Savage T, Giles M, Tomson C V, Raine A E
Anthony Raine Laboratories, Bristol, UK.
Clin Nephrol. 1998 Feb;49(2):107-12.
Left ventricular hypertrophy (LVH) is known to be a strong predictor of cardiovascular death in dialysis patients, but the mediators for its development remain to be clarified. In the non-renal population risk factors for LVH differ between the genders. We therefore studied 46 non-diabetic patients (26 male, 19 female) on maintenance hemodialysis (n = 25) or continuous ambulatory peritoneal dialysis (CAPD) (n = 20) all free from clinically evident cardiac disease, who underwent 48-hour ambulatory blood pressure (BP) monitoring, 2-D and M-mode echocardiography for left ventricular mass index (LVMI) and bloods for hemoglobin, parathyroid hormone (PTH), urea and electrolytes and liver function tests. Thirty-two out of 45 patients were taking antihypertensive drugs at the time of the study. The mean 48-hour BP was 135 +/- 19/83 +/- 13 mmHg and the mean LVMI was 144 +/- 50 g/m2. LVH (LVMI > 131 g/m2 men, > 100 g/m2 women) was present with equal frequency in both sexes: men 72% (18/25) and women 68% (13/19). Simple regression analysis showed that LVMI was correlated with 48-hour pulse pressure (r = 0.52, p < 0.00033), 48-hour systolic BP (r = 0.37, p < 0.05), PTH (r = 0.31, p < 0.04) and inversely with serum calcium (r = -0.29, p < 0.05) and hemoglobin (r = -0.33, p < 0.03). However, on multiple regression analysis pulse pressure (R2 = 28.7%), day systolic BP (R2 = 15.4%) and 48-hour systolic BP (R2 = 14.1%) were the only variables linked to LVMI. When the patients were split by gender, stepwise linear regression in the men showed a highly significant relationship between LVMI and pulse pressure (R2 = 37.1%) which was stronger at nighttime (R2 = 42.6%), but in females this was not apparent (R2 = 4.39%) and indeed no variable was linked to LVMI. Our study confirms that LVH is not only prevalent in dialysis patients but is present with equal frequency in both sexes. However the determinants of its development are different for each gender. In males pulse pressure, and therefore by implication vascular compliance, is important but in females, other unidentified factors predominate.
众所周知，左心室肥厚（LVH）是透析患者心血管死亡的有力预测指标，但其发展的介导因素仍有待阐明。在非肾人群中，LVH的危险因素存在性别差异。因此，我们研究了46例非糖尿病患者（26例男性，19例女性），他们均接受维持性血液透析（n = 25）或持续性非卧床腹膜透析（CAPD）（n = 20），且均无明显的临床心脏病，这些患者接受了48小时动态血压（BP）监测、二维和M型超声心动图以测量左心室质量指数（LVMI），并进行了血液检查以检测血红蛋白、甲状旁腺激素（PTH）、尿素、电解质及肝功能。45例患者中有32例在研究时正在服用抗高血压药物。48小时平均血压为135±19/83±13 mmHg，平均LVMI为144±50 g/m²。LVH（男性LVMI>131 g/m²，女性>100 g/m²）在两性中出现的频率相同：男性为72%（18/25），女性为68%（13/19）。简单回归分析显示，LVMI与48小时脉压（r = 0.52，p < 0.00033）、收缩压（r = 0.37，p < 0.05）、PTH（r = 0.31，p < 0.04）呈正相关，与血清钙（r = -0.29，p < 0.05）和血红蛋白（r = -0.33，p < 0.03）呈负相关。然而，多元回归分析显示，脉压（R² = 28.7%）、日间收缩压（R² = 15.4%）和48小时收缩压（R² = 14.1%）是与LVMI相关的唯一变量。当按性别对患者进行分组时，男性的逐步线性回归显示LVMI与脉压之间存在高度显著的关系（R² = 37.1%），夜间这种关系更强（R² = 42.6%），但在女性中并不明显（R² = 4.39%），实际上没有变量与LVMI相关。我们的研究证实，LVH不仅在透析患者中普遍存在，而且在两性中出现的频率相同。然而，其发展的决定因素在每种性别中有所不同。在男性中，脉压以及由此暗示的血管顺应性很重要，但在女性中，其他未明确的因素占主导地位。
