摘要
目的探讨慢性肾脏病（CKD）患者心脏结构和功能改变以及CKD病变程度对其的影响。方法收集2007年2月至2010年6月我院泌尿内科209例CKD患者的临床资料，以同期我院心内科和风湿科心脏结构基本正常的25例非CKD患者为对照组，采用彩色多普勒超声对患者心脏结构和功能进行评估，并分析其实验室检查资料。结果209例CKD患者中，CKDI期、Ⅱ期、Ⅲ期、Ⅳ期和V期分别有3例、12例、23例、30例和141例。CKD患者心脏病变主要有主动脉瓣关闭不全（AI，58．4％）、二尖瓣关闭不全（MI，55．0％）、三尖瓣关闭不全（TI，42．6％）：左房扩大（23．9％）、左室扩大（41．6％）、肺动脉高压（18．6％）、心包积液（PE，24．9％）、左室肥厚（LVH，36．8％）、左室舒张功能降低（63．2％）。与对照组相比，CKDI～Ⅱ期开始AI、MI、TI和左室舒张功能障碍发生率显著升高（P均〈0．05），室间隔（IVS）显著增厚（P〈0．05）；CKDⅢ期开始主动脉内径（AO）显著增宽（P〈0．05）、左室后壁厚度（LVPW）显著增厚（P〈0．05）、LVH发生率显著升高（P〈0．05）；CKDIV期开始左房和左室内径开始增宽（P〈0．05）、左室质量（LVM）显著增加（P〈0．05）、PE发生率明显升高（P〈0．05）；CKDV期主动脉瓣钙化和肺动脉高压发生率显著升高（P均〈0．05）。患者心脏结构和功能随着CKD病情进展有逐步加重趋势。结论CKD患者心脏结构和功能病变显著，在CKD早期已出现心脏解剖结构和功能病理改变，随着肾功能恶化患者心脏病变逐步加重。
Objective To study the changes of cardiac structure and function in patients with chronic kidney disease（CKD） and its influence by the lesion degree of CKD. Methods A total of 209 in - patients with CKD at the department of nephrology in the first affiliated hospital of medical college of shantou university were enrolled between February 2007 to June 2010, and 25 patients without CKD at the department of cardiology and rheumatism in the present study were enrolled as control group. Color ultrasonic Doppler was taken to evaluate the cardiac structure and function. The clinical and laboratory parameters of patients were collected and analyzed. Results Among 209 patients with CKD, the cases of CKD I , CKDⅡ , CKDⅢ, CKD IV and CKD V were 3,12,23,30 and 141, respectively. The cardiac pathological changes of CKD mainly included aortic incompetence （AI, 58.4% ） , mitral incompetence （MI, 55.0% ）, tricuspid incompetenee（TI, 42% ）, left atrial expansion（23.9% ）, left ventricular ex- pansion （ 11.5% ）, pulmonary hypertension （ 18.6% ）, pericardial effusion （ PE, 24.9% ）, left ven- tricular hypertrophy （ LVH,36.8% ） and impaired diastolic function of left ventricular （63.2%）. Com- pared with the control group, the incidences of AI, MI, TI and impaired diastolic function of left ventrie- ular were significantly increased from CKD Ⅰ ～Ⅱ （ P 〈 0.05） , and the thickness of interventricular septum increased significantly（ P 〈0.05）. Since CKD Ⅲ stage ,aortic dimension and posterior left ventricular wall increased significantly （P 〈 0.05）, and the incidence of left ventricular hypertrophy increased significantly （P 〈 0. 05）. Since CKD IV stage, left atrial diameter and left ventricular end -diastolic dimension increased significantly （ P 〈 0.05）, and left ventricular mass and the incidence of pericardial effusion significantly increased （ P 〈 0.05 ）. The incidences of aortic valve calcification and pulmonary artery hypertension significantly
出处
《中国实用医刊》
2011年第7期11-14,共4页
Chinese Journal of Practical Medicine
基金
广东省自然科学基金（9151503102000007）,广东省科技计划项目（20088030301238）
关键词
慢性肾脏病
心血管病
心脏结构
心脏功能
左室结构
Chronic kidney disease
Cardiovascular disease
Cardiac structure
Cardiac function
Left ventricular structure
