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目的:探讨左心室肥厚(LVH)的现患率在透析患者中是否存在性别差异。方法:本研究纳入同一透析中心的190例患者,包括40例血液透析(HD)患者和150例腹膜透析(PD)患者。使用超声心动图检查测得的指标诊断LVH。对左心室质量(LVM)分别用体表面积(BSA)和身高2.7进行标准化计算获得2种左心室质量指数(LVMI-BSA和LVMI-身高2.7)。结果:HD和PD患者的平均年龄分别为(60±14)岁和(60±13)岁,透析龄的中位数分别为43个月和20个月。HD和PD患者中男性和女性之间的年龄、糖尿病、高血压、降压药的使用情况等差异均无统计学意义,使用2种方法标化的LVMI比较均显示女性的LVH现患率高于男性(在HD患者中,使用BSA标化的LVMI来诊断LVH,男女比例分别为41.7和81.3,P<0.05;在PD患者中,使用BSA标化的LVMI来诊断LVH,男女比例分别为47.7和64.7,P<0.05;HD患者中,用身高2.7标化的LVMI来诊断LVH,男女比例分别为41.6和68.8,P=0.082;在PD患者中,用身高2.7标化的LVMI来诊断LVH,男女比例分别为52.3和74.1,P<0.01)。将患者按LVH的发生与否分为2组,发现2组之间存在明显的性别差异[用BSA标化的LVMI,HD患者中男女之间分别为为(126.1±38.7)g/m2和(136.0±48.1)g/m2,P<0.05;PD患者中,均数分别为(123.4±43.2)g/m2和(139.1±53.1)g/m2,P<0.05;用身高2.7标化的LVMI,HD患者中男女均数分别为(51.6±15.5)g/m2和(61.0±20.9)g/m2,PD患者中男女均数分别为(52.6±18.0)g/m2和(66.0±26.0)g/m2,P<0.01]。多元回归分析结果提示,女性是LVH的一个独立危险因素(用BSA标化的指数LVH为因变量时OR=2.48,95CI1.33～4.59;以身高2.7标化的指数LVH为因变量时OR=4.05,95CI1.96～8.38)。结论:透析患者LVH的现患率在女性患者明显高于男性;女性发生LVH的危险性比年龄和糖尿病匹配的男性高2.5～4倍。
Objective: To investigate whether there is a gender difference in the prevalence of left ventricular hypertrophy (LVH) in dialysis patients. METHODS: This study enrolled 190 patients in the same dialysis center, including 40 hemodialysis (HD) patients and 150 PD (peritoneal dialysis) patients. LVH was diagnosed using echocardiography. Two kinds of left ventricular mass index (LVMI-BSA and LVMI-height 2.7) were obtained by normalizing left ventricular mass (LVM) with body surface area (BSA) and height 2.7 respectively. RESULTS: The mean age at HD and PD was (60 ± 14) years and (60 ± 13) years, respectively. The median dialysis age was 43 months and 20 months, respectively. There were no significant differences in the age, diabetes, hypertension, antihypertensive drug use between men and women in HD and PD patients. The LVMI standardized by 2 methods showed that the prevalence of LVH in women was higher than Male (LV HDL was diagnosed in HD patients using BSA-standardized LVMI for 41.7 and 81.3 respectively, P <0.05; in patients with PD, LVH was diagnosed using BSA-standardized LVMI for 47.7 and 64.7, P <0.05. In HD patients, LVH was diagnosed by LVMI with a height of 2.7. The ratio of male to female was 41.6 and 68.8, respectively, P = 0.082. LVD was diagnosed in LV patients with PD The proportions were 52.3 and 74.1, respectively, P <0.01). The patients were divided into two groups according to the incidence of LVH. There was a significant gender difference between the two groups [LVMI in BSA was (126.1 ± 38.7) g / m2 and (126.1 ± 38.7) g / m2 and 136.0 ± 48.1) g / m2, P <0.05; mean PD was 123.4 ± 43.2 g / m2 and 139.1 ± 53.1 g / m2, respectively; P <0.05; The average number of men and women in HD patients was (51.6 ± 15.5) g / m 2 and (61.0 ± 20.9) g / m 2, respectively. The mean male and female PD patients were 52.6 ± 18.0 g / m 2 and 66.0 ± 26.0 g / m2, P <0.01]. Multivariate regression analysis showed that women were an independent risk factor for LVH (index of LVH was normalized by BSA OR = 2.48,95 CI 1.33-4.59; index LVH was standardized by height of 2.7 OR = 4.05, 95CI 1.96 ~ 8.38). CONCLUSIONS: The prevalence of LVH in dialysis patients is significantly higher in women than in men; the risk of LVH in women is 2.5 to 4 times greater than in men with age and diabetes.