维持性血液透析对慢性肾功衰竭患者右心功能的影响

Effects of Maintenance Hemodialysis on Right Ventricular Dysfunction in Patients with End-stage Renal Disease

中文关键词:  动静脉内瘘 血液透析 肺动脉高压 右心室肥厚 右心室舒张功能不全

英文关键词:Arterivoenous fistula Hemodialysis Pulmonary hypertension Right ventricular hypertrophy Right ventricular diastolic dysfunction

中文摘要:

      目的 探讨维持性血液透析对经动静脉内瘘 （arteriovenous fistula，AVF）行透析的慢性肾功能衰竭患者右心功能的影响。方法 纳入经AVF行维持性血液透析治疗的慢性肾功能衰竭患者67例，根据是否发生肺动脉高压分为肺动脉高压组及无肺动脉高压组。利用超声多普勒采集两组右心室功能、左心室射血分数（LVEF）以及血管通路的流量，评估两组间临床基线指标、透析相关因素、右心功能指标，应用logistic回归分析肺动脉高压的危险因素。结果 本组患者肺动脉高压发生率37.31% (25/67)，右心室肥厚发生率17.91% (12/67)。与无肺动脉高压组比较，肺动脉高压组患者收缩压升高 （P<0.01），血红蛋白值以及尿素消除指数（Kt/V）值降低 （P=0.03，P<0.01)；肺动脉高压组LVEF低于无肺动脉高压组 (P=0.04)，右心室肥厚发生率增高 (P=0.04)，且右心室舒张功能受损较无肺动脉高压组明显，然两组间血管通路流量差异无统计学意义。相关分析显示：收缩期肺动脉压（sPAP）与收缩压、右室壁厚度正相关 (r=0.246，0.394，P<0.05)，与LVEF值负相关 （r=-0.373，P=0.002）。Logistic 回归分析提示：对肺动脉高压的发生与否具影响和预测性的指标是LVEF值 (回归系数b=-0. 096,OR=1.100, P=0.01)及收缩压值 （回归系数b=0.063,OR=0.940, P=0.002）。结论 经AVF行维持性血液透析患者约1/5~1/3发生肺动脉高压以及右心室肥厚；尿毒症患者左心功能状态、血压控制不佳可能共同参与肺动脉高压、右心室肥厚、右心室舒张功能不全的发生。

英文摘要:

      Objective To analyze the effects of maintenance hemodialysis (HD) on right ventricular dysfunction (RVD) in the patients with end-stage renal disease (ESRD). Methods The study population consisted of 67 patients with ESRD, who were maintained on long-term hemodialysis therapy via surgically created native arteriovenous (A-V) access in our HD center. The patients were divided into pulmonary hypertension (PHT) and non-PHT groups according to systolic pulmonary artery pressure (sPAP). Doppler echocardiography of right ventricular (RV),left ventricular ejection fraction (LVEF) and vascular access flow were performed in all patients. Echocardiography parameters of RV, dialysis related factors as well as clinical data were collected and compared between the two groups. The risk factors of PHT were analyzed by logistic regression analysis. Results There were 25 patients (37.31%) had PHT, while 12 patients (17.91%) had right ventricular hypertrophy. Compared with the non-PHT group, the patients with PHT had a higher systolic blood pressure (P<0.01), while had a lower level of hemoglobin and Kt/V value (P=0.03 and P<0.01 respectively). The patients in PHT group demonstrated lower LVEF than those in non-PHT group (P=0.04). The PHT group showed a higher incidence of RV hypertrophy (P=0.04). Additionally, PHT patients exhibited worse RV diastolic function compared to non-PHT patients. However, there was no statistical difference in vascular access flow between the two groups. Pearson correlation analysis showed that sPAP was correlated with systolic blood pressure and RV wall thickness positively (r=0.246，0.394，P<0.05), while with LVEF negatively （r=-0.373，P=0.002）.The results of logistic regression analysis revealed that LVEF contributed to the predictability of incidence of PHT ( regression coefficient b=-0. 096, OR=1.100, P=0. 01) as well as systolic blood pressure ( regression coefficient b= 0. 063,OR=0.940, P=0.002). Conclusions The high incidence of PHT and RV hypertrophy in ESRD patients under maintenance hemodialysis via surgically created native arteriovenous access arrange from one fifth to one third. The status of LV function, poor control of systolic blood pressure may play important roles in the mechanism of PHT, RV hypertrophy and RV diastolic dysfunction in chronic uremia patients.