腹膜透析患者心胸比观察的临床意义

发布时间：2018-01-07 18:29

本文关键词：腹膜透析患者心胸比观察的临床意义　出处：《肾脏病与透析肾移植杂志》2017年03期 　论文类型：期刊论文

【摘要】：目的:探讨长期腹膜透析(PD)患者心胸比(CTR)变化特点,分析其与充血性心力衰竭(CHF)之间的联系。方法:选择国家肾脏疾病临床医学研究中心行PD置管并规律随访的终末期肾病(ESRD)患者158例,每6个月随访一次,记录胸片及心脏超声结构,计算CTR及左心室质量指数(LVMI),同时收集患者临床及实验室检验、透析参数等指标。比较不同透析龄时患者CTR及LVMI变化趋势,分析相关影响因素,比较不同CTR患者CHF患病率及死亡率,并探索因果关系。结果:PD患者CTR逐渐增大,48月间CTR从0.467±0.039增至0.533±0.063;CHF患者CTR始终大于非CHF患者,且增加幅度更为明显;CTR较大的患者CHF患病率及死亡率均更高;透析龄、血清白蛋白(Alb)、脉压与患者CTR密切相关,体质量指数(BMI)及尿量与CTR增大独立相关。结论:PD患者随着透析龄延长其CTR逐渐增加,CTR越大则CHF患病率及死亡率均较高;Alb、脉压、BMI、尿量及透析时间是影响CTR的因素。
[Abstract]:Objective: to investigate the changes of cardiothoracic ratio (CTR) in patients with chronic peritoneal dialysis (PDD). Methods: 158 patients with end-stage renal disease (ESRD), who were treated with PD catheter and regular follow-up, were selected from the National Center for Clinical Medical Research of Renal Diseases to analyze its association with CHF in congestive heart failure (CHF). All patients were followed up every 6 months. Chest radiographs and echocardiographic structures were recorded, CTR and left ventricular mass index (LVMI) were calculated, and clinical and laboratory examinations were collected. The changes of CTR and LVMI in patients with different dialysis age were compared, the related factors were analyzed, and the morbidity and mortality of CHF in different CTR patients were compared. Results the CTR increased gradually in the patients with PD, and the CTR increased from 0.467 卤0.039 to 0.533 卤0.063 in 48 months. The CTR of CHF patients was always higher than that of non-#en2# patients, and the increase was more obvious. The morbidity and mortality of CHF were higher in patients with larger CTR. There was a close relationship between pulse pressure and CTR. Body mass index (BMI) and urine volume were independently correlated with the increase of CTR. Conclusion the higher the age of hemodialysis, the higher the CHF prevalence and mortality in the patients with CTR. Alb, pulse pressure, urine volume and dialysis time were the factors affecting CTR.
【作者单位】：南京大学医学院附属金陵医院(南京军区南京总医院)肾脏科国家肾脏疾病临床医学研究中心全军肾脏病研究所;
【基金】：国家科技支撑计划项目课题(2015BAI09B05,2015BAI12B02) 国家“精准医学”重点研发计划项目(2016YFC0904100)
【分类号】：R692.5
【正文快照】： 由于腹膜透析(PD)避免了血流动力学不稳定,加上可以保护残余肾功能(RRF),曾一度被认为与血液透析(HD)相比其对患者心血管系统起保护性作用。然而,目前越来越多的研究发现PD患者心血管疾病(CVD)发病率及死亡率突出,部分文献显示其CVD发生比例甚至高于HD[1-3],尤其充血性心力衰

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