目的 分析慢性肾脏病（chronic kidney disease，CKD）非透析患者左心房增大(left atrial enlargement，LAE)的危险因素、发生率及对预后的影响。方法 选择2018年1月-2019年12月CKD 1～5期尚未进入透析，在首都医科大学宣武医院肾内科病房住院治疗且进行超声心动图检查的患者，将患者分为LAE组和非LAE组，收集患者人口学资料和生化检验资料。随访时间截止至2021年11月1日，全因死亡为随访的终点事件。结果 入选 524例CKD患者中，LAE 发生率57.06% （299/524）。多因素 Logistic 回归分析结果显示，合并慢性心血管疾病（OR=3.365，95%CI 1.896～5970，P＜0.001）、合并高脂血症（OR=1.845，95%CI 1.042～3.265，P=0.036）及低血钙（OR=0.273，95%CI 0.082～0.912，P＜0.035）为 CKD 患者出现LAE的独立影响因素。随访过程中60例患者死亡，Kaplan-Meier生存曲线分析结果显示，存在LAE 的CKD组累积生存率显著降低（Log-rankχ2=13.093，P＜0.001），但多因素 Cox 回归分析结果显示，年龄（Exp(B)=1.036，95%CI 1.011～1.062，P=0.005）及合并慢性心血管疾病（Exp(B)=2.175，95%CI 1.133～4.176，P=0.020）是CKD患者全因死亡的独立危险因素。结论 50%以上CKD 1～5 期非透析患者发生LAE，合并慢性心血管疾病、合并高脂血症及血钙偏低为CKD非透析患者出现LAE的独立危险因素。合并LAE的CKD患者死亡风险显著增高，但不是CKD患者全因死亡的独立危险因素。
[Abstract] Objective To analyze the risk factors, prevalence and prognostic effects of left atrial enlargement (LAE) in non-dialysis patients with chronic kidney disease （CKD）.Methods From January 2018 to December 2019, patients with stage 1 to 5 CKD who had not initiated dialysis and were hospitalized in the Department of Nephrology, Xuanwu Hospital of Capital Medical University and underwent echocardiography were selected and divided into LAE group and non-LAE group according to the diagnostic criteria of LAE. The demographic and biochemical data of patients were collected. The follow-up period ended November, 2021, and all-cause death or lost follow-up were the end point event. Results Among of the 524 patients with CKD, 299 had LAE （ 57.06%，299 / 524). The results of multivariate Logistic regression analysis showed that pre-existing chronic cardiovascular disease (OR = 3.365,95% CI 1.896-5970, P <0.001), hyperlipidemia (OR = 1.845,95% CI 1.042-3.265, P=0.036) and hypocalcemia (OR = 0.273,95% CI 0.082-0.912, P <0.035) were independent influencing factors for LAE in CKD patients. CKD patients with LAE had lower survival rate than those without LAE by Kaplan-Meier analysis(Log-rankχ2=13.093，P＜0.001）whereas the multivariate Cox regression analysis showed that age (Exp (B) =1.036,95%CI 1.011~1.062, P=0.005) and combined chronic cardiovascular disease (Exp (B) =2.175,95%CI 1.133~4.176, P=0.020) were independent risk factors for all-cause death in patients with chronic kidney diseases. Conclusions Prevalence of LAE is more than 50% of patients with stages 1 to 5 CKD. Chronic cardiovascular disease, hyperlipidemia and low blood calcium were independent risk factors for CKD patients with LAE, LAE increase risk all-cause death of CKD but it is not an independent risk factors for all-cause death in non-dialysis CKD patients.
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