文章摘要
刘赛球,陈 莉,许军英,余 红,张雅茹.高通量血液透析对糖尿病肾病血液透析患者心脏功能及结构的影响及预后的影响因素分析[J].,2021,(14):2744-2747
高通量血液透析对糖尿病肾病血液透析患者心脏功能及结构的影响及预后的影响因素分析
The Influence of High Flux Hemodialysis on Cardiac Function and Structure and the Influencing Factors of Prognosis in Hemodialysis Patients with Diabetic Nephropathy
投稿时间:2020-11-04  修订日期:2020-11-28
DOI:10.13241/j.cnki.pmb.2021.14.031
中文关键词: 高通量血液透析  糖尿病肾病  血液透析  心脏功能  心脏结构  预后
英文关键词: High flux hemodialysis  Diabetic nephropathy  Hemodialysis  Cardiac function  Cardiac structure  Prognosis
基金项目:湖南省自然科学基金面上项目(2016JJ6161);湖南省脑科医院院级课题(2018B15)
作者单位E-mail
刘赛球 湖南省脑科医院/湖南省第二人民医院肾内科 湖南 长沙 430015 lxc305416@163.com 
陈 莉 湖南省脑科医院/湖南省第二人民医院肾内科 湖南 长沙 430015  
许军英 湖南省脑科医院/湖南省第二人民医院肾内科 湖南 长沙 430015  
余 红 湖南省脑科医院/湖南省第二人民医院肾内科 湖南 长沙 430015  
张雅茹 湖南省脑科医院/湖南省第二人民医院肾内科 湖南 长沙 430015  
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中文摘要:
      摘要 目的:探讨高通量血液透析对糖尿病肾病(DN)血液透析患者心脏功能及结构的影响,并分析预后的影响因素。方法:选取2017年5月~2018年11月期间我院收治的DN血液透析患者(n=172),上述DN血液透析患者中普通透析治疗者60例(普通透析组)、高通量血液透析治疗者112例(高通量透析组)。普通透析组采用低通量透析治疗,高通量透析组采用高通量透析治疗,比较两组患者心脏功能及结构以及预后情况,采用单因素、多因素Logistic回归分析预后的影响因素。结果:高通量透析组治疗6个月后左心房内径(LAD)、左心室舒张末内径(LVDd)、左心室心肌重量指数(LVMI)低于治疗前和普通透析组(P<0.05),高通量透析组治疗6个月后左心室射血分数( LVEF )高于治疗前和普通透析组(P<0.05)。高通量透析组的生存率高于普通透析组(P<0.05)。存活组年龄、上机前舒张压、上机前收缩压、血磷、全段甲状旁腺激素(iPTH)均低于死亡组(P<0.05),存活组透析频率、白蛋白、血红蛋白均高于死亡组(P<0.05),两组性别、血钙比较无差异(P>0.05)。多因素Logistic回归分析结果显示,上机前舒张压高、上机前收缩压高、血磷高、iPTH高、透析频率少、白蛋白低、血红蛋白低均是DN血液透析患者死亡的危险因素(P<0.05)。结论:高通量血液透析能减轻DN患者血液透析所引起的心脏功能及结构损伤,改善患者预后。影响DN血液透析患者预后的因素较多,其中上机前舒张压、上机前收缩压、血磷、iPTH越高,白蛋白、血红蛋白越低,透析频率越少,患者的死亡风险越大。
英文摘要:
      ABSTRACT Objective: To investigate the effect of high flux hemodialysis on cardiac function and structure in hemodialysis patients with diabetic nephropathy (DN), and to analyze the prognostic factors. Methods: The clinical data of DN hemodialysis patients (n = 172) admitted to our hospital from May 2017 to November 2018 were retrospectively selected. Among the above-mentioned DN hemodialysis patients, 60 patients were treated with common dialysis (common dialysis group) and 112 patients were treated with high-throughput hemodialysis (high-throughput dialysis group). The common dialysis group was treated with low-throughput dialysis, while the high-throughput dialysis group was treated with high-throughput dialysis. Single factor and Multivariate Logistic regression were used to analyze influencing factors of prognosis. Results: 6 months after treatment, left atrial diameter (LAD), left ventricular end-diastolic diameter (LVDd) and left ventricular myocardial mass index (LVMI) of the high-throughput dialysis group were lower than those of the before treatment and common dialysis group (P<0.05), and left ventricular ejection fraction (LVEF) of the high-throughput dialysis group was higher than that of the before treatment and common dialysis group (P<0.05). The survival rate of the high-throughput dialysis group was higher than that of the common dialysis group (P<0.05). Age, pre-operative diastolic blood pressure, pre-operative systolic blood pressure, blood phosphorus, and full parathyroid hormone (iPTH) of the survival group were all lower than those of the death group (P<0.05), and the dialysis frequency, albumin, and hemoglobin of the survival group were all higher than those of the death group (P<0.05). There were no significant differences between the two groups in gender and blood calcium (P>0.05). Multivariate Logistic regression analysis showed that high diastolic blood pressure, high systolic blood pressure before admission, high blood phosphorus, high iPTH, low dialysis frequency, low albumin and low hemoglobin were all risk factors for death in hemodialysis patients with DN (P<0.05). Conclusion: High flux hemodialysis can reduce the cardiac function and structural damage caused by hemodialysis patients with DN, and improve the prognosis of patients. There are many factors affecting the prognosis of hemodialysis patients with DN, among which, the higher diastolic blood pressure, the higher preoperative systolic blood pressure, blood phosphorus and iPTH, the lower the albumin and hemoglobin, and the lower the dialysis frequency, the greater the risk of death.
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