作者：许嵘，吕文律，曹学森，余金波，沈波，许佳瑞，徐辰祺，丁小强，邹建洲，李正红

单位：

1.江苏省中医院南京中医药大学附属医院肾内科2.复旦大学附属中山医院肾内科

单位（英文）：

1.Department of Nephrology, Jiangsu Province Hospital of Chinese Medicine/Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China 2.Departmen of Nephrology, Zhongshan Hospital Fudan University, Shanghai 200032, China

关键词：

肺动脉高压; 维持性血液透析; 危险因素;

关键词（英文）：

Pulmonary arterial hypertension; Maintained hemodialysis; Risk factors

中图分类号：

R 541.5

DOI：

10.12114/j.issn.1008-5971.2023.00.024

基金项目：

：国家自然科学基金青年科学基金项目（82000706）；上海市申康医院发展中心市级医院新兴前沿技术联合攻关项目 （SHDC12018127）；上海市“科技创新行动计划”技术标准项目基金（19DZ2205600）

摘要：

目的 探究维持性血液透析（MHD）患者发生肺动脉高压（PAH）的危险因素。方法 选取2012年11月至2021年3月在复旦大学附属中山医院血液透析中心治疗的MHD患者335例。根据PAH[肺动脉收缩压（PASP）>35mm Hg]发生情况将患者分为PAH组和非PAH组。比较两组一般资料、实验室检查指标、超声心动图检查结果。采用多因素Logistic回归分析探讨MHD患者发生PAH的影响因素。结果 本研究共有129例患者发生PAH。PAH组透析间期体质量增长率高于非PAH组（P<0.05）。PAH组N末端脑钠肽前体（NT-proBNP）、肿瘤坏死因子α(TNF-α)高于非PAH组，红细胞分布宽度（RDW）、左心房内径、左心室舒张末期内径、左心室收缩末期内径、左心室后壁厚度大于非PAH组，血钙、血红蛋白、左心室射血分数低于非PAH组（P<0.05）。多因素Logistic回归分析结果显示，NT-proBNP升高、血钙降低、RDW增大和TNF-α升高是MHD患者发生PAH的独立危险因素（P<0.05）。结论 NTproBNP升高、血钙降低、RDW增大和TNF-α升高是MHD患者发生PAH的独立危险因素，对MHD患者进行定期检查、评估，并早期干预容量超负荷状态，调节钙磷代谢紊乱，改善营养状况及微炎症状态，有助于减少PAH的发生。

英文摘要：

Objective To explore the risk factors of pulmonary arterial hypertension (PAH) in maintenance hemodialysis (MHD) patients. Methods A total of 335 MHD patients in the Hemodialysis Center of Zhongshan Hospital Fudan University from November 2012 to March 2021 were selected. Patients were divided into PAH group and non-PAH group according to the occurrence of PAH [pulmonary arterial systolic blood pressure (PASP) > 35 mm Hg] . The general data, laboratory examination indexes and echocardiographic examination indexes of the two groups were compared. Multivariate Logistic regression analysis was used to investigate the influencing factors of PAH in MHD patients. Results There were 129 cases of PAH in this study. The increase ratio of interdialytic body mass in PAH group was higher than that in non-PAH group (P < 0.05) . N-terminal pro brain natriuretic peptide (NT-proBNP) , tumor necrosis factor-α (TNF-α) in PAH group were higher than those in non-PAH group, redcell distribution width (RDW) , left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and left ventricular posterior wall thickness were greater than those in non-PAH group, and serum calcium, hemoglobin and left ventricular ejection fraction were lower than those in non-PAH group (P < 0.05) . Multivariate Logistic regression analysis results showed that elevated NT-proBNP, reduced blood calcium, enlarged RDW and elevated TNF-α were independent risk factors of PAH in MHD patients (P < 0.05) . Conclusion Elevated NT-proBNP, reduced blood calcium, enlarged RDW and elevated TNF-α are independent risk factors of PAH in MHD patients. Regular examination and evaluation of MHD patients, early intervention of volume overload state, regulation of calcium and phosphorus metabolism disorders, improvement of nutritional status and micro-inflammatory status are conducive to reduce the occurrence of PAH.

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