前瞻性队列研究：初发腹膜透析患者左心室质量指数进展的预后价值。

Prognostic values of left ventricular mass index progression in incident peritoneal dialysis patients : a prospective cohort study.

机构信息

Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China.

出版信息

BMC Nephrol. 2022 May 31;23(1):200. doi: 10.1186/s12882-022-02831-6.

DOI:10.1186/s12882-022-02831-6

PMID:35641920

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9158358/

Abstract

BACKGROUND

Left ventricular hypertrophy (LVH) is common among patients undergoing dialysis. However, the dynamic structural changes of LV are rarely discussed. The study aimed to investigate the prognostic significance of left ventricular mass index (LVMI)-progression in incident peritoneal dialysis (PD) patients, and explore risks factors for LVMI-progression.

METHODS

Incident PD patients between February 2008 and July 2018 were recruited. Echocardiography was performed yearly to collect LVMI and evaluate its changes. Participants were divided into three subgroups: group with LVMI-regression, group with LVMI stable and group with LVMI-progression. The end points include all-cause mortality, cardiovascular mortality and cardiovascular events. Cox regression models were performed to identify the associations between LVMI-progression and these endpoints. Multivariate logistic regression was conducted to identify risk factors for LVMI-progression.

RESULTS

A total of 216 PD patients (130 men,60.2%) with a mean age of 54.3 ± 16.8 years were recruited. LVMI-progression was identified in 72 patients (33.3%) after PD initiation. The cohort was followed for a median duration of 65.9 months. Multivariable Cox regression analysis revealed that LVMI-progression was an independent predictor of all-cause mortality (HR, 1.419; 95% CI, 1.016-1.982; p = 0.040), cardiovascular mortality (HR, 1.836; 95%CI, 1.084-3.108; p = 0.024), and cardiovascular events (HR, 1.494; 95%CI, 1.063-2.099; p = 0.021). Multivariable logistic regression showed that hemoglobin, ferritin, blood pressure and fibrinogen were significantly associated with LVMI-progression.

CONCLUSION

Early LVMI-progression was independently associated with all-cause mortality and cardiovascular outcomes in PD patients. The dynamic monitoring of LVMI might therefore help identify high-risk patients.

摘要

背景

左心室肥厚（LVH）在接受透析的患者中很常见。然而，LV 的动态结构变化很少被讨论。本研究旨在探讨新诊断腹膜透析（PD）患者左心室质量指数（LVMI）进展的预后意义，并探讨 LVMI 进展的危险因素。

方法

招募了 2008 年 2 月至 2018 年 7 月期间的新诊断 PD 患者。每年进行超声心动图检查以收集 LVMI 并评估其变化。参与者被分为三组：LVMI 降低组、LVMI 稳定组和 LVMI 进展组。终点包括全因死亡率、心血管死亡率和心血管事件。Cox 回归模型用于确定 LVMI 进展与这些终点之间的关联。多变量逻辑回归用于确定 LVMI 进展的危险因素。

结果

共纳入 216 名 PD 患者（130 名男性，60.2%），平均年龄为 54.3±16.8 岁。在 PD 开始后，72 名患者（33.3%）出现 LVMI 进展。该队列的中位随访时间为 65.9 个月。多变量 Cox 回归分析显示，LVMI 进展是全因死亡率（HR，1.419；95%CI，1.016-1.982；p=0.040）、心血管死亡率（HR，1.836；95%CI，1.084-3.108；p=0.024）和心血管事件（HR，1.494；95%CI，1.063-2.099；p=0.021）的独立预测因子。多变量逻辑回归显示，血红蛋白、铁蛋白、血压和纤维蛋白原与 LVMI 进展显著相关。