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目的:探讨长期腹膜透析(PD)患者心胸比(CTR)变化特点,分析其与充血性心力衰竭(CHF)之间的联系。方法:选择国家肾脏疾病临床医学研究中心行PD置管并规律随访的终末期肾病(ESRD)患者158例,每6个月随访一次,记录胸片及心脏超声结构,计算CTR及左心室质量指数(LVMI),同时收集患者临床及实验室检验、透析参数等指标。比较不同透析龄时患者CTR及LVMI变化趋势,分析相关影响因素,比较不同CTR患者CHF患病率及死亡率,并探索因果关系。结果:PD患者CTR逐渐增大,48月间CTR从0.467±0.039增至0.533±0.063;CHF患者CTR始终大于非CHF患者,且增加幅度更为明显;CTR较大的患者CHF患病率及死亡率均更高;透析龄、血清白蛋白(Alb)、脉压与患者CTR密切相关,体质量指数(BMI)及尿量与CTR增大独立相关。结论:PD患者随着透析龄延长其CTR逐渐增加,CTR越大则CHF患病率及死亡率均较高;Alb、脉压、BMI、尿量及透析时间是影响CTR的因素。
OBJECTIVE: To investigate the changes of cardiothoracic ratio (CTR) in patients with long-term peritoneal dialysis (PD) and analyze its association with congestive heart failure (CHF). Methods: A total of 158 patients with end-stage renal disease (ESRD) who underwent PD catheterization and regular follow-up were enrolled in the National Kidney Disease Clinical Medical Center. The follow-up was performed every 6 months. The structures of the chest radiograph and the heart were recorded. The CTR and the left ventricular mass index (LVMI), while collecting clinical and laboratory tests, dialysis parameters and other indicators. The changes of CTR and LVMI in patients under different dialysis ages were compared. The influencing factors were analyzed, and the prevalence of CHF and mortality in different CTR patients were compared, and causality was also explored. Results: The CTR of PD patients increased gradually, and CTR increased from 0.467 ± 0.039 to 0.533 ± 0.063 in 48 months. The CTR of patients with CHF was always higher than that of non-CHF patients, and the increase rate was more obvious. The prevalence of CHF and death Dialysate age, serum albumin (Alb), pulse pressure and patients with CTR are closely related to the body mass index (BMI) and urine output and CTR increased independently. Conclusions: The CTR of PD patients increases gradually with the extension of dialysis. The higher the CTR is, the higher the morbidity and mortality of CHF are. Alb, pulse pressure, BMI, urine output and dialysis time are the factors affecting CTR.