Elderly patients in chronic hemodialysis: risk factors for left ventricular hypertrophy.
Elderly patients in chronic hemodialysis: risk factors for left ventricular hypertrophy.
复制标题
慢性血液透析老年患者：左心室肥厚的危险因素。
DOI：
10.1016/s0272-6386(97)90056-1
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发表时间：
1997
期刊：
影响因子：
--
通讯作者：
I. Bernardo
中科院分区：
文献类型：
--
作者：
P. Neves;A. P. Silva;I. Bernardo
在过去的几年中，在西方国家，开始肾脏替代治疗的老年患者比例越来越高。左心室肥大（LVH）与心血管疾病导致的死亡率增加相关，心血管疾病是慢性血液透析患者死亡的主要原因。在这项研究中，我们评估了67名65岁以上的慢性血液透析患者（33名女性和34名男性;平均年龄，72.6岁;平均慢性血液透析时间，51.3个月）。分析了一些生物学和实验室数据。采用Penn标准计算左心室质量。49例患者（73%）观察到LVH。将这49例患者分为两组（组1，向心性肥厚，n = 22;组2，离心性肥厚，n = 27），并与对照组（无LVH的患者，n = 18）进行比较。组1（P = 0.06）和组2（P = 0.055）显示收缩压较高，组2显示红细胞压积较低（P = 0.024）。超声心动图参数相差很大：组1左室后壁厚度（P = 0.0001），室间隔厚度（P = 0.0001），左室壁相对厚度（P = 0.002），组2左室舒张末期内径（P = 0.0001）、室间隔厚度（P = 0.01）和左室后壁厚度（P = 0.023）。以左室质量指数为因变量，以生物学和实验室检查资料为自变量，在逐步多元回归模型中发现，只有收缩压（t = 3.430; P = 0.0011），年龄（t = 2.059; P = 0.044），透析间期体重增加（t = 2.236; P = 0.029）和红细胞压积（t =-1.961; P = 0.054）独立影响左心室质量指数（R2= 0.313; P = 0.0001）。需要进一步研究以确定通过控制血压和纠正贫血来降低左心室质量指数是否会减少该特定人群的心血管事件。
In the past few years in Western countries, there has been an increasing proportion of elderly patients beginning renal replacement therapy. Left ventricular hypertrophy (LVH) is associated with an increased mortality rate due to cardiovascular disease, the main cause of death in patients on chronic hemodialysis. In this study, we evaluated 67 chronic hemodialysis patients older than 65 years (33 women and 34 men; mean age, 72.6 years; mean time on chronic hemodialysis, 51.3 months). Several biological and laboratory data were analyzed. The left ventricular mass was calculated using the Penn convention criteria. LVH was observed in 49 patients (73%). These 49 patients were divided into two groups (group 1, concentric hypertrophy, n = 22; and group 2, eccentric hypertrophy, n = 27) and compared with a control group (patients without LVH, n = 18). Group 1 (P = 0.06) and group 2 (P = 0.055) showed higher systolic blood pressures and group 2 showed a lower hematocrit (P = 0.024). The echocardiographic parameters were expectedly different: group 1 had higher posterior left ventricular wall thickness (P = 0.0001), interventricular septum thickness (P = 0.0001), and left ventricular wall relative thickness (P = 0.002), and group 2 had higher left ventricular end-diastolic diameter (P = 0.0001), interventricular septum thickness (P = 0.01), and posterior left ventricular wall thickness (P = 0.023). Using the left ventricular mass index as the dependent variable and the evaluated biological and laboratory data as the independent variables, we found in a stepwise multiple regression model that only systolic blood pressure (t = 3.430; P = 0.0011), age (t = 2.059; P = 0.044), interdialytic weight gain (t = 2.236; P = 0.029), and hematocrit (t = −1.961; P = 0.054) independently influenced the left ventricular mass index (R2= 0.313; P = 0.0001). Further studies are needed to determine whether reduction of the left ventricular mass index, through control of blood pressure and correction of anemia, will decrease the cardiovascular events in this particular population.