CAJ | 학술논문

背景:维持性血液透析患者颈-股动脉脉搏波速度改变受多种因素影响.目的:探讨维持性血液透析患者颈-股动脉脉搏波速度改变及其相关因素分析.设计、时间及地点:相关性分析,交叉对照实验,于2006-01/08北京大学第三医院肾脏内科完成.对象:北京大学第三医院临床情况稳定的66例维持性血液透析患者.方法:收集患者一般情况、生化学指标、颈-股动脉脉搏波速度和主观综合营养状态的评估等4个方面资料.根据SGA营养评分将患者分为营养正常组49例、营养不良组17例.比较两组脉搏波速度的差异,采用单因素相关和多因素回归分析探讨脉搏波速度的相关因素.主要观察指标:患者颈-股动脉脉搏波速度,血白蛋白和甲状旁腺激素.结果:血液透析患者颈-股动脉脉搏波速度与年龄(r=0.284,P=0.021)、收缩压(r=0.468,P<0.001)、脉压(r=0.451,P<0.001)存在显著正相关,与透前血清肌酐(r=0.347,P=0.004)、转铁蛋白(r=0.284,P<0.05)、血前蛋白(r=0.318,P<0.05),血浆白蛋白(r=0.263,P<0.05)和甲状旁腺激素(r=0.167,P<0.05)存在负相关.多元逐步回归分析显示脉压和甲状旁腺激素是颈-股动脉脉搏波速度的独立影响因素.采用SGA营养评估营养状态,营养不良组颈-股动脉脉搏波速度明显增快,与营养正常组比较差异有显著性意义(P< 0.05).结论:脉压是维持性血液透析患者颈-股动脉脉搏波速度独立的影响因素.营养不良与动脉粥样硬化是维持性血液透析常见的并发症,两者关系密切,营养不良者脉搏波速度值增高.
배경:유지성혈액투석환자경-고동맥맥박파속도개변수다충인소영향.목적:탐토유지성혈액투석환자경-고동맥맥박파속도개변급기상관인소분석.설계、시간급지점:상관성분석,교차대조실험,우2006-01/08북경대학제삼의원신장내과완성.대상:북경대학제삼의원림상정황은정적66례유지성혈액투석환자.방법:수집환자일반정황、생화학지표、경-고동맥맥박파속도화주관종합영양상태적평고등4개방면자료.근거SGA영양평분장환자분위영양정상조49례、영양불량조17례.비교량조맥박파속도적차이,채용단인소상관화다인소회귀분석탐토맥박파속도적상관인소.주요관찰지표:환자경-고동맥맥박파속도,혈백단백화갑상방선격소.결과:혈액투석환자경-고동맥맥박파속도여년령(r=0.284,P=0.021)、수축압(r=0.468,P<0.001)、맥압(r=0.451,P<0.001)존재현저정상관,여투전혈청기항(r=0.347,P=0.004)、전철단백(r=0.284,P<0.05)、혈전단백(r=0.318,P<0.05),혈장백단백(r=0.263,P<0.05)화갑상방선격소(r=0.167,P<0.05)존재부상관.다원축보회귀분석현시맥압화갑상방선격소시경-고동맥맥박파속도적독립영향인소.채용SGA영양평고영양상태,영양불량조경-고동맥맥박파속도명현증쾌,여영양정상조비교차이유현저성의의(P< 0.05).결론:맥압시유지성혈액투석환자경-고동맥맥박파속도독립적영향인소.영양불량여동맥죽양경화시유지성혈액투석상견적병발증,량자관계밀절,영양불량자맥박파속도치증고.
BACKGROUND: Carotid-femoral pulse wave velocity in hemodialysis patients is influenced by multiple factors.OBJECTIVE: To explore the carotid-femoral pulse wave velocity (PWVcf) changes and related factors in maintenance hemodialysis (MHD) patients.DESIGN, TIME AND SETTING: Non-randomized control experiment was performed at the Third Hospital of Peking University from January to August 2006.PARTICIPANTS: A total of 66 MHD patients were selected from Third Hospital of Peking University.METHODS: General clinical conditions, biochemical indexes, PWVcf and subjective nutritional state were evaluated. MHD patients were divided into two groups according to the state of nutrition evaluated with SGA: non-malnutrition (n=49), malnutrition group (n=17). The PWVcf of two groups was compared, and one-way and multiple regression analyses were performed to explore PWVcf-relatest factors.MAIN OUTCOME MEASURES: PWVcf, blood albumin and parathyroid hormone.RESULTS: PWVcf was significantly positively correlated with age (r= 0.284, P< 0.05), systolic blood pressure (r= 0.468, P<0. 001), and pulse pressure (r=0.451, P< 0.001), while negatively correlated with prealbumin (r=0.318, P< 0. 05),plasma-albumin (r=0.263, P< 0.05), parathyroid hormone (r=0.167, P< 0.05), serum creatinine (r=0.347, P= 0.004)and transferring (r=0.284, P < 0.05) before dialysis. Multiple regression analysis demonstrated that pulse pressure and parathyroid hormone were independently related with PWVcf. The PWVcf was significantly increased in malnutrition group compared with non-malnutrition group (P < 0.05). CONCLUSION: Pulse pressure is the major clinical determinants of arterial stiffness in patients with MHD independent of conventional risk factors for cardiovascular disease; Malnutrition and atherosclerosis are common complications of MHD,showing close relationship. The PWVcf was significantly increased in malnutrition patients.