中国血液净化

中国血液净化 ›› 2019, Vol. 18 ›› Issue (09): 603-606.doi: 10.3969/j.issn.1671-4091.2019.09.006

• 临床研究 • 上一篇    下一篇

腹膜透析患者动脉僵硬度及血清甲状旁腺素水平的影响因素分析

张嘉惠1.2,张琪1.2,金海姣1,2,车霞静1,2,戚超君1,2,黄佳颖1,2, 顾爱萍1,2,倪兆慧1,2   

  1. 1. 上海交通大学医学院附属仁济医院肾脏科
    2. 上海交通大学医学院临床研究中心
  • 收稿日期:2019-04-08 修回日期:2019-05-24 出版日期:2019-09-12 发布日期:2019-09-02
  • 通讯作者: 倪兆慧 profnizh@126.com E-mail:profnizh@126.com
  • 基金资助:
    国家自然科学基金(81770666)，国家自然科学基金(81570604)，上海市科委基础研究项目(12DJ1400200)，上海交通大学医学院多中心临床研究项目(DLY201805)，我国常见慢性肾病评估与优化诊疗一体化研究(2013BA109B05)，上海交通大学“交大之星”计划医工交叉研究基金（YG2019QNA29）

  • Received:2019-04-08 Revised:2019-05-24 Online:2019-09-12 Published:2019-09-02

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摘要：

【摘要】目的继发性甲状旁腺功能亢进(secondary hyperparathyroidism，SHPT)及血管钙化是腹膜透析(peritoneal dialysis,PD)患者常见的并发症，可导致动脉僵硬度增加。本研究拟探讨腹膜透析患者动脉僵硬度及血清甲状旁腺素(parathyroid hormone，PTH)增高的影响因素，以及两者之间的关系。方法入选上海交通大学医学院附属仁济医院肾脏科2014 年6 月18 日～2015 年4 月7 日期间维持性PD患者，收集患者人口统计学指标、基线实验室指标、腹膜透析平衡试验及透析充分性检测指标，采用颈股动脉脉搏波(catroid-femoral artery pulse wave velocity，cfPWV)评估动脉僵硬度。结果研究共入选260 例患者，其中男性146 例(56.2%)，平均年龄(55.57±13.77)岁，平均cfPVW(8.84±2.23)m/s。Logistic 回归分析结果显示，年龄(OR=1.073,95% CI 1.029～1.119, P=0.001)、合并糖尿病(OR=1.523,95% CI:1.112～1.409, P＜0.001)、肱动脉收缩压(OR=1.048,95% CI 1.024～1.072,P＜0.001)、糖化血红蛋白(OR=3.667 95% CI 1.710～7.872 ,P=0.001)为影响动脉僵硬度的独立危险因素。多元线性回归显示腹膜透析患者血清PTH 与cfPWV 无统计学相关性，与钙磷乘积(β=0.312，P＜0.001)、总胆固醇(β=0.125，P=0.024)、腹膜透析龄正相关(β=0.334，P＜0.001)，与脉压差负相关(β= -0.110，P=0.047)。结论维持性PD 患者动脉僵硬度与年龄、合并糖尿病、肱动脉收缩压、糖化血红蛋白水平有关。血清PTH与钙磷乘积、总胆固醇、腹膜透析龄、脉压差相关，但未能发现与cfPWV相关。

关键词: 继发性甲状旁腺功能亢进, 动脉僵硬度, 颈股动脉脉搏波, 腹膜透析

Abstract:

【Abstract】Objective Secondary hyperparathyroidism (SHPT) and vascular calcification are the common complications in peritoneal dialysis (PD) patients, which can lead to increased arterial stiffness. The purpose of this study was to investigate the risk factors for arterial stiffness and higher serum parathyroid hormone (PTH) level in PD patients and the relationship between arterial stiffness and PTH level. Methods PD patients treated in the period from June 18, 2014 to April 7, 2015 were enrolled in this study. Demographic data,baseline laboratory indicators, peritoneal dialysis balance tests and dialysis adequacy parameters were collected. Carotid-femoral pulse wave velocity (cfPWV) was used to evaluate arterial stiffness. Results A total of 260 patients (146 males; average age 55.57+13.77 years) were enrolled in this study. Their average cfPVW was 8.84+2.23m/s. Logistic regression analysis showed that age (OR=1.073, 95% CI 1.029～1.119, P=0.001),diabetes mellitus (OR=1.523, 95% CI 1.112～1.409, P＜0.001), brachial artery systolic pressure (OR 1.048,CI 1.024～1.072, P＜0.001), and glycosylated hemoglobin (OR=3.667, 95% CI 1.710～7.872, P=0.001) were the independent risk factors for arterial stiffness. Multivariate linear regression showed that there was no statistical correlation between serum PTH and cfPWV in PD patients; PTH was positively correlated with calcium phosphorus product (β=0.312, P＜0.001), total cholesterol (β=0.125, P=0.024) and PD duration (β=0.334, P＜ 0.001) and negatively correlated with pulse pressure (β=-0.110, P=0.047). Conclusion In PD patients, arterial stiffness was related to age, diabetes mellitus, brachial artery systolic pressure and glycosylated hemoglobin level. Serum PTH was correlated with calcium-phosphorus product, total cholesterol, PD age and pulse pressure but not with cfPWV.

Key words: Secondary hyperparathyroidism, Arterial stiffness, Carotid- femoral pulse wave velocity, Peritoneal dialysis

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