Hüting J, Kramer W, Reitinger J, Kühn K, Wizemann V, Schütterle G
Center of Internal Medicine, Justus-Liebig University, Federal Republic of Germany.
Am Heart J. 1990 Feb;119(2 Pt 1):344-52. doi: 10.1016/s0002-8703(05)80026-2.
Continuous ambulatory peritoneal dialysis (CAPD) is associated with obvious hemodynamic and blood purification advantages over intermittent hemodialysis. To determine whether this is reflected in favorable left ventricular (LV) structure and function, a group of 55 normotensive patients (aged 58.4 +/- 11.0 years) undergoing CAPD was analyzed by means of echocardiography. Characteristic findings were LV hypertrophy (158 +/- 50 gm/m2), mainly the result of septal thickening (13.3 +/- 2.8 mm), and left atrial dilatation (40.9 +/- 7.4 mm). Mean LV diameter in end diastole and end systole and posterior wall thickness were normal. Parameters of LV systolic function (ejection fraction [EF]: 62.0 +/- 13.0%; velocity of circumferential fiber shortening [Vcf]: 1.58 +/- 0.46 circ/sec) were in the upper normal range at a hyperdynamic circulatory state (cardiac index [CI] 4.67 +/- 1.82 L/min/m2. The amount of LV hypertrophy was related to the amount of hypercirculation (CI: p less than 0.001; hemoglobin: p less than 0.025) and quality of blood purification (creatinine, urea: p less than 0.02) but not to blood pressure, age, or duration of dialysis. Left atrial dilatation was inversely related to LV systolic function (EF, Vcf: p less than 0.001) and directly related to LV muscle mass (p less than 0.02). A low prevalence (13%) of pericardial effusion was independent of blood purification. We conclude that in normotensive patients receiving CAPD, a high prevalence of left atrial dilatation and asymmetric septal hypertrophy is found, the latter being related both to the amount of hypercirculation and the quality of blood purification.
持续非卧床腹膜透析（CAPD）与间歇性血液透析相比，具有明显的血流动力学和血液净化优势。为了确定这是否反映在有利的左心室（LV）结构和功能上，通过超声心动图对一组55例接受CAPD的血压正常患者（年龄58.4±11.0岁）进行了分析。特征性表现为左心室肥厚（158±50 g/m²），主要是室间隔增厚（13.3±2.8 mm）的结果，以及左心房扩大（40.9±7.4 mm）。舒张末期和收缩末期的平均左心室直径以及后壁厚度正常。左心室收缩功能参数（射血分数[EF]：62.0±13.0%；圆周纤维缩短速度[Vcf]：1.58±0.46周/秒）在高动力循环状态下（心脏指数[CI] 4.67±1.82 L/min/m²）处于正常范围上限。左心室肥厚的程度与高循环量（CI：p<0.001；血红蛋白：p<0.025）和血液净化质量（肌酐、尿素：p<0.02）有关，但与血压、年龄或透析时间无关。左心房扩大与左心室收缩功能呈负相关（EF、Vcf：p<0.001），与左心室肌肉质量呈正相关（p<0.02）。心包积液的低患病率（13%）与血液净化无关。我们得出结论，在接受CAPD的血压正常患者中，发现左心房扩大和不对称性室间隔肥厚的患病率较高，后者与高循环量和血液净化质量均有关。
