维持性血液透析患者钙磷代谢及透析龄与左心室心肌质量指数的关系

目的:探讨维持性血液透析患者钙磷代谢及透析龄与左心室心肌质量指数的关系。方法:研究对象为上海市第六人民医院血液透析中心接受维持性血液治疗1年以上的102例患者,按血磷分为高磷组(Pi>1.78 mmol/L,n=72)和对照组(Pi:1.13 mmol/L~1.78 mmol/L,n=30);按钙磷乘积分为对照组(钙磷乘积≤55 mg2/dl2,n=47)和高钙磷乘积组(钙磷乘积>55 mg2/dl2,n=55);按透析龄分为A组(透析龄1~5年,n=61)和B组(透析龄>5年,n=41)。用超声心动图测定左心室舒张末内径(LVDd)、左心室收缩末内径(LVDs)、左房内径(LAD)、左心室后壁厚度(LVPWT)、室间隔厚度(IVST),并收集临床指标。结果:(1)将血磷、钙磷乘积及透析龄与反应心脏结构的指标(LVDd、LVDs、LAD、IVST、LVPWT、LVMI)进行相关性分析,结果发现维持性血液透析患者心脏结构的改变与钙磷代谢及透析龄密切相关。另外,钙磷乘积和透析龄与FS存在相关性。(2)高磷组LVDd、LVDs及LVMI与对照组比较,其差异均有统计学意义(P<0.05),说明高磷血症患者出现左心室肥大。(3)高钙磷乘积组的LVDd、LVDs及LVMI与对照组比较,其差异均有统计学意义(P<0.05),说明钙磷乘积升高组,左心室肥大较对照组显著。(4)两组患者比较LVH发生比率,结果显示,B组要高于A组(71.89%vs37.78%,P=0.045),差异有统计学意义。A组LVDd、LVDs、LVPWT、LVMI及FS与B组比较,其差异均有统计学意义(P<0.05),说明随着透析时间的增长,心脏结构的改变越来越明显,左心室肥大的发生率越来越高。结论:维持性血液透析患者普遍存在心脏结构的改变,随着透析龄的增加,心脏结构和功能进一步恶化。钙磷代谢及透析龄影响心脏结构改变,最终导致心功能衰竭。

Relationship of Left Ventricular Mass Index and Different Dialysis Ages, Calcium - phosphorus Metabolism in Patients with Maintenance Hemodialysis

Objective ： To analyze the relationship between duration of hemodialysis, calcium - phosphorus metabolism and left ventricular mass index in maintenance hemodialysis（MHD） patients, nethods：102 MHD patients are from Nephropathy Center and have acccepted maintenance hemodialysis at last 1 year, and they were divided by phosphorus into contrast group （Pi：1.13 mmol/L 1.78 mmol/L, n = 30）and hyperphosphatemia group （Pi 〉 1.78mmol/L, n = 72 ） ;and divdied by calcium -phosphorus product into contrast group （ Ca x P≤55 mg2/dl2 ,n = 47） and elevated calcium - phosphorus product group（ Ca x P 〉 55 mg^2/dl^2, n = 55 ） ; and divided into A group（ duration of hemodialysis 1 N 5 years, n = 61）和 B group （ duration of hemodialysis 〉 5 years, n = 41 ）, The left ventricular end - diastolic diameter（ LVDd）, left ventricular end - systolic diameter（ LVDs）, left atrial diameter（ LAD）, left ventricular posterior wall thickness （LVPWT） ,interventricular septal thickness（IVST） were detected by ultrasonic cardiography. And other correlated parameters were also measured. Results： （ 1 ） phosphorus, calcium - phosphorus product and duration of hemodialysis are compared with the response of heart structure index by Correlation analysis, we find that The changes of cardiac structure are closely related with calcium - phosphorus metabolism and duration of hemodialysis. On the other hand, calcium - phosphorus product and duration of hemodialysis were also correlated with FS. （2）LVDd, LVDs and LVMI increased in hyperphosphatemia group compared with contrast group , The difference was statistically significant（P 〈 0.05）, Hyperphosphatemia in patients with left ventricular hypertrophy. （3） LVDd, LVDs and LVMI increased in elevated calcium - phosphorus product group compared with contrast group , The difference was statistically significant （P 〈 0.05 ）, Higher calcium phosphate product group, left ventricular hypertrophy significantly. （4） Two groups of patients with LVH incidence ratio, it is confirmed that the B group is higher than that of A group（71.89% vs 37.78%, P = 0.045）, the difference has statistical significance. In group A, LVDd, LVDs, LVPWT, LVMI and FS compared with group B, The difference was statistically significant（ P 〈 0.05 ） ;this shows that with duration of hemodialysis increasing, the changes of cardiac structure is more and more obvious, and LVH incidence rate is more and more high. Conclusion：MHD patients generally have the changes of cardiac structure, cardiac structure and function further deteriorated with the increase of hemodialysis