中华全科医师杂志
中華全科醫師雜誌
중화전과의사잡지
CHINESE JOURNAL OF GENERAL PRACTITIONERS
2014年
8期
659-663
,共5页
张春华%崔太根%赵素梅%王世相%张小东
張春華%崔太根%趙素梅%王世相%張小東
장춘화%최태근%조소매%왕세상%장소동
慢性肾脏病%阿司匹林抵抗%危险因素
慢性腎髒病%阿司匹林牴抗%危險因素
만성신장병%아사필림저항%위험인소
Chronic kidney disease%Aspirin resistance%Risk factors
目的 探讨慢性肾脏病(CKD)3 ～4期患者血小板聚集功能、阿司匹林抵抗(AR)发生率及相关影响因素.方法 对首都医科大学附属北京朝阳医院泌尿肾病中心肾内科门诊108例3 ～4期CKD患者(CKD组),行生化指标及颈动脉超声检查,以血栓弹力图(TEG)的花生四烯酸(AA)类药物抑制率＞50％为AR.以估算的肾小球滤过率(eGFR)正常、没有肾脏损伤证据且年龄、性别相匹配的110例患者为对照组.结果 CKD组心脑血管疾病(38例)、外周血管疾病(30例)、颈动脉斑块比例(55例)及颈动脉内膜厚度[IMT,(1.17 ±0.24) mm]与对照组[分别为24、18和34例,(1.05±0.18) mm]相比,差异有统计学意义(x2值分别为4.51、4.14和9.04,t=2.11,均P＜0.05).CKD组的血栓最大弹力度[MA值,(62 ±8) mm]、超敏C反应蛋白[hsCRP,(5.5±1.2) mg/L]、同型半胱氨酸[Hcy,(36±10) μmol/L]水平显著高于对照组[(56 ±6) mm,(4.6±1.2) mg/L,(30±10)μmol/L],反应时间[R值,(5.45±1.45) min]显著低于对照组[(6.31 ±1.55) min](均P＜0.05).CKD组AR率(32.4％,25/108)比对照组(20.0％,22/110)显著增高(x2=4.34,P＜0.05).CKD组以eGFR为因变量进行单因素相关分析发现,MA值、hsCRP、Hcy、IMT与eGFR呈负相关(r值分别为-0.55、-0.31、-0.31和-0.41,均P＜0.05),R值与eGFR呈正相关(r=0.27,P＜0.05).CKD组存在AR者(AR组)和阿司匹林敏感者(AS组)的女性(28/35与32/73)、糖尿病(20/35与15/73)、心脑血管疾病(18/35与20/73)及外周血管疾病(14/35与16/73)比例、有无颈动脉斑块比例(24/11与31/42)、IMT[(1.18 ±0.20)与(1.05±0.16) mm]、空腹血糖(FBG)[(6.0±0.5)与(5.6±0.8) mmol/L]、eGFR[(28±6)与(43±10) ml· min-1· 1.73 m-2]、hsCRP[(7.3±1.4)与(5.3±1.5) mg/L]、Hcy[(39±6)与(33±7)μmol/L]、MA值[(66±8)与(53±6)mm]、R值[(4.96±0.98)与(5.32 ±0.62) min]水平比较,差异有统计学意义(均P＜0.05),logistic回归分析糖尿病、FBG、eGFR、hsCRP是CKD患者发生AR的独立危险因素(P＜0.05).结论 CKD 3～4期患者存在明显的血小板活化,且随着eGFR下降血小板活化及动脉粥样硬化加剧,AR患者发生率显著增高;糖尿病、FBG、eGFR、hsCRP是CKD 3 ～4期患者发生AR的独立危险因素.
