated with early intervention of left ventricular hypertrophy to improve the prognosis of maintenance hemodialysis patients. At the same time, regular EKG examination is helpful for early detection of left ventricular hypertrophy. Hemoglobin substandard is one of the independent risk factors for left ventricular hypertrophy in maintenance hemodialysis patients. Hemoglobin in maintenance hemodialysis patients with left ventricular hypertrophy can partially reverse left ventricular hypertrophy.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.5

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