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目的:探讨慢性肾脏病(CKD)患者肺动脉压变化情况及其相关因素。方法:选取167例(CKD1期～CKD5期)非透析慢性肾脏病患者和17例健康对照者,测定并比较各组肺动脉压(PASP)和血浆脑钠肽(BNP)、血红蛋白(Hb)、甲状旁腺素(PTH)及钙磷乘积的差异,探讨CKD患者肺动脉压变化及其相关因素。结果:(1)从CKD1期起,肺动脉压随肾功能恶化逐渐升高,CKD3期开始其变化更加明显。CKD3期较CKD2期、CKD4期较CKD3期、CKD5期较CKD4期之肺动脉压差异均有统计学意义(P<0.01);17.96%(30/167)CKD患者合并肺动脉高压(PHT;PASP≥40mmHg);(2)与肺动脉压正常组相比,PHT组患者BUN、Scr、PTH、钙磷乘积和ln(BNP)均显著增高(P<0.05),而Hb却明显下降(P<0.01)。肺动脉压与ln(BNP)、Scr、BUN、PTH、钙磷乘积呈正相关(P<0.01),与Hb水平负相关(P<0.01)。ln(BNP)和Hb进入以肺动脉压为因变量的回归方程:y=20.404+3.556x1-0.103x2,其中y代表PASP(mmHg),x1为血浆ln(BNP)(pg/ml),x2为Hb(g/L)。结论:慢性肾脏病患者容易合并肺动脉高压,其严重程度及发生率与CKD严重程度相关。血浆脑钠肽水平和贫血程度与肺动脉高压形成密切相关。
Objective: To investigate the changes of pulmonary arterial pressure in patients with chronic kidney disease (CKD) and its related factors. Methods: A total of 167 patients (CKD1 ~ CKD5) with chronic kidney disease and 17 healthy controls were enrolled in this study. Pulmonary arterial pressure (PASP), plasma BNP, Hb, Parathyroid hormone (PTH) and calcium and phosphorus product of differences in CKD patients with pulmonary arterial pressure changes and its related factors. Results: (1) From the CKD1 stage, pulmonary arterial pressure gradually increased as the renal function deteriorated. The change of CKD3 stage was more obvious. The difference of pulmonary arterial pressure between CKD3 and CKD2, CKD4, CKD3, CKD5 and CKD4 were statistically significant (P <0.01); 17.96% (30/167) patients with CKD had pulmonary hypertension (PHT; PASP≥40mmHg ); (2) The BUN, Scr, PTH, calcium and phosphorus products and ln (BNP) in PHT group were significantly higher than those in normal pulmonary arterial pressure group (P <0.05), while Hb was significantly decreased (P <0.01). Pulmonary arterial pressure was positively correlated with ln (BNP), Scr, BUN, PTH and calcium and phosphorus products (P <0.01), but negatively correlated with Hb level (P <0.01). ln (BNP) and Hb into the regression equation of pulmonary hypertension as a dependent variable: y = 20.404 + 3.556x1-0.103x2, where y represents PASP (mmHg), x1 is plasma ln (pg / ml), x2 is Hb (g / L). Conclusion: Patients with chronic kidney disease are prone to pulmonary hypertension. The severity and incidence of pulmonary hypertension are related to the severity of CKD. Plasma brain natriuretic peptide levels and anemia are closely related to the formation of pulmonary hypertension.