摘要
目的探讨不同腹膜透析龄患者血红蛋白变异性与心脏结构和功能的相关性。方法慢性肾功能衰竭行腹膜透析并规律随访患者60例,依据透析龄分为<12个月组13例,12～24个月组20例和>24个月组27例,检测3组血红蛋白水平,计算血红蛋白变异度、斜率和振幅;行超声心动图检查测定室间隔舒张末期厚度、左心室后壁舒张末期厚度、左心室舒张末期内径、左室射血分数,计算左心室舒张早期和晚期最大血流速度比(E/A)、左心室质量指数;Spearman法分析血红蛋白变异性指标与超声心动图参数的相关性。结果 <12个月组血红蛋白变异度[18.78(7.27,33.89)g/L]高于12～24个月组[8.98(5.69,11.91)g/L](P<0.05),与>24个月组[11.95(9.37,20.24)g/L]比较差异无统计学意义(P>0.05);<12个月组血红蛋白斜率[-1.50(-4.08,-0.57)]低于>24个月组[-0.28(-0.60,-0.16)](P<0.05),与12～24个月组[-0.82 (-1.67,-0.12)]比较差异无统计学意义(P>0.05);<12个月组血红蛋白[(110.54±17.45)g/L]高于12～24个月组[(86.60±20.50)g/L]和>24个月组[(86.85±15.45)g/L](P<0.05);3组血红蛋白振幅、左心房内径、室间隔舒张末期厚度、左心室后壁舒张末期厚度、左心室舒张末期内径、左心室质量、左心室质量指数、左室射血分数、E/A比值比较差异无统计学意义(P>0.05);血红蛋白变异度、血红蛋白振幅与室间隔舒张末期厚度、左心室后壁舒张末期厚度、左心室舒张末期内径、左心室质量指数、左室射血分数均无明显线性相关性(P>0.05),血红蛋白与左心室后壁舒张末期厚度、左心室舒张末期内径、左心室质量指数呈负相关(r=-0.317,P=0.025;r=-0.480,P<0.001;r=-0.452,P=0.001)。结论腹膜透析患者存在不同的血红蛋白变异性、心脏结构和功能改变,纠正贫血、减少血红蛋白变异性有助于改善心脏结构及功能。
Objective To investigate the relationship of hemoglobin variation with cardiac structure and function in patients with different peritoneal dialysis duration.Methods Sixty patients with chronic renal failure undergoing peritoneal dialysis for over 6 months were divided into<12 months group,12-24 months group and>24 months group according to dialysis duration.Hemoglobin levels were detected in three groups,and hemoglobin variability,slope and amplitude were calculated.The ventricular septal end-diastolic thickness,left ventricular posterior wall end-diastolic thickness,left ventricular end-diastolic dimension,left ventricular ejection fraction,and left ventricular diastolic early and late maximum blood flow velocity ratio(E/A)were measured by echocardiography.The left ventricular mass index was calculated.The correlation between hemoglobin variation and echocardiography indexes was analyzed by Spearman method.Results The hemoglobin variability was significantly higher in<12 months group(18.78(7.27,33.89)g/L)than that in 12-24 months group(8.98(5.69,11.91)g/L)(P<0.05),and showed no significant difference compared with>24months group(11.95(9.37,20.24)g/L)(P>0.05).The hemoglobin slope was significantly lower in<12 months group(-1.50(-4.08,-0.57))than that in>24months group(-0.28(-0.60,-0.16)),and showed no significant difference compared with 12-24 months group(-0.82(-1.67,-0.12))(P>0.05).The hemoglobin level was significantly higher in <12 months group((110.54±17.45)g/L)than that in 12-24 months group((86.60±20.50)g/L)and <12 months group((86.85±15.45)g/L)(P<0.05).There were no significant differences in hemoglobin amplitude,left atrial diameter,ventricular end-diastolic thickness,left ventricular posterior end-diastolic thickness,left ventricular end-diastolic dimension,left ventricular mass,left ventricular mass index,left ventricular ejection fraction and E/A ratio among three groups(P>0.05).The hemoglobin variability and hemoglobin amplitude were not linearly correlated with ventricular septal thickness,left ventricular posterior wall end-diastolic thickness,left ventricular end-diastolic dimension,left ventricular mass index and left ventricular ejection fraction(P>0.05),and the hemoglobin level was negatively correlated with left ventricular posterior wall end-diastolic thickness,left ventricular end-diastolic dimension and left ventricular mass index(r=-0.317,P=0.025;r=-0.480,P=0.000;r=-0.452,P=0.001).Conclusion Hemoglobin variation and cardiac structure and function changes are commonly found in patients with different peritoneal dialysis duration.Correcting anemia and reducing hemoglobin variation may contribute to the improvement of cardiac structure and function.
作者
撒利建
马蓓佳
赵瑛瑛
SA Lijian;MA Beijia;ZHAO Yingying(Grade 2016,the Second Clinical College of Zhengzhou University, Zhengzhou 450014,China;Department of Nephrology,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China)
出处
《中华实用诊断与治疗杂志》
2019年第1期43-46,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省科技攻关项目(172102310032)
关键词
慢性肾功能衰竭
血红蛋白变异性
心脏结构与功能
腹膜透析
chronic renal failure
hemoglobin variation
cardiac structure and function
peritoneal dialysis
