本文選題：慢性腎臟病 + 心功能　； 參考：《上海醫(yī)學(xué)》2017年01期

【摘要】：目的分析上海崇明地區(qū)慢性腎臟病(CKD)患者的心功能狀況,探討CKD患者發(fā)生心血管疾病(CVD)的危險(xiǎn)因素,為臨床早期干預(yù)后降低CKD患者CVD的致殘率和致死率提供理論依據(jù)。方法回顧性分析上海交通大學(xué)醫(yī)學(xué)院附屬新華醫(yī)院崇明分院100例CKD患者的臨床資料,比較不同CKD分期、有無行透析治療、不同透析方式(血液透析和腹膜透析)、原發(fā)性或繼發(fā)性CKD患者的心功能指標(biāo)[腦利鈉肽(BNP)水平、左心室射血分?jǐn)?shù)(LVEF)、左心室舒張末期內(nèi)徑(LVEDD)]和CVD發(fā)生的危險(xiǎn)因素[血紅蛋白(Hb)、血β2微球蛋白(β2-M)、甲狀旁腺激素(PTH)和電解質(zhì)(血鉀、血鈣、血磷)水平]。結(jié)果不同CKD分期、有無行透析治療、不同透析方式的CKD患者性別構(gòu)成和年齡的差異均無統(tǒng)計(jì)學(xué)意義(P值均0.05);繼發(fā)性CKD患者的年齡顯著大于原發(fā)性CKD患者(P0.05),兩者間性別構(gòu)成的差異無統(tǒng)計(jì)學(xué)意義(P0.05)。CKD 4至5期患者的血磷、BNP、血β2-M、PTH水平均顯著高于CKD 1至3期患者(P值均0.05),LVEDD顯著大于CKD1至3期患者(P0.05),Hb水平顯著低于CKD 1至3期患者(P0.05);兩者間血鉀、血鈣、LVEF的差異均無統(tǒng)計(jì)學(xué)意義(P值均0.05)。透析患者的血磷、BNP、血β2-M、PTH水平均顯著高于未透析患者(P值均0.05),LVEF顯著低于未透析患者(P0.05);兩者間血鉀、血鈣、Hb水平和LVEDD的差異均無統(tǒng)計(jì)學(xué)意義(P值均0.05)。腹膜透析患者的血鉀水平顯著低于血液透析患者(P0.05),血β2-M水平顯著高于血液透析患者(P0.05),LVEDD顯著小于血液透析患者(P0.05);兩者間血鈣、血磷、BNP、Hb、PTH水平和LVEF的差異均無統(tǒng)計(jì)學(xué)差異(P值均0.05)。繼發(fā)性CKD患者的Hb水平顯著低于原發(fā)性CKD患者(P0.05);兩者間血鉀、血鈣、血磷、BNP、血β2-M、PTH水平,以及LVEDD、LVEF的差異均無統(tǒng)計(jì)學(xué)意義(P值均0.05)。結(jié)論對于不同CKD分期、有無行透析治療、不同透析方式(血液透析和腹膜透析)、原發(fā)性或繼發(fā)性CKD患者,積極改善CVD發(fā)生相關(guān)的危險(xiǎn)因素,如糾正貧血、改善礦物質(zhì)和骨代謝異常、延緩腎功能減退、合理選擇透析方式等,可能有助于CVD的防治。
[Abstract]:Objective to analyze the cardiac function of patients with chronic kidney disease (CKD) in Chongming district of Shanghai, and to explore the risk factors of cardiovascular disease in patients with CKD, so as to provide a theoretical basis for reducing the rate of disability and mortality of CVD in patients with CKD after early intervention. Methods the clinical data of 100 patients with CKD in Chongming Branch of Xinhua Hospital affiliated to Shanghai Jiaotong University Medical College were retrospectively analyzed. Different dialysis methods (hemodialysis and peritoneal dialysis), cardiac function index [brain natriuretic peptide] in patients with primary or secondary CKD, Left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDDD)] and risk factors of CVD [hemoglobin Hbn, serum 尾 _ 2-microglobulin (尾 _ 2-M _ 2, parathyroid hormone CVD) and electrolyte (serum potassium, blood calcium, blood phosphorus)]. Results there were different CKD stages. There was no significant difference in sex composition and age of CKD patients with different dialysis methods (P < 0.05), and the age of secondary CKD patients was significantly larger than that of primary CKD patients (P 0.05), and there was no significant difference in sex composition between them (P 0.05, P 0.05, P < 0.05), and the age of secondary CKD patients was significantly higher than that of primary CKD patients (P 0.05, P < 0.05). The serum levels of 尾 _ 2-MCKD and 尾 _ 2-MN in patients with stage 5 were significantly higher than those in patients with CKD from stage 1 to stage 3 (P < 0.05), and the levels of Hb in patients with CKD1 from stage 1 to stage 3 were significantly lower than those in patients with CKD from stage 1 to stage 3, and the levels of serum potassium between the two groups were significantly lower than those in patients with stage 1 to stage 3 of CKD. There was no significant difference in LVEF between two groups (P = 0.05). The levels of serum P and 尾 2-MN in dialysis patients were significantly higher than those in patients without dialysis (P < 0.05), but there was no significant difference in serum potassium, calcium, HB and LVEDD between the two groups (P < 0.05). The serum potassium level in peritoneal dialysis patients was significantly lower than that in hemodialysis patients, and the serum 尾 2-M level was significantly higher than that in hemodialysis patients. The HB level in secondary CKD patients was significantly lower than that in primary CKD patients (P 0.05). Conclusion for patients with different CKD stages, with or without dialysis treatment, with different dialysis methods (hemodialysis and peritoneal dialysis, primary or secondary CKD), the risk factors associated with CVD, such as correcting anemia, are positively improved. It may be helpful to prevent and cure CVD by improving abnormal mineral and bone metabolism, delaying renal dysfunction and selecting dialysis methods reasonably.
【作者單位】： 上海交通大學(xué)醫(yī)學(xué)院附屬新華醫(yī)院崇明分院腎內(nèi)科;
【基金】：上海交通大學(xué)醫(yī)學(xué)院科技基金項(xiàng)目資助(14XJ22016)
【分類號】：R692;R54

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