中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2009年
1期
18-23
,共6页
牟姗%施蓓莉%王琴%曹励欧%周文彦%俞梅花%倪兆慧%钱家麒
牟姍%施蓓莉%王琴%曹勵歐%週文彥%俞梅花%倪兆慧%錢傢麒
모산%시배리%왕금%조려구%주문언%유매화%예조혜%전가기
尿毒症%腹膜透析%心血管疾病
尿毒癥%腹膜透析%心血管疾病
뇨독증%복막투석%심혈관질병
Uremia%Peritoneal dialysis%Cardiovascular diseases
目的 了解终末期肾脏病(ESRD)腹膜透析患者的心血管疾病(CVD)发病率和有关高发危险因素,以及并发CVD的腹膜透析患者治疗时需关注的问题.方法 研究对象为上海交通大学医学院附属仁济医院慢性肾脏病(CKD)5期接受腹膜透析的患者,共254例入选,采用横断面回顾性调查分析方法.平均随访时间中位数为49个月.采集病史、血生化检测结果、腹膜透析充分性评估、颈动脉及心脏彩色多普勒超声检测结果.评估CVD事件的发生、发展和预后,以及进行相关因素分析.结果 CVD事件发生率为37%(93/254).发生CVD的患者多伴有糖尿病、透析龄较长、血三酰甘油水平较高、血清白蛋白较低、前白蛋白较低.彩色多普勒超声显示,发生CVD组的左房内径(LAD)(mm)、室间隔厚度(LVST)(mm)、左室心肌质量指数(LVMI)(g/m2)显著高于未发生CVD组(43.16±4.93比38.02±4.77、11.19±2.05比10.01±1.45、中位数192.03比150.28,均P<0.05);颈动脉内膜中层厚度(IMT)较厚(中位数0.80比0.65),颈动脉内径增宽;收缩期峰值流速(SPV)和舒张期峰值流速(DV)流速降低.既往无CVD的患者在随访过程中发生CVD时,其Ccr、Kt/V、D/Pr、理想体质量校正的蛋白分解率(nPCR)及血清白蛋白水平与无发生CVD组差异有统计学意义(P=0.045、0.015、0.051、0.029及0.005).在随访过程中出现新发CVD或CVD病情恶化的原有CVD的患者,都是透析龄较长以及三酰甘油水平较高者.LAD、LVST、LVMI及IMT在新发CVD和未发CVD两组间差异有统计学意义(P=0.033、0.022、0.045及0.029).Kaplan-Meier生存分析显示,既往CVD史和CVD症状是生存的独立危险因素.血清门蛋白<330 g/L、LAD>39.6 mm及曾患腹膜炎的患者生存率较低.结论 ESRD腹膜透析患者是CVD的高发群体,需了解这些患者的病史和伴随症状;保持透析的充分性;同时要防止腹膜炎的发生.
目的 瞭解終末期腎髒病(ESRD)腹膜透析患者的心血管疾病(CVD)髮病率和有關高髮危險因素,以及併髮CVD的腹膜透析患者治療時需關註的問題.方法 研究對象為上海交通大學醫學院附屬仁濟醫院慢性腎髒病(CKD)5期接受腹膜透析的患者,共254例入選,採用橫斷麵迴顧性調查分析方法.平均隨訪時間中位數為49箇月.採集病史、血生化檢測結果、腹膜透析充分性評估、頸動脈及心髒綵色多普勒超聲檢測結果.評估CVD事件的髮生、髮展和預後,以及進行相關因素分析.結果 CVD事件髮生率為37%(93/254).髮生CVD的患者多伴有糖尿病、透析齡較長、血三酰甘油水平較高、血清白蛋白較低、前白蛋白較低.綵色多普勒超聲顯示,髮生CVD組的左房內徑(LAD)(mm)、室間隔厚度(LVST)(mm)、左室心肌質量指數(LVMI)(g/m2)顯著高于未髮生CVD組(43.16±4.93比38.02±4.77、11.19±2.05比10.01±1.45、中位數192.03比150.28,均P<0.05);頸動脈內膜中層厚度(IMT)較厚(中位數0.80比0.65),頸動脈內徑增寬;收縮期峰值流速(SPV)和舒張期峰值流速(DV)流速降低.既往無CVD的患者在隨訪過程中髮生CVD時,其Ccr、Kt/V、D/Pr、理想體質量校正的蛋白分解率(nPCR)及血清白蛋白水平與無髮生CVD組差異有統計學意義(P=0.045、0.015、0.051、0.029及0.005).在隨訪過程中齣現新髮CVD或CVD病情噁化的原有CVD的患者,都是透析齡較長以及三酰甘油水平較高者.LAD、LVST、LVMI及IMT在新髮CVD和未髮CVD兩組間差異有統計學意義(P=0.033、0.022、0.045及0.029).Kaplan-Meier生存分析顯示,既往CVD史和CVD癥狀是生存的獨立危險因素.血清門蛋白<330 g/L、LAD>39.6 mm及曾患腹膜炎的患者生存率較低.結論 ESRD腹膜透析患者是CVD的高髮群體,需瞭解這些患者的病史和伴隨癥狀;保持透析的充分性;同時要防止腹膜炎的髮生.
