Paoletti Ernesto, Bellino Diego, Cassottana Paolo, Rolla Davide, Cannella Giuseppe
Divisionse di Nefrologia, Dialisi e Trapianto and Cardiologia, Azienda Ospedaliera Universitaria S Martino, Genova, Italy.
Am J Kidney Dis. 2005 Aug;46(2):320-7. doi: 10.1053/j.ajkd.2005.04.031.
Although left ventricular hypertrophy (LVH) is a strong predictor of mortality in patients with end-stage renal disease, few studies are available before the start of dialysis treatment. The purpose of this study is to evaluate the prevalence and clinical correlates of LVH in nondiabetic patients with chronic kidney disease (CKD) not yet undergoing renal replacement therapy.
We investigated 244 nondiabetic patients with CKD; 57 patients (42 men; age, 20 to 78 years) had stages 1 to 2 CKD and 187 patients (122 men; age, 18 to 77 years) had stages 3 to 5 CKD. Fifty-two normotensive healthy subjects served as controls. Each patient had blood pressure (BP) measured by means of 24-hour ambulatory BP monitoring and left ventricular mass index (LVMi) assessed by means of M-mode echocardiography. Creatinine clearance was estimated by means of the Cockcroft-Gault formula, and hemoglobin, serum lipid, and intact parathyroid hormone concentrations and daily urinary protein excretion were assessed by using routine methods.
In the overall group, prevalences of arterial hypertension and LVH were 66% and 74%, respectively. LVMi was 160 +/- 50 g/m2 body surface area and associated directly with age (P = 0.0013), duration of arterial hypertension (P = 0.0075), 24-hour systolic BP (P = 0.0113), pulse pressure (P = 0.0003), daytime (P = 0.0206) and nighttime systolic BP (P = 0.0059), and urinary protein excretion (P < 0.05) and inversely with creatinine clearance (P = 0.0103) and hemoglobin level (P = 0.0276). In patients with CKD stages 1 to 2 (LVH prevalence, 51%), age, duration of arterial hypertension, pulse pressure, and urinary protein excretion were significant predictors of LVMi (P < 0.00002) by using stepwise regression analysis, whereas in those with CKD stages 3 to 5 (LVH prevalence, 78%), pulse pressure emerged as the sole predictor of LVMi (P = 0.0011).
The prevalence of LVH in nondiabetic predialysis patients with CKD is greater than previously reported, and there is evidence that LVH already is present in the early stages of renal disease. Arterial hypertension is associated with LVH in patients with CKD, and the strong relationship between elevated pulse pressure and LVH in those with more advanced CKD suggests that increased arterial stiffness might have a role for LVH well before the start of dialysis therapy.
尽管左心室肥厚（LVH）是终末期肾病患者死亡率的有力预测指标，但在透析治疗开始前，相关研究较少。本研究旨在评估尚未接受肾脏替代治疗的非糖尿病慢性肾脏病（CKD）患者中LVH的患病率及其临床相关因素。
我们调查了244例非糖尿病CKD患者；其中57例（42例男性；年龄20至78岁）为1至2期CKD患者，187例（122例男性；年龄18至77岁）为3至5期CKD患者。52名血压正常的健康受试者作为对照。每位患者均通过24小时动态血压监测测量血压（BP），并通过M型超声心动图评估左心室质量指数（LVMi）。通过Cockcroft - Gault公式估算肌酐清除率，并采用常规方法评估血红蛋白、血脂、完整甲状旁腺激素浓度及每日尿蛋白排泄量。
在整个研究组中，动脉高血压和LVH的患病率分别为66%和74%。LVMi为160±50 g/m²体表面积，与年龄（P = 0.0013）、动脉高血压病程（P = 0.0075）、24小时收缩压（P = 0.0113）、脉压（P = 0.0003）、日间（P = 0.0206）和夜间收缩压（P = 0.0059）以及尿蛋白排泄量（P < 0.05）呈正相关，与肌酐清除率（P = 0.0103）和血红蛋白水平（P = 0.0276）呈负相关。在1至2期CKD患者（LVH患病率为51%）中，通过逐步回归分析，年龄、动脉高血压病程、脉压和尿蛋白排泄量是LVMi的显著预测因素（P < 0.00002），而在3至5期CKD患者（LVH患病率为78%）中，脉压是LVMi的唯一预测因素（P = 0.0011）。
非糖尿病CKD透析前患者中LVH的患病率高于先前报道，且有证据表明LVH在肾病早期就已存在。动脉高血压与CKD患者的LVH相关，在更晚期CKD患者中脉压升高与LVH之间的密切关系表明，在透析治疗开始前，动脉僵硬度增加可能在LVH的发生中起作用。
