Takeda K, Nakamoto M, Baba M, Tanaka T, Yasunaga C, Nishihara G, Matsuo K, Urabe M
Kidney Center, Saiseikai Yahata Hospital, Fukuoka, Japan.
Clin Nephrol. 1998 May;49(5):308-12.
In dialysis patients, the prevalence of severe left ventricular (LV) hypertrophy and systolic failure, important predictors of cardiovascular morbidity and mortality, has been reported to be very high. Therefore, we investigated cardiac function in 17 long-term CAPD patients (dialysis duration: 76.5 +/- 13.2 months; L-CAPD) by echocardiography and pulsed Doppler, and then compared with 16 short-term CAPD patients (dialysis duration: 28.9 +/- 11.9 months; S-CAPD), 21 long-term hemodialysis patients (dialysis duration: 165.1 +/- 52.7 months; L-HD), and 22 short-term hemodialysis patients (dialysis duration: 71.3 +/- 28.9 months; S-HD), except for the cases with diabetes mellitus, ischemic heart disease, cardiac surgery or overt congestive heart failure. We selected 13 normotensive patients with normal kidney function as normal control group matched for sex and age (Control). Concerning with L-CAPD, S-CAPD, L-HD, and S-HD, these four groups were matched for age and original diseases. We examined blood pressure (BP), cardiothoracic rate (CTR), antihypertensive (AHT) drugs and laboratory data. Wall thickness, left atrium, ventricular chamber size, ejection fraction (EF) and left ventricular mass (LV mass) [Devereux et al. 1986] were measured by echocardiograph. Peak early diastolic flow velocity (E), peak atrial filling velocity (A), A/E ratio and deceleration time of peak early diastolic flow velocity (DT) were calculated by analyzing transmitral flow, recorded by pulsed Doppler. BP control, CTR and EF were significantly worse in L-CAPD than in other patient groups. A/E as one of parameters for cardiac diastolic function was significantly higher in L-CAPD than in HD patients. LVMI (LV mass index: LV mass/body surface area) was significantly higher in L-CAPD than in other groups. LVMI in CAPD patients was shown to be significantly worse as time goes. Volume control by itself without AHT drugs could achieve good BP control in the long-term CAPD patients who were changed to maintenance hemodialysis because of peritoneal sclerosis. We concluded that LV hypertrophy and systolic dysfunction tend to progress in CAPD patients as time goes on. Also it is suggested that the cause of cardiac dysfunction in CAPD patients was mainly based on poor BP control probably due to overhydration, and therefore, appropriate volume control in CAPD patients is especially important.
据报道，在透析患者中，严重左心室肥厚和收缩功能衰竭的患病率很高，而这两者是心血管疾病发病率和死亡率的重要预测指标。因此，我们通过超声心动图和脉冲多普勒对17例长期持续性非卧床腹膜透析（CAPD）患者（透析时间：76.5±13.2个月；L-CAPD）的心脏功能进行了研究，然后将其与16例短期CAPD患者（透析时间：28.9±11.9个月；S-CAPD）、21例长期血液透析患者（透析时间：165.1±52.7个月；L-HD）和22例短期血液透析患者（透析时间：71.3±28.9个月；S-HD）进行比较，排除患有糖尿病、缺血性心脏病、心脏手术或明显充血性心力衰竭的病例。我们选择了13例血压正常且肾功能正常的患者作为年龄和性别匹配的正常对照组（对照组）。关于L-CAPD、S-CAPD、L-HD和S-HD，这四组在年龄和原发病方面进行了匹配。我们检测了血压（BP）、心胸比率（CTR）、抗高血压（AHT）药物和实验室数据。通过超声心动图测量室壁厚度、左心房、心室腔大小、射血分数（EF）和左心室质量（LV质量）[德弗罗等人，1986年]。通过分析脉冲多普勒记录的二尖瓣血流来计算舒张早期峰值流速（E）、心房充盈峰值流速（A）、A/E比值和舒张早期峰值流速减速时间（DT）。L-CAPD组的血压控制、CTR和EF显著差于其他患者组。作为心脏舒张功能参数之一的A/E在L-CAPD组显著高于血液透析患者。L-CAPD组的左心室质量指数（LVMI：LV质量/体表面积）显著高于其他组。CAPD患者的LVMI随时间推移显著变差。对于因腹膜硬化而改为维持性血液透析的长期CAPD患者，仅通过容量控制而不使用AHT药物就能实现良好的血压控制。我们得出结论，随着时间的推移，CAPD患者的左心室肥厚和收缩功能障碍往往会进展。此外，提示CAPD患者心脏功能障碍的原因主要是由于水钠潴留导致的血压控制不佳，因此，CAPD患者进行适当的容量控制尤为重要。