목적 료해종말기신장병(ESRD)복막투석환자적심혈관질병(CVD)발병솔화유관고발위험인소,이급병발CVD적복막투석환자치료시수관주적문제.방법 연구대상위상해교통대학의학원부속인제의원만성신장병(CKD)5기접수복막투석적환자,공254례입선,채용횡단면회고성조사분석방법.평균수방시간중위수위49개월.채집병사、혈생화검측결과、복막투석충분성평고、경동맥급심장채색다보륵초성검측결과.평고CVD사건적발생、발전화예후,이급진행상관인소분석.결과 CVD사건발생솔위37%(93/254).발생CVD적환자다반유당뇨병、투석령교장、혈삼선감유수평교고、혈청백단백교저、전백단백교저.채색다보륵초성현시,발생CVD조적좌방내경(LAD)(mm)、실간격후도(LVST)(mm)、좌실심기질량지수(LVMI)(g/m2)현저고우미발생CVD조(43.16±4.93비38.02±4.77、11.19±2.05비10.01±1.45、중위수192.03비150.28,균P<0.05);경동맥내막중층후도(IMT)교후(중위수0.80비0.65),경동맥내경증관;수축기봉치류속(SPV)화서장기봉치류속(DV)류속강저.기왕무CVD적환자재수방과정중발생CVD시,기Ccr、Kt/V、D/Pr、이상체질량교정적단백분해솔(nPCR)급혈청백단백수평여무발생CVD조차이유통계학의의(P=0.045、0.015、0.051、0.029급0.005).재수방과정중출현신발CVD혹CVD병정악화적원유CVD적환자,도시투석령교장이급삼선감유수평교고자.LAD、LVST、LVMI급IMT재신발CVD화미발CVD량조간차이유통계학의의(P=0.033、0.022、0.045급0.029).Kaplan-Meier생존분석현시,기왕CVD사화CVD증상시생존적독립위험인소.혈청문단백<330 g/L、LAD>39.6 mm급증환복막염적환자생존솔교저.결론 ESRD복막투석환자시CVD적고발군체,수료해저사환자적병사화반수증상;보지투석적충분성;동시요방지복막염적발생.
Objective To elucidate the prevalence and risk factors of cardiovascular disease (CVD) in end-stage renal disease (ESRD) patients on peritoneal dialysis (PD), and to investigate the associated problems in treatment. Methods A total of 254 PD patients in our division were enrolled in this study. CVD history, laboratory measurements, examinations of carotid atherosclerosis and left ventricular hypertrophy by ultrasonography were collected and associated factors were analyzed. The median follow-up time was 49 months. Results The overall prevalence of CVD was 37% (93/254). Diabetes, longer dialysis duration, hypertfiglyceridemia, hypoalbuminemia, hypoprealbuminemia were commonly found in the patients with new CVD event. The patients without pre-existing CVD had the higher Ccr, Kt/V, D/Pr, nPCR, serum albumin level. In those with pre-existing CVD, the hypertriglyceridemia and the duration of dialysis were independent predictors of progression of CVD. Differences of LAD, LVST, LVMI and IMT were significant between with and without pre-existing CVD groups. Kaplan-Meier curves showed that the presence of CVD was the independent risk factor of survival. Alb<330 g/L, LAD>39.6 mm and peritonitis were risk factors of CVD. Conclusion The prevalence of CVD in PD patients is quite high. CVD history should be realized, dialysis adequacy should be maintained, and peritonitis should be prevented.
