维持性血液透析患者的左心室肥厚相关因素分析及心电图对其诊断的临床评价.docVIP

维持性血液透析患者的左心室肥厚相关因素分析及心电图对其诊断的临床评价 练小铭 蒋更如 上海交通大学医学院附属新华医院肾内科 上海 200092 摘要： 目的：观察维持性血液透析患者左心室肥厚情况，及其相关危险因素。并比较目前常用的三种心电图诊断标准对左心室肥厚的诊断价值之间的差异。 方法：选取上海新华医院肾内科99例原发病为慢性肾炎的维持性血液透析患者，收集他们的临床数据，同时对其心脏进行超声心动图及心电图检查，分析左心室肥厚的相关因素。 结果：99例慢性肾炎维持性血透患者中，符合左心室肥厚（LVH）患者为81例（81.8%），非左心室肥厚患者为18例（18.2%）。单因素分析结果显示左心室肥厚组与非肥厚组性别、收缩压、贫血、血磷浓度、钙磷乘积、甲状旁腺素（PTH）、CRP阳性的差异比较有统计学意义(P0．05)。多因素Logestic分析示收缩压增高、PTH增高、贫血是LVH的独立危险因素。使用心电图对左室肥厚进行诊断，在国内标准，Cornall标准，欧洲2013高血压管理指南标准三者中，敏感度最高者为欧洲2013高血压管理指南（37.04%)，特异度最高者为国内标准（88.89%）。 结论：维持性血液透析患者的左心室肥厚发生率较高，与收缩压、血红蛋白、钙磷代谢状态、CRP阳性密切相关。对于存在上述临床特征的患者，应进行早期的预防性治疗以改善患者的预后。此外，定期行UCG和EKG检查，有助于早期发现此类患者心脏结构的改变。 关键词：血液透析；左心室肥厚；超声心动描记术；心电图 Risk facts of Left Ventricular Hypertension(LVH) and the Clinical evaluation of electrocardiogram for the diagnosis of maintenance hemodialysis(MHD) patients Lian Xiaoming,Jiang Gengru Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine nephrology department 200092 Abstract Objective To investigate the incidence and risk factors of left ventricular hypertrophy in MHD patients.And compare the sensitivities and specificities of LVH according to three electrocardiographic methods which are commonly used. Methods 99 patients who underwent hemodialysis in Shanghai Xinhua hospital were enrolled in this study．Collecting their baseline anthropometric and laboratory parameters and at the same time assessing their cardiac structure by echocardiography and electrocardiogram. Results In the 99 MHD patients,Left Ventricular Hypertension was found in 81(81.8%)patients,and non Left Ventricular Hypertension in 18(18.2%) patients.Single factor analysis showed significant difference among gende,systemic pressure,anemi,hyperphosphatemia ,calcium phosphate product,parathormone and positive CRP between left ventricular hypertrophy group and non LVH group(P0.05).Multivariate logistic regression analysis revealed that the independent factors for LVH were high systemic pressure，low hemoglobin，and high parathormone．By using e