Pulmonary hypertension in patients with stage 1-3 chronic kidney disease
Pulmonary hypertension in patients with stage 1-3 chronic kidney disease
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DOI：
10.4238/2014.july.25.25
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发表时间：
2014-01-01
影响因子：
0.4
通讯作者：
Bao, X. R.
中科院分区：
文献类型：
--
作者：
Yang, Q. M.;Bao, X. R.
继发于慢性肾脏病（CKD）的肺动脉高压（PH）很常见，但在1-3期CKD患者中，尚不清楚。我们试图评估PH的患病率，并阐明中国早期肾脏疾病患者的可能发病机制。对101例肾小球滤过率（GFR）≥ 60 mL/min/1.73 m（2）和27例GFR < 60 mL/min/1.73 m（2）的CKD患者进行多普勒估计肺动脉收缩压（PASP）测定。记录超声心动图参数、血浆脑钠肽（BNP）和患者基线特征。PH被定义为PASP >= 35 mmHg。GFR ≥ 60 mL/min/1.73 m2组PH患病率为23.76%（24/101），GFR < 60 mL/min/1.73 m2组PH患病率为48.15%（13/27），P < 0.05。37例PH患者的平均InBNP为4.93 ± 1.60 pg/mL，而无PH患者为2.89 ± 1.29 pg/mL，P < 0.01。左房内径（LA）在PH组（43.94 ± 5.81 mm）与非PH组（37.76 ± 7.48 mm）之间存在差异，P < 0.01。PH组GFR（44.10 ± 22.90 mL/min/1.73 m（2））较非PH组（75.59 ± 31.62 mL/min/1.73 m（2））显著下降，P < 0.01。lnBNP、LA和GFR是PASP的独立影响因素（r = 0.651，0.595，-0.488，P < 0.01）。PH在中国1-3期CKD患者中普遍存在。多普勒估计的PASP与lnBNP、扩大的LA和GFR密切相关。监测PASP、血浆BNP及评价肾功能有助于发现和预防CKD患者的重度PH。
Pulmonary hypertension (PH) secondary to chronic kidney disease (CKD) is common, but in stages 1-3 CKD patients, it remains unclear. We sought to evaluate the prevalence of PH and elucidate the possible pathogenesis in Chinese patients with early stage kidney disease. Doppler-estimated pulmonary systolic artery pressure (PASP) was measured in 101 CKD patients with glomerular filtration rate (GFR) >= 60 mL/min/1.73 m(2) and 27 CKD patients with GFR < 60 mL/min/1.73 m(2). Echocardiographic parameters, plasma brain natriuretic peptide (BNP), and baseline characteristics of patients were recorded. PH was defined as a PASP >= 35 mmHg. PH prevalence was 23.76% (24/101) in GFR >= 60 mL/min/1.73 m(2) group and 48.15% (13/27) in GFR < 60 mL/min/1.73 m(2) group, P < 0.05. Mean lnBNP was 4.93 +/- 1.60 pg/mL in 37 cases with PH and 2.89 +/- 1.29 pg/mL in those without, P < 0.01. Left atrial diameter (LA) showed deviation between patients with (43.94 +/- 5.81 mm) and without PH (37.76 +/- 7.48 mm), P < 0.01. GFR declined significantly in PH group (44.10 +/- 22.90 mL/min/1.73 m(2)) compared to non-PH group (75.59 +/- 31.62 mL/min/1.73 m(2)), P < 0.01. lnBNP, LA and GFR were independent determinants (r = 0.651, 0.595, -0.488, P < 0.01) of PASP. PH is prevalent among stage 1-3 CKD patients in China. Doppler-estimated PASP is strongly associated with lnBNP, enlarged LA and GFR. Monitoring PASP, plasma BNP and evaluation renal function may help to detect and prevent severe PH in CKD.