目的 探討慢性腎髒病(CKD)3 ～4期患者血小闆聚集功能、阿司匹林牴抗(AR)髮生率及相關影響因素.方法 對首都醫科大學附屬北京朝暘醫院泌尿腎病中心腎內科門診108例3 ～4期CKD患者(CKD組),行生化指標及頸動脈超聲檢查,以血栓彈力圖(TEG)的花生四烯痠(AA)類藥物抑製率＞50％為AR.以估算的腎小毬濾過率(eGFR)正常、沒有腎髒損傷證據且年齡、性彆相匹配的110例患者為對照組.結果 CKD組心腦血管疾病(38例)、外週血管疾病(30例)、頸動脈斑塊比例(55例)及頸動脈內膜厚度[IMT,(1.17 ±0.24) mm]與對照組[分彆為24、18和34例,(1.05±0.18) mm]相比,差異有統計學意義(x2值分彆為4.51、4.14和9.04,t=2.11,均P＜0.05).CKD組的血栓最大彈力度[MA值,(62 ±8) mm]、超敏C反應蛋白[hsCRP,(5.5±1.2) mg/L]、同型半胱氨痠[Hcy,(36±10) μmol/L]水平顯著高于對照組[(56 ±6) mm,(4.6±1.2) mg/L,(30±10)μmol/L],反應時間[R值,(5.45±1.45) min]顯著低于對照組[(6.31 ±1.55) min](均P＜0.05).CKD組AR率(32.4％,25/108)比對照組(20.0％,22/110)顯著增高(x2=4.34,P＜0.05).CKD組以eGFR為因變量進行單因素相關分析髮現,MA值、hsCRP、Hcy、IMT與eGFR呈負相關(r值分彆為-0.55、-0.31、-0.31和-0.41,均P＜0.05),R值與eGFR呈正相關(r=0.27,P＜0.05).CKD組存在AR者(AR組)和阿司匹林敏感者(AS組)的女性(28/35與32/73)、糖尿病(20/35與15/73)、心腦血管疾病(18/35與20/73)及外週血管疾病(14/35與16/73)比例、有無頸動脈斑塊比例(24/11與31/42)、IMT[(1.18 ±0.20)與(1.05±0.16) mm]、空腹血糖(FBG)[(6.0±0.5)與(5.6±0.8) mmol/L]、eGFR[(28±6)與(43±10) ml· min-1· 1.73 m-2]、hsCRP[(7.3±1.4)與(5.3±1.5) mg/L]、Hcy[(39±6)與(33±7)μmol/L]、MA值[(66±8)與(53±6)mm]、R值[(4.96±0.98)與(5.32 ±0.62) min]水平比較,差異有統計學意義(均P＜0.05),logistic迴歸分析糖尿病、FBG、eGFR、hsCRP是CKD患者髮生AR的獨立危險因素(P＜0.05).結論 CKD 3～4期患者存在明顯的血小闆活化,且隨著eGFR下降血小闆活化及動脈粥樣硬化加劇,AR患者髮生率顯著增高;糖尿病、FBG、eGFR、hsCRP是CKD 3 ～4期患者髮生AR的獨立危險因素.
