俞盛　何飞名

[关键词] 肺动脉高压;腹膜透析;收缩压;慢性肾脏病

[中图分类号] R459.5          [文献标识码] B          [文章编号] 1673-9701（2021）17-0041-04

Analysis of risk factors of pulmonary hypertension in patients with peritoneal dialysis within one year

YU Sheng   HE Feiming

Department of Nephrology， the First Hospital of Sanming City in Fujian Province， Sanming   365000， China

[Abstract] Objective To investigate the occurrence and risk factors of pulmonary hypertension （PH） in patients with peritoneal dialysis within one year. Methods The peritoneal dialysis patients in our hospital who met the requirements from January 31， 2014 to December 31， 2017 were selected. Their general data， laboratory and echocardiographic examination results were collected. The pulmonary artery pressure>35 mmHg was diagnosed as PH. The incidence and risk factors of PH were statistically analyzed. Results Among 111 peritoneal dialysis patients， the incidence of PH was 20.72%. Patients in the PH group had significant high systolic blood pressure， high iPTH， increased left atrium， right ventricle， and right ventricular diameter. The proportion of combined heart failure also increased， while hemoglobin and serum protein levels were reduced. Logistic regression analysis showed that high systolic blood pressure and increased right ventricular diameter were risk factors for pulmonary hypertension. Conclusion PH has a higher incidence in early peritoneal dialysis patients. Poor systolic blood pressure control and increased right ventricular diameter are the main risk factors affecting PH.

[Key words] Pulmonary hypertension; Peritoneal dialysis; Systolic blood pressure; Chronic kidney disease

慢性腎脏病（Chronic kidney disease，CKD）是临床上的常见病，有数据显示，2017年全球CKD患病率为9.1%[1]，而在稍早的国内研究中CKD的发病率达10.8%[2]，住院患者合并CKD达4.8%[3]。影响CKD患者生活质量和预后因素很多，如蛋白尿、高血糖、贫血、钙磷代谢紊乱及心血管疾病等[4-5]。肺动脉高压是常见的心血管疾病之一，国内学者发现PH的患病率随着肾功能的恶化而增加[6]。国外也有研究认为，PH不仅仅与慢性肾脏病和终末性肾病患者心血管事件的风险显著增加相关，而且增加了患者住院率和死亡率[7-8]。但国内对于慢性肾脏病患者中PH的进一步研究较少，尤其对于腹膜透析早期（1年内）患者中肺动脉高压的发病率及相关危险因素缺少认识。本研究旨在通过我院腹膜透析1年内患者出现肺动脉高压的发病情况进行分析，从而为了解CKD发生PH的机制提供依据，现报道如下。

1 资料与方法

1.1 一般资料

选取2014年1月31日至2017年12月31日我科住院符合下列标准的患者111例。

1.1.1 纳入标准[9-11]  ①临床确诊的慢性肾脏病5期行腹膜透析者（2012年KDIGO标准）;②年龄>18岁者;③接受腹膜透析治疗12个月内者;④采集数据时未合并感染者;⑤实验室检查和超声心动图结果的完整临床数据者。

1.1.2排除标准[9-14]  ①年龄<18岁者;②确诊先天性心脏病、瓣膜性心脏病者;③确诊阻塞性肺部、限制性肺部疾病者;④慢性肝病者;⑤结缔组织病者;⑥HIV感染者;⑦甲状腺疾病者。

1.2 方法

1.2.1 一般资料采集  包括性别、年龄、身高、体重、体重指数（Body mass index，BMI）、收缩压、舒张压、有无糖尿病（Diabetes mellitus，DM）史，有无慢性心力衰竭（Chronic heart failure，CRF）病史（符合NYHA分级诊断标准[15]）。

1.2.2 实验室指标  包括血红蛋白（Hemoglobin，HGB）、红细胞分布宽度变……