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慢性肾脏病合并肺动脉高压患者的流行病学及危险因素:一项回顾性研究

Epidemiology and risk factors in CKD patients with pulmonary hypertension: a retrospective study.

作者信息

Zhang Qian, Wang Le, Zeng Hongbing, Lv Yongman, Huang Yi

机构信息

Division of Nephrology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.

出版信息

BMC Nephrol. 2018 Mar 20;19(1):70. doi: 10.1186/s12882-018-0866-9.

DOI:10.1186/s12882-018-0866-9
PMID:29554879
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5859392/
Abstract

BACKGROUND

Pulmonary hypertension (PH) is a rare disease often associated with high mortality and is recently recognized as a common complication secondary to chronic kidney disease (CKD). Epidemiological data for this disorder across the spectrum of CKD is poorly understood.

METHODS

We retrospectively analyzed 705 CKD patients with complete clinical records from July 2013 to September 2015. All the patients were estimated by echocardiography and PH was defined as pulmonary artery systolic pressure (PASP) > 35 mmHg. The prevalence of PH in CKD patients was investigated, and their association was evaluated with a logistic regression model.

RESULTS

The overall prevalence of PH was 47.38%, in which mild, moderate and severe PH accounted for 22.13, 15.04 and 10.21%, respectively. The prevalence of PH in CKD stage 1-5 was 14.29, 33.33, 38.89, 40.91 and 64.47%. The prevalence of total PH was 57.63% in PD patients and 58.82% in HD patients. Compared with the non-dialysis patients, the prevalence of PH was much higher in patients receiving dialysis. Body mass index (BMI), hemoglobin, triglyceride (TG), proteinuria, parathyroid hormone (PTH) and estimated glomerular filtration rate (eGFR) were independent risk factors of PH in CKD patients.

CONCLUSIONS

The prevalence of PH is increased with the deterioration of renal function, however, which has no direct relation to the severity of PH. PH occurs more frequently in dialysis patients. Higher BMI and TG, more sever anemia, proteinuria and secondary hyperparathyroidism, poor renal dysfunction predict predict the more prevalence of PH in CKD patients.

摘要

背景

肺动脉高压(PH)是一种罕见疾病,常伴有高死亡率,最近被认为是慢性肾脏病(CKD)的常见并发症。目前对CKD全谱范围内该疾病的流行病学数据了解甚少。

方法

我们回顾性分析了2013年7月至2015年9月期间705例具有完整临床记录的CKD患者。所有患者均通过超声心动图进行评估,PH定义为肺动脉收缩压(PASP)>35mmHg。调查CKD患者中PH的患病率,并使用逻辑回归模型评估其相关性。

结果

PH的总体患病率为47.38%,其中轻度、中度和重度PH分别占22.13%、15.04%和10.21%。CKD 1-5期患者中PH的患病率分别为14.29%、33.33%、38.89%、40.91%和64.47%。腹膜透析(PD)患者中总PH患病率为57.63%,血液透析(HD)患者中为58.82%。与未透析患者相比,接受透析的患者中PH患病率要高得多。体重指数(BMI)、血红蛋白、甘油三酯(TG)、蛋白尿、甲状旁腺激素(PTH)和估算肾小球滤过率(eGFR)是CKD患者PH的独立危险因素。

结论

PH的患病率随肾功能恶化而增加,但与PH的严重程度无直接关系。PH在透析患者中更常见。较高的BMI和TG、更严重的贫血、蛋白尿和继发性甲状旁腺功能亢进、较差的肾功能预示着CKD患者中PH的患病率更高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5b0c/5859392/3dd801ad1516/12882_2018_866_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5b0c/5859392/8a9b2d59fad7/12882_2018_866_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5b0c/5859392/5e1aff2ff0a2/12882_2018_866_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5b0c/5859392/3dd801ad1516/12882_2018_866_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5b0c/5859392/8a9b2d59fad7/12882_2018_866_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5b0c/5859392/5e1aff2ff0a2/12882_2018_866_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5b0c/5859392/3dd801ad1516/12882_2018_866_Fig3_HTML.jpg

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