维持性血液透析患者肺动脉高压相关因素分析

发布时间：2018-03-05 00:13

本文选题：维持性血液透析　切入点：慢性肾脏病　出处：《重庆医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的探讨维持性血液透析(Maintain hemodialysis, MHD)患者并发肺动脉高压的相关危险因素。方法回顾性分析2011年11月-2014年5月我科收治的维持性血液透析患者98例,根据是否并发肺动脉高压(Pulmonary hypertension, PH)分为PH组和非PH组。详细记录一般资料,包括：年龄、性别、原发病(除外合并有先天性心脏病、心脏瓣膜病变、慢性阻塞性肺病、肺栓塞、系统性红斑狼疮、血管炎等全身性疾病)、透析前血压、透析通路类型、血红蛋白(Hemoglobin, Hb)、血肌酐(Serum creatinine, Scr)、血尿素(Blood urea nitrogen, BNU)、血钙、血磷、甲状旁腺激素(Parathyroid hormone, PTH)、高敏C反应蛋白(high-sensitivity C-reactive protein, hsCRP)、脑钠肽(Brain natriuretic peptide, BNP);肺动脉压(Pulmonary artery pressure, PAP)以及多普勒超声心动图指标：左心室短轴缩短指数(Fraction shortening, FS)、左心室射血分数(Ejection fraction, EF)、左室舒张末内径、左室收缩末内径、室间隔舒张末厚度、左室后壁舒张末厚度、左房前后径、右室舒张末期内径、右房横径、室间隔搏动幅度、左室后壁搏动幅度。采用SPSS17.0统计软件对上述因素作相关分析,探讨MHD患者并发PH的相关危险因素。结果选取的98例MHD患者中男性54例(55%),女性44例(45%),PH的总发生率为53.1%。将PH组与非PH组患者的一般资料、实验室检查指标及多普勒超声心动图指标单因素分析结果提示,PH组中透析前舒张压、PTH的自然对数(LnPTH)及BNP的自然对数(LnBNP)均有显著升高,左室收缩末内径、左房前后径及右房横径有明显增大,左室舒张末内径、室间隔舒张末厚度、左室后壁舒张末厚度和右室舒张末内径也有不同程度的增加,Hb、FS、EF、室间隔搏动幅度及左室后壁搏动幅度则有明显的下降。Logistic回归分析结果显示MHD患者并发PH与Hb、LnBNP、LnPTH、EF、左室收缩末内径及室间隔舒张末厚度相关,其回归方程为：y=15.528+0.332xi+0.928x2-0.340x3-0.049x4+0.653x5-0.219x6，其中y代表是否并发PH,x1为LnBNP(pg/ml),x2为LnPTH (pg/ml),x3为EF(%),x4为Hb(g/L),x5为室间隔舒张末厚度(mm),x6为左室收缩末内径(mm)。结论MHD患者容易并发肺动脉高压,而导致终末期肾病的原发疾病与此无关。是否并发肺动脉高压与透析前舒张压、Hb、LnPTH、 LnBNP、FS、EF、室间隔搏动幅度、左室后壁搏动幅度、左室舒张末内径、左室收缩末内径、室间隔舒张末厚度、左室后壁舒张末厚度、左房前后径、右室舒张末内径以及右房横径等指标均有关,其中LnBNP、LnPTH及室间隔舒张末厚度为ESRD患者并发PH的独立危险因素,而提高EF、纠正贫血及缩小左室收缩末内径则可以减少或者延缓MHD患者PH的发生。
[Abstract]:Objective to investigate the risk factors associated with pulmonary hypertension in patients with maintenance hemodialysis (MHD). Methods 98 patients with maintenance hemodialysis from November 2011 to May 2014 were retrospectively analyzed. The patients were divided into PH group and non-PH group according to whether they were complicated with pulmonary hypertension. The data included age, sex, primary disease (except congenital heart disease, heart valve disease, chronic obstructive pulmonary disease, pulmonary embolism). Systemic lupus erythematosus, vasculitis and other systemic diseases, pre-dialysis blood pressure, type of dialysis pathway, hemoglobin hemoglobin, HB, serum creatinine, scrur, blood urea, blood urea nitrogen, BNUN, blood calcium, blood phosphorus, Parathyroid hormone, PTHX, Gao Min C-reactive protein, brain natriuretic peptide, brain natriuretic peptide, pulmonary artery pressure (PAPs) and Doppler echocardiography indicators: left ventricular short-axis shortening index Fraction shorting, FSU, left ventricular ejection fractionation, EFFET, left ventricular ejection fraction (EFEX), left ventricular ejection fraction, left ventricular ejection fraction, left ventricular ejection fraction, left ventricular ejection fraction, left ventricular ejection fraction, left ventricular ejection fraction, left ventricular ejection fraction, left ventricular ejection fraction, left ventricular ejection fraction, left ventricular ejection fraction, left ventricular ejection fraction, left ventricular ejection fraction, left ventricular ejection fraction, Left ventricular end-diastolic diameter, Left ventricular end systolic diameter, interventricular septal end diastolic thickness, left ventricular posterior wall end diastolic thickness, left atrial anterior diameter, right ventricular end diastolic diameter, right atrial transverse diameter, ventricular septal beat amplitude, The pulsatile amplitude of left ventricular posterior wall was analyzed by SPSS17.0 software. To investigate the risk factors associated with PH in patients with MHD. Results among 98 patients with MHD, 54 were male and 55 were male, and the total incidence of PH in 44 women was 53.1. The general data of PH group and non-PH group were analyzed. The results of univariate analysis of laboratory and Doppler echocardiography showed that the natural logarithm of PTH and the natural logarithm of BNP in PH group were significantly increased, and left ventricular end-systolic diameter was significantly increased. The anteroposterior diameter of left atrium and the transverse diameter of right atrium increased obviously, the end diastolic diameter of left ventricle and the thickness of interventricular septal end diastolic, Left ventricular posterior wall diastolic thickness and right ventricular end-diastolic diameter increased in varying degrees, ventricular septal beat amplitude and left ventricular posterior wall pulsatile amplitude decreased significantly. Logistic regression analysis showed that MHD patients complicated with PH and HbBNPLnPTHEFL, left ventricular adduction. The end systolic diameter and interventricular septal end diastolic thickness were correlated, The regression equation is as follows: yam 15.528 0.332xi 0.928x2-0.340x3-0.049x4 0.653x5-0.219x6, where y stands for LnBNPpgnpgMERMNX2 (LnBNPPNPpggMNX _ 2), LnPTH / pggcncx3 is EFX _ 4, Hbg / L ~ (+) X _ (5) is left ventricular end diastolic thickness (LVT), and it is an internal diameter of left ventricular end systolic tract. Conclusion patients with MHD are prone to complicated with pulmonary hypertension. There was no correlation between pulmonary hypertension and pre-dialysis diastolic pressure, LnPTH, LnBNP-FSSEF, ventricular septal pulsation amplitude, left ventricular posterior wall pulsation amplitude, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left ventricular end-diastolic diameter, left ventricular end-diastolic diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left ventricular septal pulsatile amplitude, left ventricular end-diastolic diameter, left ventricular end-systolic diameter. The interventricular septal end diastolic thickness, left ventricular posterior wall end diastolic thickness, left atrial anteroposterior diameter, right ventricular end diastolic diameter and right atrial transverse diameter were all correlated. LnBNPN / LnPTH and interventricular septal diastolic thickness were independent risk factors for PH in ESRD patients. Raising EFs, correcting anemia and reducing left ventricular end-systolic diameter can decrease or delay PH in MHD patients.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R544.1

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