【摘要】 目的探讨透析患者肺动脉高压(pulmonary hypertension,PHT)与血管钙化之间的关系,为临床透析患者PHT的预防与治疗提供依据。方法回顾性分析自贡市第一人民医院透析中心病情稳定的患者172例,其中血液透析88例,腹膜透析患者84例。纳入标准:透析时间>3个月,病情稳定的规律性透析患者;排除标准:怀孕、艾滋病毒感染者、严重的感染、肝胆疾病、活动性消耗性疾病(如恶性肿瘤或肺结核);急性心肌梗死、心力衰竭、急性脑血管疾病;原发性甲状旁腺疾病,行甲状旁腺切除、手术、创伤和严重营养不良的患者均排除。所有患者使用超声心动图检查提示肺动脉收缩压大于37 mmHg定义为PHT。采用双手及骨盆X片检查评估患者血管钙化情况。结果血液透析患者PHT、的发生率明显高于腹膜透析患者(51.2%比22.7%);透析患者中有PHT的患者的血管钙化严重程度高于无。PHT的透析患者。多因素分析显示血管钙化程度(OR=2.68)、二尖瓣病变(OR=7.79)、血液透析(OR=3.35)、左心房内径增大(OR=11.39)是透析患者发生PHT的独立危险因素。结论血液透析患者PHT的发生率高于腹膜透析患者;透析患者中血管钙化可能是预测患者PHT发生的独立危险因素,预防透析患者血管钙化的发生对减轻透析患者PHT可能有着重要的临床意义。更多还原

【Abstract】 Objective To discuss the relationship between pulmonary hypertension and peripheral vascular calcification in dialysis patients,and provide the basis for the prevention and treatment of pulmonary hypertension.Methods In this retrospective study,we included 172 ESRD patients undergoing dialysis(n= 88 for hemodialysis,and n = 84 for peritoneal dialysis) in West China Hospital of Sichuan University.Inclusion criteria included dialysis age >3 months,stable condition,and regular dialysis.The exclusion criteria included pregnancy,HIV infection,serious infection,liver disease,active wasting diseases(such as malignant tumor or tuberculosis).The patients with acute myocardial infarction,heart failure,acute cerebrovascular disease,primary parathyroid disease,parathyroid gland resection,surgery,trauma and severe malnutrition were also excluded.All patients had the echocardiography.Pulmonary hypertension was defined when pulmonary artery systolic pressure was greater than 37 mmHg in all patients subject to echocardiography.Using both hands and pelvic X-ray,vascular calcification was observed.Results The incidence of pulmonary hypertension in HD patients was significantly higher than in PD patients(51.2%vs.22.7.5%).The dialysis patients with pulmonary hypertension had more severe vascular calcification than patients without pulmonary hypertension.Multifactor analysis revealed that severe vascular calcification(OR= 2.68),mitral valve disease(OR=7.79),HD(OR = 3.35),and larger left atrial diameter(OR= 11.39) were independent risk factors for pulmonary hypertensioa Conclusions The incidence of pulmonary hypertension in hemodialysis patients was higher than in peritoneal dialysis patients.Vascular calcification could be independent risk factors for pulmonary hypertension in dialysis patients,so preventing the occurrence of vascular calcification in the dialysis patients may have important clinical significance for pulmonary hypertension更多还原