목적 탐토만성신장병(CKD)3 ～4기환자혈소판취집공능、아사필림저항(AR)발생솔급상관영향인소.방법 대수도의과대학부속북경조양의원비뇨신병중심신내과문진108례3 ～4기CKD환자(CKD조),행생화지표급경동맥초성검사,이혈전탄력도(TEG)적화생사희산(AA)류약물억제솔＞50％위AR.이고산적신소구려과솔(eGFR)정상、몰유신장손상증거차년령、성별상필배적110례환자위대조조.결과 CKD조심뇌혈관질병(38례)、외주혈관질병(30례)、경동맥반괴비례(55례)급경동맥내막후도[IMT,(1.17 ±0.24) mm]여대조조[분별위24、18화34례,(1.05±0.18) mm]상비,차이유통계학의의(x2치분별위4.51、4.14화9.04,t=2.11,균P＜0.05).CKD조적혈전최대탄력도[MA치,(62 ±8) mm]、초민C반응단백[hsCRP,(5.5±1.2) mg/L]、동형반광안산[Hcy,(36±10) μmol/L]수평현저고우대조조[(56 ±6) mm,(4.6±1.2) mg/L,(30±10)μmol/L],반응시간[R치,(5.45±1.45) min]현저저우대조조[(6.31 ±1.55) min](균P＜0.05).CKD조AR솔(32.4％,25/108)비대조조(20.0％,22/110)현저증고(x2=4.34,P＜0.05).CKD조이eGFR위인변량진행단인소상관분석발현,MA치、hsCRP、Hcy、IMT여eGFR정부상관(r치분별위-0.55、-0.31、-0.31화-0.41,균P＜0.05),R치여eGFR정정상관(r=0.27,P＜0.05).CKD조존재AR자(AR조)화아사필림민감자(AS조)적녀성(28/35여32/73)、당뇨병(20/35여15/73)、심뇌혈관질병(18/35여20/73)급외주혈관질병(14/35여16/73)비례、유무경동맥반괴비례(24/11여31/42)、IMT[(1.18 ±0.20)여(1.05±0.16) mm]、공복혈당(FBG)[(6.0±0.5)여(5.6±0.8) mmol/L]、eGFR[(28±6)여(43±10) ml· min-1· 1.73 m-2]、hsCRP[(7.3±1.4)여(5.3±1.5) mg/L]、Hcy[(39±6)여(33±7)μmol/L]、MA치[(66±8)여(53±6)mm]、R치[(4.96±0.98)여(5.32 ±0.62) min]수평비교,차이유통계학의의(균P＜0.05),logistic회귀분석당뇨병、FBG、eGFR、hsCRP시CKD환자발생AR적독립위험인소(P＜0.05).결론 CKD 3～4기환자존재명현적혈소판활화,차수착eGFR하강혈소판활화급동맥죽양경화가극,AR환자발생솔현저증고;당뇨병、FBG、eGFR、hsCRP시CKD 3 ～4기환자발생AR적독립위험인소.
Objective To investigate aspirin resistance (AR) and its related factors in patients with stage 3-4 chronic kidney disease(CKD).Methods The clinical data of 108 patients with stage 3-4CKD from nephrology department in Beijing Chaoyang Hospital were collected (CKD group) ; and 110 age and sex-matched subjects with normal renal function served as control group.Anthropometric parameters,blood biochemistry index,ultrasonography and thromboelastograph (TEG) were examined in both groups; and inhibition ratio of arachidonic acid ＞ 50％ on TEG was defined as AR.Results The incidence of cardio-cerebral vascular disease,the incidence of peripheral vascular disease,ratio of female,the intimamedia thickness (IMT) of carotid artery,the levels of high-sensitive C-reactive protein (hsCRP),homocysteine(Hcy),evaluated glomerular filtration rate(eGFR) and maximal thrombelastodegree (MA) on TEG in CKD group were significantly higher than those in control group (all P ＜ 0.05),while R value was significantly lower in CKD group.Pearson's correlation analysis revealed that the levels of MA,hsCRP,Hcy,IMT were positively correlated and R value was negatively correlated with eGFR in CKD group.The incidence of AR in CKD group (32.4％) was significantly higher than in control group (20.0％).According to TEG,the patients were divided into AR group (n =35) and aspirin sensitive (AS) group (n =73).The incidence of cardio-cerebral vascular disease,the incidence of peripheral vascular disease,ratio of female,IMT,ratio of diabetes,the levels of hsCRP,Hcy,fasting plasma glucose (FBG),eGFR and MA in AR group were significantly higher than those in AS group (all P ＜ 0.05),while R value was significantly lower in AR group.Binary logistic regressive analysis revealed that the ratio of diabete,FBG,eGFR,hsCRP were independent risk factors for AR in patients with stage 3-4 CKD.Conclusions CKD stage 3-4 is associated with increased ratio of platelet activation and atherosclerosis,and this condition is aggravated while eGFR declining.Incidence of AR is 32.4％ in this group of CKD patients,the independent risk factors of AR in CKD patients are the ratio of diabetes,FBG,eGFR and hsCRP.
