中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (01): 10-13.doi: 10.3969/j.issn.1671-4091.2016.01.003

• 临床研究 • 上一篇    下一篇

脉搏波速度对维持性血液透析患者心脑血管及全因死亡的预后意义

吴凡12,甘良英1,杨镜华1,檀敏1,左力1,王梅1   

  1. 1. 北京大学人民医院肾内科，2.郑州市第三人民医院
  • 收稿日期:2015-05-19 修回日期:2015-07-13 出版日期:2016-01-12 发布日期:2016-05-19
  • 通讯作者: 甘良英 E-mail:ganliangying@yahoo.com
  • 基金资助:

    北京市科学技术委员会首都临床特色应用研究支持项目，项目编号：Z131107002213122, 北京大学“临床医院合作专项”2013-1-05

Pulse wave velocity and its prognostic value in maintenance hemodialysis patients

  • Received:2015-05-19 Revised:2015-07-13 Online:2016-01-12 Published:2016-05-19

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摘要： 目的探讨颈动脉-股动脉脉搏波速度(carotid-femoral pulse wave velocity,CFPWV)对维持性血液透析患者心脑血管及全因死亡的预测意义。方法以北京大学人民医院血液透析中心76例维持性血液透析(maintenance hemodialysis patients,MHD)患者作为研究对象,收集患者一般临床资料，包括原发病、透析龄、血压、血钙、血磷、白蛋白、三酰甘油、胆固醇、高密度脂蛋白、低密度脂蛋白、全段甲状旁腺素等，测定患者单次透析前CFPWV,并对患者进行5 年随访,收集患者心脑血管疾病发生情况及死亡原因,绘制生存曲线，明确CFPWV 在MHD 患者中的临床预后意义。结果具有不同水平CFPWV 患者(大于等于13m/s、小于13m/s)的远期预后存在显著性差异，CFPWV 小于13m/s 的患者累积生存率及因心脑血管疾病死亡的生存率高于CFPWV 大于等于13m/s 的患者；Cox 回归分析发现年龄(HR 1.052，95%CI 1.019～1.086，P=0.002)以及是否患有糖尿病(HR 2.972，95% CI 1.240～6.590，P=0.007)是MHD 患者全因死亡的独立危险因素，而CFPWV(HR 5.697, 95% CI 1.460～22.235，P=0.012)及年龄(HR 1.080，95% CI 1.014～1.150，P=0.017)、糖尿病(HR 5.961，95% CI 1.590～22.354，P=0.008)、平均动脉压(HR1.056，95% CI 1.003～1.112，P=0.038)、脉压(HR 0.952，95% CI 0.911～0.995，P=0.030)是MHD 患者心血管死亡的独立危险因素。结论CFPWV 的不同水平对维持性血液透析患者的预后有显著影响，更高的CFPWV 水平与维持性血液透析患者的不良预后相关，是维持性血液透析患者心脑血管死亡的独立危险因
素。

关键词: 血液透析, 动脉僵硬度, 脉搏波速度, 预后

Abstract: Objective To explore the predictive value of aortic stiffness for cardio- cerebral vascular (CV) mortality and all-cause mortality in maintenance hemodialysis (MHD) patients. Methods A cohort of 76 MHD patients from Peking University People’s Hospital was recruited. Demographic data was collected. Laboratory examinations and carotid-femoral pulse wave velocity (CFPWV) were performed. Results In a follow-up period of 5 years 17 fatal and 9 non-fatal CV events occurred, and 33 patients died. Patients with a CFPWV >13m/s had lower all-cause and CV survival rates by Kaplan-Meier survival analysis, as compared
those with a CFPWV <13m/s. Age and diabetes were the independent predictors for all-cause survival, and age, diabetes, mean arterial pressure, pulse pressure and CFPWV were the independent predictors for CV survival. Conclusions MHD patients with higher CFPWV have lower all-cause and CV survival rates. Higher CFPWV is an independent predictor for CV survival in MHD patients.

Key words: Hemodialysis, Arterial stiffness, Pulse wave velocity, Prognosis