肺彗星对血液透析患者心功能的评估作用
Assessment of heart function by lung comets in maintenance hemodialysis patients

王自良.肺彗星对血液透析患者心功能的评估作用[J].内科急危重症杂志,2019,25(5):387-390

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DOI：10.11768/nkjwzzzz20190510

英文关键词:Transnasal hyperflow oxygen therapy Acute exacerbation of chronic obstructive pulmonary disease Sequential treatment

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作者	单位	E-mail
王自良	济南市人民医院	lwlh2009wch76@126.com

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中文摘要:

目的：评估肺彗星对血液透析患者心功能的评估作用。方法：选取维持性血液透析患者142例，根据美国心脏病协会（NYHA）心功能分级方法进行分级，142例患者中NYHA分级1~2级66例，3~4级76例，所有患者进行多普勒超声肺部及心脏检测；并检测血常规、生化、超敏C反应蛋白、肿瘤坏死因子水平。结果： NYHA1~2级组透析龄、血红蛋白、血白蛋白、胆固醇、左室射血分数均高于NYHA3~4级组；NYHA1~2级组的平均年龄、透析间期体重增加、肺彗星数目、肺动脉收缩压、超敏C反应蛋白、肿瘤坏死因子、肌钙蛋白均低于NYHA3~4级组 (均P＜0.05)。多因素logistics回归分析显示肺彗星数目、左室射血分数、透析龄是NYHA独立相关危险因素(均P<0.05)。肺彗星是预示NYHA恶化的独立危险因素（标准化回归系数为8.6662）。结论：不同心功能分级的血液透析患者出现肺部彗星指数不同，肺彗星是心功能变化的良好标记物，肺彗星对血液透析患者心力衰竭判断有重要作用。

英文摘要:

Objective: To assess heart function by lung comets in long-term hemodialys patients . Methods: According to NYHA functional classification, 142 patients receiving hemodialysis were divided into NYHA Class I/II group(66 patients) and the NYHA Class III/IV group(76 patients). All patients were subjected to echocardiography and lung ultrasound. Blood count, clinical biochemistry, high sensitivity C-reactive protein and tumor necrosis factor were detected.Results: Dialysis vintage, hemoglobin, serum albumin, total cholesterol, left ventricular ejection fraction were significantly higher in NYHA Class I/Ⅱ group than in NYHA Class Ⅲ/Ⅳ group ( P<0.05 for all); age was significantly younger, and interdialytic weight gain, lung comets score, pulmonary artery systolic pressure, high sensitivity C-reactive protein, TNF-α , troponin I were significantly lower in NYHA Class I/Ⅱ group than in NYHA Class Ⅲ/Ⅳgroup (P<0.05 for all). The multivariate logistic regression revealed lung comets score, left ventricular ejection fraction, and dialysis vintage were the independent risk factors for NYHA functional class ification (P<0.05 for all). Among all the variables analyzed, lung comets score was a predictor of NYHA progression (standardized estimate= 8.6662). Conclusion: Lung comets scores vary from different heart function classifications. Lung comets are marker of changes in heart function and play an important role in assessing heart failure in hemodialysis patients.