摘要
目的探讨中国慢性肾脏病(CKD)患者左心室肥厚(LVH)的发生率及影响因素。方法收集2010～2012年入住中山大学附属第三医院肾内科CKD 3～5期非透析患者270例,使用携带式动态血压计进行动态血压监测,并测量临床血压,彩超评价心脏结构和功能改变,收集尿蛋白及血生物化学等临床指标。结果 46.67%的患者合并LVH,其中男性为39.74%,女性为55.46%,女性患者LVH发生率较男性显著增多(P<0.05)。CKD 3、4、5期患者LVH发生率分别为25.0%、44.9%和53.6%,三组间差异有统计学意义(P<0.05)。与非LVH患者相比,LVH患者的体质指数(BMI)、甲状旁腺激素(iPTH)、血磷、血肌酐、左心室质量指数、脉压差、脉搏及临床收缩压明显升高,24 h动态收缩压及舒张压、白天及夜间收缩压和舒张压也明显升高(P<0.05);而估算肾小球滤过率、血红蛋白、血总钙、心脏射血分数则显著下降(P<0.05)。多元线性回归分析显示BMI、iPTH和夜间收缩压与左心室质量指数独立相关,多因素逻辑回归分析显示,女性、BMI、iPTH、白天及夜间收缩压是LVH的独立危险因素。结论 LVH是CKD患者常见的合并症,高iPTH及动态收缩压增高是其独立危险因素。
Aim To explore the incidence and affecting factors of left ventricular hypertrophy （LVH） in chronic kidney disease （CKD） 3-5 patients. Methods 270 CKD 3 ～ 5 patients were enrolled from department of nephrology, the 3rd hospital of Sun Yat-Sen University in this study from 2010 to 2012. Ambulatory blood pressure, clinical blood pressure, cardiac ultrasonography, proteinuria, and other clinical data were collected. Results 46. 67% CKD patients had LVH, in which male accounted for 39.74% and female accounted for 55.46%. Female group had more LVH patients than male group （P〈0.05）. There were 25.0% CKD 3 patients, 44.9% CKD 4 patients and 53. 6% CKD 5 patients with LVH respectively, which had significant difference among the three groups （ P 〈 0. 05 ）. LVH group had higher intact parathyroid hormone （ iPTH）, body mass index （ BMI）, phosphorus, serum creatinine （ SCr）, left ventricular mass index （LVMI）, pulse, PP, left ventricular end diastolic dimension （LVI）d）, left ventricular posterior wall thickness （LVPWT）, interventricular septal thickness （IVST）, and higher clinic systolic blood pressure （SBP）, ambulatory SBP and diastolic blood pressure （DBP）, day and night SBP and DBP（ P〈0.05）, but had lower estimated glomerular filtration rate （eGFR）, hemoglobin （HGB）, calcium （Ca） and ejection fraction （EF） value （ P〈0.05） compared with non LVH group. Multivariate linear analysis indicated that BMI, iPTH and night SBP were independently associated with LVMI. Multivariate Logistic regression analysis showed female, BMI, iPTH, day and night SBP were independent risk factors of LVH. Conclusion LVH is common complication of CKD 3 ～ 5 patients. Ambulatory SBP and iPTH are independent risk factors of LVH.
出处
《中国动脉硬化杂志》
CAS
CSCD
北大核心
2013年第5期435-439,共5页
Chinese Journal of Arteriosclerosis
关键词
动态血压
慢性肾脏病
左心室肥厚
甲状旁腺激素
Ambulatory Blood Pressure
Chronic Kidney Disease
Left Ventricular Hypertrophy
Intact Parathyroid Hormone
