中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (05): 304-307.doi: 10.3969/j.issn.1671-4091.2018.05.004

• 临床研究 • 上一篇    下一篇

高踝臂指数与腹膜透析患者心血管事件的相关分析

苏晓燕1,郑伟平1,李爱婷1,梁翔1,谢应业1,丁苏1,黄辉2   

  1. 1. 中山大学附属东华医院肾内科
    2. 中山大学孙逸仙纪念医院心内科
  • 收稿日期:2018-01-08 修回日期:2018-02-18 出版日期:2018-05-12 发布日期:2018-05-12
  • 通讯作者: 苏晓燕 suxiaoyan769@hotmail.com E-mail:suxiaoyan769@hotmail.com
  • 基金资助:

    国家自然科学基金优秀青年科学基金项目(项目编号：81422011) 广东省医学科学技术研究基金面上项目(编号：A2016248)

Relationship between high ankle-brachial index and cardiovascular events in patients on peritoneal dialysis

  • Received:2018-01-08 Revised:2018-02-18 Online:2018-05-12 Published:2018-05-12

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摘要： 【摘要】目的评价高踝臂指数(ankle-brachial index,ABI)与腹膜透析患者主要不良心血管事件(major adverse cardiovascular events,MACE)的相关性。方法研究对象为慢性肾脏病5 期行腹膜透析(PD)治疗超过3 个月的患者98 例，收集患者基础资料、ABI、Framingham 心血管疾病风险因素及各项实验室指标，并对相关指标进行分析。结果单侧或双侧ABI＞1.3 为高ABI 组(33 例)，0.9＜双侧ABI＜1.3 为正常ABI 组(65 例)，随访期间共发生MACE 28 例，高ABI 组患者MACE 发生率明显较正常ABI 组高(15/33 比13/65,P =0.008)。高ABI 组患者透析龄、血压、钙、缺血修饰白蛋白(ischemia modified albumin，IMA)水平、超敏C 反应蛋白(hypersensitive Creactive protein，hs-CRP)较正常ABI 组高，血浆白蛋白、残余肾小球滤过率(residual glomerular filtration rate,rGFR)、24h 尿量较正常ABI 组
低，差异有统计学意义。依据Framingham 心血管疾病(cardiovascular disease，CVD)风险因素将入组患者分为CVD 0～1 组(36 例，无风险因素或仅1 个CVD 风险因素)，CVD 2～3 组(40 例，存在2～3 个CVD 风险因素)，CVD 4 组(22 例，存在4 个以上CVD 风险因素)，3 组高ABI 发生率分别为19.444%(7/36)、27.500%
(11/40)、68.181%(15/22)，3 组之间高ABI 发生率比较有统计学意义(χ2=15.676，P ＜0.001)。Logistic回归分析显示透析龄、钙、IMA、hs-CRP 是最主要影响因素。结论高踝臂指数与腹膜透析患者心血管事件密切相关，透析龄、血钙水平、氧化应激和炎症是高ABI 的最主要影响因素。

关键词: 踝臂指数, 腹膜透析, 动脉钙化, 主要不良心血管事件

Abstract: 【Abstract】Objective To investigate the relationship between high ankle-brachial index (ABI) and major adverse cardiovascular events (MACE) in patients on peritoneal dialysis (PD). Methods A total of 98 chronic kidney disease patients treated with PD over 3 months were recruited. Baseline characteristics, ABI,
Framingham cardiovascular risk factors and other laboratory measurements were collected and analyzed. Results Patients were divided into two subgroups according to ABI value. Among these participants, 33 participants (one-side or two-sides ABI＞1.3) were assigned in high ABI group and the other 65 participants (0.9＜two-sides ABI＜1.3) were assigned in normal ABI group. Twenty-eight patients suffered MACE. PD patients with high ABI had higher incidence of MACE than those with normal ABI (15/33 vs. 13/65, P=0.008). Compared with normal ABI group, patients in high ABI group had significantly higher dialysis age, blood pressure, serum calcium, ischemia modified albumin (IMA) and high sensitivity C-reactive protein (hs-CRP), and lower serum albumin, residual GFR (rGFR) and 24h urine volume. According to Framingham cardiovascular risk factors, all of the PD patients could be divided into three groups: cardiovascular disease (CVD) 0~1 group (36 participants with 0~1 Framingham cardiovascular risk factor), CVD 2~3 group (40 participants with 2~3
Framingham cardiovascular risk factors), CVD 4 group (22 participants with more than 4 Framingham cardiovascular risk factors). The prevalence of high ABI was statistically different among the three groups (19.444%, 27.500% and 68.181%; chi square=15.676, P=0.000). Logistic regression analysis showed that dialysis age, serum calcium, IMA level and hs-CRP level were the independent risk factors for high ABI. Conclusions High ABI was closely related to cardiovascular events in PD patients. Dialysis age, serum calcium, oxidative stress and inflammation were the most important factors for high ABI.

Key words: Ankle-brachial index, Peritoneal dialysis, Arterial calcification, Major adverse cardiovascular events