腹膜透析患者心胸比例的变化及相关因素分析

肾脏病与透析肾移植杂志 ›› 2013, Vol. 22 ›› Issue (2): 112-117.

腹膜透析患者心胸比例的变化及相关因素分析

出版日期:2013-04-28 发布日期:2013-04-29

Changes of cardiothoracic ratio and its relative factors in patients with peritoneal dialysis

Online:2013-04-28 Published:2013-04-29

摘要/Abstract

摘要：

摘要目的：探讨腹膜透析(PD)患者心胸比变化情况及相关影响因素。方法：选取2010年6月至2011年12月于我院行PD置管术的123例终末期肾病(ESRD)患者，观察PD治疗后心脏形态相关指标的变化。患者每3个月进行一次临床随访，全面评估透析状况，包括血浆白蛋白(Alb)、收缩压(SBP)、舒张压(DBP)、体重、体重指数(BMI)、尿量(UV)、超滤量、液体清除量、血钠、每周尿素氮总清除率(Kt/V total)、每周肌酐总清除率(Ccr total)、残余肾小球滤过率(rGFR)水平，并通过心脏超声和胸部平片检查，每6个月对PD患者的心脏形态学指标及功能进行评估，观察其动态变化，探讨心胸比的变化及相关影响因素。结果：（1）随PD时间延长患者心胸比逐渐增加，透析前、透析后6个月、12个月时分别为0.465±0.041、0.474±0.045、0.492±0.060(P<0.01)，射血分数呈下降趋势(P>0.05)。（2）20例(16.3%)出现胸闷、夜间不能平卧等心功能不全表现，分析这些患者临床特点发现，糖尿病肾病患者7例(35%)，难治性高血压16例(80%)，持续不卧床腹膜透析患者8例(40%)且 rGFR下降快，贫血重。（3）相关回归分析发现PD患者心胸比与BMI(r=0.375,β=0.442)、收缩压(r=0.281,β=0.217)、血红蛋白(r=-0.283,β=-0.199)、液体清除量(r=-0.231,β=-0.851)独立相关。（4）不同残余肾功能（rGFR）状态下心胸比不同，rGFR水平为<3min/ml，3~6 min/ml，>6 min/ml，心胸比分别为0.493±0.062，0.468±0.043，0.456±0.042(P<0.05)。结论：随着透析时间的延长，PD患者心脏结构及功能发生改变，除与透析本身导致机体容量负荷持续增高外，与残余肾功能、BMI、Hb、液体清除量及血压状态亦密切相关。

Abstract:

ABSTRACT Objective: To investigate the change of cardiothoracic ratio and its risk factors in patients with peritoneal dialysis (PD). Methodology: One hundred and twenty-three patients who received peritoneal dialysis (PD) from June 2010 to December 2011 were enrolled into this prospective study, and the patients with acute kidney injury were excluded. The album, blood pressure, body weight, urine volume, ultrafiltration, fluid removal, residual glomerular filtration rate (rGFR), Urea Kt/V, creatinine clearance (Ccr) were examined regularly during the follow up. to explore dynamic changes of all indexes and risk factors of cardiothoracic ratio. To explore dynamic changes of all indexes and risk factors of cardiothoracic ratio, the cardial function and construct were also determined by echocardiography and chest radiograph every 6 month in all patients. Result: (1)With the extending of time on PD treatment, CTR was gradually increasing. CTR was 0.465±0.041、0.474±0.045、0.492±0.060 respectively (P<0.01) on pre-PD, and six, twelve months after PD in all patients. Ejection fraction (EF) presented the downward trend. (2) 20 cases (16.3%) showed swollen, chest distress, blood pressure significantly increased and other clinical manifestation of cardia insufficiency. Among them, diabetic nephropathy was in 7 (35%), refractory hypertension in 16 (80%), CAPD in 8 cases (40%), and these patients were with serious anemia and rapid decline of rGFR. (3)Correlation and regression analysis revealed that BMI (r=0.375, β=0.442), SBP (r=0.281, β=0.217),Hb (r=-0.283, β=-0.199), fluid removal (r=-0.231, β=-0.851) were independent factors for CTR. (4) With different degrees of residual renal function, CTR have changed. The records were divided into three groups according to RRF, <3min/ml, 3~6min/ml, >6min/ml, CTR was 0.493±0.062, 0.468±0.043, 0.456±0.042 (P<0.05). Conclusion: With the extending of time on PD treatment, cardiac structure and function was changed, which related to volume overload by PD itself, meanwhile, BMI, SBP, Hb, rGFR, fluid removal was also significantly correlated with it.

Key words: Key Words , peritoneal dialysis,vulune status, relative factors, cardiothoracic ratio

王涵，周岩，周婷婷，等. 腹膜透析患者心胸比例的变化及相关因素分析[J]. 肾脏病与透析肾移植杂志, 2013, 22(2): 112-117.

WANG Han, ZHOU Yan, ZHOU Ting-ting,et al. Changes of cardiothoracic ratio and its relative factors in patients with peritoneal dialysis[J]. Chinese Journal of Nephrology, Dialysis & Transplantation, 2013, 22(2): 112-117.

ISSN 1006-298X CN 32-1425/R