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目的分析老年慢性肾衰竭非透析患者心血管并发症的发病情况及特点,并探讨其危险因素。方法选取2011年1月~2015年12月间在本院住院治疗的老年慢性肾衰竭非透析患者112例。应用MDRD公式对肾小球滤过率(eGFR)进行估算分为四组,分别为1eGFR≥45ml/min(27例);2eGFR=30~44 ml/min(26例);3eGFR=15~29 ml/min(36例);4eGFR≤14 ml/min(23例)。收集患者的临床资料、生化指标并进行超声心电图检查,探讨各组间患者心脏结构和功能的变化,并分析其影响因素。结果四组患者平均年龄、血红蛋白、尿酸、尿总蛋白与肌酐比值、钙离子通道阻滞剂使用率、ACEI抑制剂使用率、收缩压和舒张压水平之间差异均有统计学意义(P<0.05)。伴随着eGFR水平降低,患者左心室质量指数逐渐升高,差异有统计学意义(P<0.05);左心室肥厚可分为向心和离心肥厚,各组间向心肥厚和离心肥厚发生率差异均有统计学意义(P<0.05)。Logistic回归分析显示,心血管疾病史、尿总蛋白与肌酐比值、eGFR分组为左心室肥厚的危险因素。左心室舒张和收缩功能减退情况、心包积液和瓣膜反流发生率四组间差异均无统计学意义(P>0.05)。结论老年慢性肾衰竭非透析患者左心室质量指数随着eGFR的降低而升高,主要表现为左心室肥厚,早期以向心性肥厚多见。eGFR分组、心血管疾病史、尿总蛋白与肌酐比值可能为左室肥厚的主要危险因素。
Objective To analyze the incidence and characteristics of cardiovascular complications in non-dialysis elderly patients with chronic renal failure and to explore its risk factors. Methods A total of 112 elderly patients with chronic renal failure who were hospitalized in our hospital from January 2011 to December 2015 were selected. The GFR was calculated by MDRD formula and divided into four groups, 1eGFR≥45ml / min (27 cases), 2eGFR = 30 ~ 44ml / min (26 cases), 3eGFR = 15 ~ 29 ml / min (36 cases); 4eGFR≤14 ml / min (23 cases). The clinical data, biochemical indexes and echocardiography were collected to investigate the changes of cardiac structure and function in patients and the influencing factors were analyzed. Results There were significant differences in mean age, hemoglobin, uric acid, total urinary protein and creatinine ratio, calcium channel blocker utilization, inhibitor of ACEI utilization, systolic blood pressure and diastolic blood pressure in the four groups (P < 0.05). With the decrease of eGFR level, the left ventricular mass index of patients gradually increased, the difference was statistically significant (P <0.05); left ventricular hypertrophy can be divided into centripetal and eccentric hypertrophy, the incidence of centripetal and eccentric hypertrophy in each group differences All were statistically significant (P <0.05). Logistic regression analysis showed that the history of cardiovascular disease, urinary protein and creatinine ratio, eGFR group as a risk factor for left ventricular hypertrophy. Left ventricular diastolic and systolic dysfunction, pericardial effusion and the incidence of valve regurgitation was no significant difference among the four groups (P> 0.05). Conclusion In elderly patients with chronic renal failure without dialysis, left ventricular mass index increased with the decrease of eGFR, mainly as left ventricular hypertrophy, and early concentric hypertrophy more common. eGFR group, history of cardiovascular disease, urinary protein and creatinine ratio may be the main risk factors for left ventricular hypertrophy.