Fabbian Fabio, Cantelli Stefano, Molino Christian, Pala Marco, Longhini Carlo, Portaluppi Francesco
Department of Clinical and Experimental Medicine, University Hospital St. Anna, Corso Giovecca 203, 44100 Ferrara, Italy.
Int J Nephrol. 2010 Sep 30;2011:283475. doi: 10.4061/2011/283475.
Introduction. Pulmonary hypertension (PHT) is an independent predictor of mortality. The aim of this study was to relate pulmonary arterial pressure (PAP) to the cardiovascular status of dialysis patients. Methods. 27 peritoneal dialysis (PD) and 29 haemodialysis (HD) patients (60 ± 13 years, 37 males, dialysis vintage was 40 ± 48 months) had PAP measured by echocardiography. Clinical and laboratory data of the patients were recorded. Results. PHT (PAP > 35 mmHg) was detected in 22 patients (39%; PAP 42 ± 6 mmHg) and was diagnosed in 18.5% of PD patients and 58.6% of HD patients (P = .0021). The group of subjects with PH had higher dialysis vintage (63 ± 60 versus 27 ± 32 months, P = .016), interdialytic weight gain (2.1 ± 1 versus 1.3 ± 0.9 Kg, P = .016), lower diastolic blood pressure (73 ± 12 versus 80 ± 8 mmHg, P = .01) and ejection fraction (54 ± 13 versus 60 ± 7%, P = .021) than the patients with normal PAP. PAP was correlated positively with diastolic left ventricular volume (r = 0.32, P = .013) and negatively with ejection fraction (r = -0.54, P < .0001). PHT was independently associated with dialysis vintage (OR 1.022, 95% CI 1.002-1.041, P = .029) and diastolic blood pressure (OR 0.861, 95% CI 0.766-0.967, P = .011). Conclusions. PHT is frequent in dialysis patients, it appears to be a late complication of HD treatment, mainly related to cardiac performance and cardiovascular disease history.
引言。肺动脉高压（PHT）是死亡率的独立预测因素。本研究的目的是探讨肺动脉压（PAP）与透析患者心血管状况之间的关系。方法。通过超声心动图测量27例腹膜透析（PD）患者和29例血液透析（HD）患者（年龄60±13岁，男性37例，透析龄40±48个月）的PAP。记录患者的临床和实验室数据。结果。22例患者（39%）检测到PHT（PAP>35 mmHg），其中PD患者诊断率为18.5%，HD患者诊断率为58.6%（P = 0.0021）。PHT组患者的透析龄更长（63±60个月对27±32个月，P = 0.016），透析间期体重增加更多（2.1±1 kg对1.3±0.9 kg，P = 0.016），舒张压更低（73±12 mmHg对80±8 mmHg，P = 0.01），射血分数更低（54±13%对60±7%，P = 0.021）。PAP与左心室舒张末期容积呈正相关（r = 0.32，P = 0.013），与射血分数呈负相关（r = -0.54，P < 0.0001）。PHT与透析龄（OR 1.022，95% CI 1.002 - 1.041，P = 0.029）和舒张压（OR 0.861，95% CI 0.766 - 0.967，P = 0.011）独立相关。结论。PHT在透析患者中很常见，似乎是HD治疗的晚期并发症，主要与心脏功能和心血管疾病史有关。
