中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2013年
8期
569-573
,共5页
梁剑波%区景运%王泽彬%江丽屏%詹俊琳
樑劍波%區景運%王澤彬%江麗屏%詹俊琳
량검파%구경운%왕택빈%강려병%첨준림
心血管疾病%腹膜透析%C反应蛋白%胎球蛋白A%血管钙化
心血管疾病%腹膜透析%C反應蛋白%胎毬蛋白A%血管鈣化
심혈관질병%복막투석%C반응단백%태구단백A%혈관개화
Cardiovascular disease%Peritoneal dialysis%C-reactive protein%Fetuin A%Vascular calcification
目的 探讨腹膜透析患者颈动脉钙化与血浆胎球蛋白A(fetuin A)及C反应蛋白(CRP)之间的关系及其对心血管事件发生的影响.方法 对60例腹膜透析患者进行颈总动脉内中膜厚度(cIMT)超声、胎球蛋白A、CRP及相关临床指标的检测,观察胎球蛋白A、CRP等生化指标对腹膜透析患者动脉钙化的影响.随访18个月,观察cIMT、胎球蛋白A及CRP等指标与腹膜透析患者心血管事件发生的关系.结果 60例腹膜透析患者中,38例(63.3％)存在cIMT增厚.与无cIMT增厚患者相比,重度cIMT增厚患者血浆胎球蛋白A水平较低(P＜0.05),CPR(P ＜0.05)及钙磷乘积(P＜0.05)较高；与轻度cIMT增厚患者相比,重度cIMT增厚患者血浆胎球蛋白A水平较低(P＜0.05),钙磷乘积较高(P＜0.05).直线回归分析结果显示,胎球蛋白A与CRP(R2=0.629,F=47.522,P＜0.01)及钙磷乘积(R2=0.299,F=11.948,P=0.002)均呈负相关；多元回归分析显示,腹膜透析患者的cIMT与胎球蛋白A呈负相关(B=-0.019,t-6.042,P＜0.01).随访18月,发生心血管事件36例次,因心血管事件死亡6例,Logistic回归分析显示,cIMT增厚是心血管事件发生的重要危险因素(Wald值=7.698,OR=3.691,95％CI 1.467～9.258,P=0.006).结论 胎球蛋白A降低及钙磷乘积升高是腹膜透析患者颈动脉钙化的重要危险因素.腹膜透析患者体内微炎性反应状态(CRP升高)导致胎球蛋白A的水平下降,引起钙磷乘积升高,从而促进颈动脉钙化的发生.cIMT增厚是腹膜透析患者心血管事件的危险因素.
目的 探討腹膜透析患者頸動脈鈣化與血漿胎毬蛋白A(fetuin A)及C反應蛋白(CRP)之間的關繫及其對心血管事件髮生的影響.方法 對60例腹膜透析患者進行頸總動脈內中膜厚度(cIMT)超聲、胎毬蛋白A、CRP及相關臨床指標的檢測,觀察胎毬蛋白A、CRP等生化指標對腹膜透析患者動脈鈣化的影響.隨訪18箇月,觀察cIMT、胎毬蛋白A及CRP等指標與腹膜透析患者心血管事件髮生的關繫.結果 60例腹膜透析患者中,38例(63.3％)存在cIMT增厚.與無cIMT增厚患者相比,重度cIMT增厚患者血漿胎毬蛋白A水平較低(P＜0.05),CPR(P ＜0.05)及鈣燐乘積(P＜0.05)較高；與輕度cIMT增厚患者相比,重度cIMT增厚患者血漿胎毬蛋白A水平較低(P＜0.05),鈣燐乘積較高(P＜0.05).直線迴歸分析結果顯示,胎毬蛋白A與CRP(R2=0.629,F=47.522,P＜0.01)及鈣燐乘積(R2=0.299,F=11.948,P=0.002)均呈負相關；多元迴歸分析顯示,腹膜透析患者的cIMT與胎毬蛋白A呈負相關(B=-0.019,t-6.042,P＜0.01).隨訪18月,髮生心血管事件36例次,因心血管事件死亡6例,Logistic迴歸分析顯示,cIMT增厚是心血管事件髮生的重要危險因素(Wald值=7.698,OR=3.691,95％CI 1.467～9.258,P=0.006).結論 胎毬蛋白A降低及鈣燐乘積升高是腹膜透析患者頸動脈鈣化的重要危險因素.腹膜透析患者體內微炎性反應狀態(CRP升高)導緻胎毬蛋白A的水平下降,引起鈣燐乘積升高,從而促進頸動脈鈣化的髮生.cIMT增厚是腹膜透析患者心血管事件的危險因素.
