目的 观察慢性肾脏病(chronic kidney disease,CKD)患者肺动脉高压(pulmonary arterial hypertension，PAH)发生率、危险因素及对预后的影响。 方法 收集2018年1月1日～2019年12
月31日在首都医科大学宣武医院肾内科住院的CKD患者的一般资料，进行心脏超声检查，分析PAH情况，
并对患者进行随访，随访截止时间2021年11月1日，终点事件为全因死亡。应用Logistic回归分析CKD
患者PAH的危险因素，COX比例风险回归模型分析CKD患者死亡的风险因素。 结果 570例CKD患者中发
生PAH的患者52例，PAH发生率为9.12%。在52例PAH患者中轻度22例(42.31%)，中度25例(48.08%)，重
度5例(9.61%)。多因素Logistic回归分析显示：年龄(OR=1.036，95% CI：1.008～1.063，P=0.010)、合并
慢性心脏基础疾病(OR=4.373，95% CI：2.271～8.423，P＜0.001)、血红蛋白低于 110g/L(OR=2.218，
95% CI：1.024～4.801，P=0.043)为CKD患者出现PAH的危险因素。对570例患者进行平均27.3个月的随
访，死亡 67 例(11.7%)，失访 113 例(19.8%)，Kaplan-Meier 生存分析显示合并 PAH 的 CKD 组生存率比非
PAH 组降低(Log-rank,χ2=7.089,P=0.009),多因素 COX 回归模型显示：高龄(HR=2.502，95% CI：1.354～
4.621，P=0.003)和贫血(HR=2.486，95% CI：1.397～4.423，P=0.002)为CKD患者全因死亡的独立危险因
素。 结论 CKD 1～5期患者PAH发生率为9.12%，年龄、合并慢性心脏基础疾病、低血红蛋白为CKD患者
出现PAH的危险因素，PAH组生存率比非PAH组低，高龄和贫血为CKD患者全因死亡的独立危险因素。
【关键词】肺动脉高压；慢性肾脏病；危险因素
Objective To observe the incidence, risk factors, and prognostic value of pulmonary arterial
hypertension (PAH) in chronic kidney disease (CKD) patients at stage 1-5 and without dialysis. Methods A
total of 570 CKD patients at stage 1-5 admitted to the Department of Nephrology, Xuanwu Hospital, Capital
Medical University during the period from January1, 2018 to December 31, 2019 were recruited. They were
divided into PAH group and non-PAH group. They were followed up until November 1, 2021, and the end
event was all-cause mortality. Logistic regression was used to analyze the risk factors for PAH in the CKD patients, and Cox proportional hazards regression model was used to analyze the risk factors for death in these
patients. Results The incidence of PAH in the CKD patients was 9.12% (52/570), including 22 patients with
mild PAH (42.31%), 25 patients with moderate PAH (48.08%), and 5 patients with severe PAH (9.61%). Multivariate logistic regression showed that age (OR=1.036, 95% CI:1.008～1.063, P=0.010), complicated with
chronic heart disease (OR=4.373, 95% CI:2.271～8.423, P＜0.001) and hemoglobin lower than 110g/L (OR=
2.218, 95% CI:1.024～4.801, P=0.043) were the risk factors for PAH in CKD patients. The 570 CKD patients
were followed up for an average of 27.3 months, in which 67 cases (11.7%) died and 113 cases (19.8%) lost
the follow-up. Kaplan-Meier survival analysis showed that the survival rate of the CKD patients in PAH group
was significantly lower than those in non-PAH group (log-rank test: χ2=7.089, P=0.009). Multivariate Cox regression model showed that older age (HR=2.502, 95% CI:1.354～4.621, P=0.003) and anemia (HR=2.486,
95% CI:1.397～4.423, P=0.002) were the independent risk factors for all-cause death in CKD patients. Conclusions The incidence of PAH in CKD patients at stage 1-5 was 9.12%. Age, preexisted chronic cardiac disease and lower hemoglobin level were the risk factors for PAH. The survival rate of CKD patients in PAH
group was significantly lower than those in non-PAH group. Older age and anemia were the independent risk
factors for all-cause mortality in CKD patients.
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