低白蛋白血症作为血液透析患者左心室进行性肥厚的一个危险因素。

Hypoalbuminemia as a risk factor for progressive left-ventricular hypertrophy in hemodialysis patients.

作者信息

Moon K H, Song I S, Yang W S, Shin Y T, Kim S B, Song J K, Park J S

机构信息

Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.

出版信息

Am J Nephrol. 2000 Sep-Oct;20(5):396-401. doi: 10.1159/000013625.

DOI:10.1159/000013625

PMID:11092998

Abstract

BACKGROUND

This study was performed to evaluate the changes in left-ventricular (LV) mass in the patients starting maintenance hemodialysis and the risk factors for the progression of LVH.

METHODS

From June 1994 to February 1997, baseline echocardiography was obtained within six months after the initiation of hemodialysis in 111 patients with end-stage renal disease. Of the patients who had LVH on baseline echocardiography, 32 patients underwent follow-up echocardiography after 15 months (range: 9-24 months). LVH was defined as a left-ventricular mass index (LVMI) greater than 131 g/m(2) in males and 100 g/m(2) in females. Progressive LVH was defined as a follow-up LVMI greater than 105% of the baseline value. Hemoglobin, blood urea nitrogen, creatinine, cholesterol, albumin, prealbumin, parathyroid hormone, Kt/V, nPCR, fibrinogen, homocysteine and ACE gene polymorphism were also measured.

RESULTS

LVH was detected in 91 of 111 (82%) ESRD patients starting maintenance hemodialysis. Of the 32 patients in whom follow-up echocardiography was performed, progressive LVH occurred in 19 patients (M:F = 12:7). Progressive LVH was associated with lower diastolic blood pressure (81 +/- 11 vs. 90 +/- 12 mm Hg, p = 0.036) and lower serum albumin (3.5 +/- 0.4 vs. 3.9 +/- 0.4 g/dl, p = 0. 009). Serum albumin was negatively (r = -0.420, p = 0.017) correlated to Delta LVMI (follow-up LVMI minus baseline LVMI). Hypoalbuminemia was an independent risk factor for progressive LVH in multiple logistic regression analysis (R.R. = 1.29, p = 0.046). The association of progressive LVH with age, gender, diabetes mellitus, smoking history or other laboratory parameters was not significant.

CONCLUSION

LVH was highly prevalent in the patients starting maintenance hemodialysis for ESRD. In the follow-up echocardiography, LVH progressed in a substantial portion of the patients, and hypoalbuminemia was a risk factor for progressive LVH.

摘要

背景

本研究旨在评估开始维持性血液透析的患者左心室（LV）质量的变化以及左心室肥厚（LVH）进展的危险因素。

方法

1994年6月至1997年2月，对111例终末期肾病患者在开始血液透析后6个月内进行了基线超声心动图检查。在基线超声心动图检查发现有LVH的患者中，32例在15个月后（范围：9 - 24个月）接受了随访超声心动图检查。LVH定义为男性左心室质量指数（LVMI）大于131 g/m²，女性大于100 g/m²。进行性LVH定义为随访LVMI大于基线值的105%。还测量了血红蛋白、血尿素氮、肌酐、胆固醇、白蛋白、前白蛋白、甲状旁腺激素、Kt/V、nPCR、纤维蛋白原、同型半胱氨酸和ACE基因多态性。

结果

111例开始维持性血液透析的终末期肾病患者中，91例（82%）检测到LVH。在进行随访超声心动图检查的32例患者中，19例（男∶女 = 12∶7）发生了进行性LVH。进行性LVH与较低的舒张压（81±11 vs. 90±12 mmHg，p = 0.036）和较低的血清白蛋白（3.5±0.4 vs. 3.9±0.4 g/dl，p = 0.009）相关。血清白蛋白与ΔLVMI（随访LVMI减去基线LVMI）呈负相关（r = -0.420，p = 0.017）。在多因素逻辑回归分析中，低白蛋白血症是进行性LVH的独立危险因素（相对危险度 = 1.29，p = 0.046）。进行性LVH与年龄、性别、糖尿病、吸烟史或其他实验室参数之间的关联不显著。