목적 탐토복막투석환자경동맥개화여혈장태구단백A(fetuin A)급C반응단백(CRP)지간적관계급기대심혈관사건발생적영향.방법 대60례복막투석환자진행경총동맥내중막후도(cIMT)초성、태구단백A、CRP급상관림상지표적검측,관찰태구단백A、CRP등생화지표대복막투석환자동맥개화적영향.수방18개월,관찰cIMT、태구단백A급CRP등지표여복막투석환자심혈관사건발생적관계.결과 60례복막투석환자중,38례(63.3％)존재cIMT증후.여무cIMT증후환자상비,중도cIMT증후환자혈장태구단백A수평교저(P＜0.05),CPR(P ＜0.05)급개린승적(P＜0.05)교고；여경도cIMT증후환자상비,중도cIMT증후환자혈장태구단백A수평교저(P＜0.05),개린승적교고(P＜0.05).직선회귀분석결과현시,태구단백A여CRP(R2=0.629,F=47.522,P＜0.01)급개린승적(R2=0.299,F=11.948,P=0.002)균정부상관；다원회귀분석현시,복막투석환자적cIMT여태구단백A정부상관(B=-0.019,t-6.042,P＜0.01).수방18월,발생심혈관사건36례차,인심혈관사건사망6례,Logistic회귀분석현시,cIMT증후시심혈관사건발생적중요위험인소(Wald치=7.698,OR=3.691,95％CI 1.467～9.258,P=0.006).결론 태구단백A강저급개린승적승고시복막투석환자경동맥개화적중요위험인소.복막투석환자체내미염성반응상태(CRP승고)도치태구단백A적수평하강,인기개린승적승고,종이촉진경동맥개화적발생.cIMT증후시복막투석환자심혈관사건적위험인소.
Objective To investigate the association of vascular calcification,fetuin A and Creaction protein (CRP),and explore the influence on cardiovascular events.Methods Sixty peritoneal dialysis (PD) patients were enrolled in this study.Carotid intima-media thickness (cIMT),fetuin A and CRP,along with the other serum related parameters were detected to find out their influence on vascular calcification in PD patients.The relationship between cIMT,fetuin A,CPR and cardiovascular events was analyzed in PD patients with 18 months followed-up.Results Of the 60 PD patients,carotid intima-media thickness (cIMT) was increased in 38 patients(63.3％).Compared with the non-increased cIMT patients,serum fetuin A concentration was significantly decreased(P ＜ 0.05),CRP(P＜0.01) and calcium × phosphate products(P＜0.05) were significantly increased in the highincreased cIMT group.Compared with the low-increased cIMT patients,fetuin A concentration was obviously lower(P ＜ 0.05) and calcium×phosphate products were obviously higher(P ＜ 0.05) in the highincreased cIMT group.Linear regression analysis discovered an obvious negative correlation between CRP and fetuin A(R2 =0.629,F=47.522,P ＜ 0.01),as well as fetuin A and calcium×phosphate products (R2=0.299,F=11.948,P=0.002).Multiple regression analysis indicated that fetuin A was independently negatively correlated with cIMT(B=-0.019,t =-6.042,P ＜ 0.01).At 18 months,there were 36 newly-happened cardiovascular events and among which 6 cases died.Logistic regression analysis found that increased cIMT was risk factor to cardiovascular events in PD patients(OR=3.691,95％CI 1.467-9.258,P=0.006).Conclusion Decreased fetuin A and increased calcium×phosphate products deteriorate carotid calcification in PD patients.Micro-inflammation of PD patients represented by high CRP levels may increase calcium×phosphate products by depressing the fetuin A level,and in the end will stimulate carotid calcification.Increased cIMT is a risk factor for cardiovascular events.
