目的 探讨相位角(phase angle，PA)与维持性血液透析(maintenance hemodialysis，MHD)患者心脏结构和功能的关系。 方法 纳入2023年1月─6月在承德医学院附属医院肾脏内科行MHD的患者共109人，收集患者的一般资料、生化检查、心脏彩超、营养评分及PA，将患者分为低PA组(54人)和高PA组(55人)，比较2组临床特征，并将2组比较中有意义的心脏结构和功能指标应用单因素及多因素回归分析探讨其影响因素。 结果 与高PA组比，低PA组的左心房前后径(t=2.625,P=0.010)、舒张早期二尖瓣口血流峰值速度/舒张早期二尖瓣环运动速度(early diastolic mitral orifice peak velocity/early diastolic mitral ring mition velocity，E/E ')比值(Z=2.036,P=0.042)及瓣膜关闭不全 (χ2=4.650,P=0.031)、瓣膜钙化比例(χ2=12.660,P＜0.001)升高；单因素线性回归分析结果显示低PA与左心房前后径及E/E’比值相关(β=3.086、2.789，P=0.010、0.028)，多因素线性回归结果显示：低PA与左心房前后径独立相关(β=3.404,P=0.009)。单因素Logistics回归分析结果显示低PA时，发生心脏瓣膜关闭不全(OR=2.442,95%CI:1.075～5.546,P=0.030)、心脏瓣膜钙化(OR=4.190,95% CI:1.870～9.393,P＜0.001)的风险增大；多因素Logistics回归分析结果显示低PA是发生心脏瓣膜钙化的独立危险因素(OR =2.770,95% CI:1.042～7.364,P=0.041)。 结论 低PA与MHD患者左心房前后径扩大、E/E’比值增大、心脏瓣膜钙化、心脏瓣膜关闭不全相关，且低PA是MHD患者左心房前后径及心脏瓣膜钙化的独立危险因素。
Objective To explore the relationship between phase angle (PA) and cardiac structure and function in patients with maintenance hemodialysis (MHD). Methods A total of 109 patients undergoing MHD in Department of Nephrology, The Affiliated Hospital of Chengde Medical College from January 2023 to June 2023 were included in this study. General information, biochemical results, cardiac ultrasonography, nutritional score, and PA from body composition analyses were recruited. Patients were then divided into low PA group (54 patients) and high PA group (55 patients). Clinical characteristics were compared between the two groups. Univariate and multifactorial regression analyses were used to analyze the differences in cardiac structure and function between the two groups. Results The left atrium diameter (t=2.625, P=0.010), early diastolic mitral orifice peak velocity/early diastolic mitral ring motion velocity (E/E') ratio (Z=2.036, P=0.042), cardiac valve insufficiency (χ2=4.650, P=0.031) and cardiac valve calcification ratio (χ2=12.660, P＜0.001) were significantly increased in low PA group as compared with those in high PA group. Univariate linear regression showed that low PA was correlated with left atrium diameter and E/E' ratio (β=3.086 and 2.789, P=0.010 and 0.028). Multifactor linear regression showed that low PA was independently correlated with left atrium diameter (β=3.404, P=0.009). Univariate logistic regression found that the risks of cardiac valve insufficiency (OR=2.442, 95% CI：1.075～5.546, P=0.030) and cardiac valve calcification (OR=4.190, 95% CI：1.870～9.393, P＜0.001) increased with low PA. Multivariate logistic regression found that low PA was the independent risk factor for cardiac valve calcification (OR=2.770, 95% CI：1.042～7.364, P=0.041). Conclusion Low PA is associated with enlarged left atrium diameter, increased E/E' ratio, cardiac valve calcification and cardiac valve insufficiency in MHD patients, and is the independent risk factor for left atrium diameter and cardiac valve calcification in MHD patients.
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