摘要
目的探讨维持性血液透析(MHD)患者发生心脑血管事件的危险因素。方法回顾性分析2013年5月至2018年3月在宜兴市人民医院血液净化中心285例行MHD患者的临床治疗,透析期间137例发生心脑血管事件(发生组),148例未发生心脑血管事件(未发生组)。比较两组患者年龄、收缩压、透析龄、动脉粥样硬化方面的差异;采用Cox生存曲线分析透析龄(月)与心脑血管事件发生情况。结果两组患者的年龄、收缩压、透析龄、动脉粥样硬化发生情况以及血肌酐、血磷、超敏C反应蛋白、甘油三酯水平差异均有统计学意义(均P<0.05)。影响终末期肾病患者发生心脑血管事件的多因素logistic回归分析结果显示:年龄≥50岁(B=0.42,P=0.03,95%CI为1.06~3.06)、透析龄≥24个月(B=0.85,P=0.01,95%CI为1.23~3.79)、发生动脉粥样硬化(B=0.58,P=0.04,95%CI为1.13~4.02)、高血压(B=0.23,P<0.01,95%CI为1.34~9.25)、糖尿病肾脏疾病(DKD)(B=0.36,P<0.01,95%CI为1.19~8.27)、超敏C反应蛋白水平升高(B=0.83,P<0.01,95%CI为1.12~3.90)、高血磷(B=0.91,P<0.01,95%CI为1.06~1.54)、甘油三酯水平升高(B=0.50,P<0.01,95%CI为1.08~5.57)是发生心脑血管事件的独立相关因素。Cox生存曲线分析显示,在透析龄≥12月心脑血管事件发生概率增加,透析龄≥24个月心脑血管事件发生概率快速增加。结论年龄≥50岁、透析龄≥24个月、发生动脉粥样硬化、高血压、DKD、超敏C反应蛋白水平升高、高血磷、甘油三酯水平升高可能是MHD患者发生心脑血管事件的独立危险因素;透析龄越长发生心脑血管事件的概率越大。
Objective To investigate the risk factors of cardiovascular and cerebrovascular events in patients undergoing maintenance hemodialysis(MHD).Methods A total of 285 patients undergoing MHD in the Blood Purification Center of Yixing People′s Hospital from May 2013 to March 2018 were enrolled,including 137 patients with cardiovascular and cerebrovascular events and 148 patients without cardiovascular and cerebrovascular events.The demographic and clinical data of patients were retrospectively reviewed.The age,systolic blood pressure,duration of dialysis and prevalence of atherosclerosis were compared between the two groups;the risk factors of cardiovascular and cerebrovascular events were analyzed by multivariate logistic regression.Results There were significant differences in age,systolic blood pressure,duration of dialysis and prevalence of atherosclerosis;serum creatinine,serum phosphorus,hs-CRP and triglyceride levels between the two groups(P<0.05).Multivariate logistics analysis showed that age≥50 years(B=0.42,95%CI 1.06-3.06,P=0.03),duration of dialysis≥24 months(B=0.85,95%CI:1.23-3.79,P=0.01),atherosclerosis(B=0.58,95%CI:1.13-4.02,P=0.04),hypertension(B=0.23,95%CI:1.34-9.25,P<0.01),diabetic kidney disease(DKD)(B=0.36,95%CI:1.19-8.27,P<0.01),increased hs-CRP(B=0.83,95%CI:1.12-3.90,P<0.01),high serum phosphorus(B=0.91,95%CI:1.06-1.54,P<0.01)and elevated TG(B=0.50,95%CI:1.08-5.57,P<0.01)were independent risk factors for cardiovascular and cerebrovascular events in MHD patients.Early and active intervention of these risk factors may improve the clinical prognosis of MHD patients.The Cox survival curve showed that the probability of cardiovascular and cerebrovascular events increased when the duration of dialysis was>12 months,and it increased more significantly when the duration>24 months.Conclusion The older age,dialysis duration,comorbidities of atherosclerosis,hypertension,DKD,and elevated serum hs-CRP,phosphorus,triglyceride may increase the probability of cardiovascular and cerebrovascular events for MHD patients.
作者
蒋佳伟
樊伟
储虹
王振欣
周玲
Jiang Jiawei;Fan Wei;Chu Hong;Wang Zhenxin;Zhou Ling(Department of Nephrology,Yixing People′s Hospital,Yixing 214200,China;Department of Oncology,the First Affiliated Hospital of Soochow University,Suzhou 215000,China;Department of Nephrology,the First Affiliated Hospital of Soochow University,Suzhou 215000,China)
出处
《中华全科医师杂志》
2020年第9期829-834,共6页
Chinese Journal of General Practitioners
基金
国家自然科学基金青年项目(81600565)
江苏省自然科学基金优秀青年基金项目(BK20190052)。
关键词
肾透析
肾功能衰竭
慢性
心血管疾病
卒中
危险因素
Renal dialysis
Kidney failure,chronic
Cardiovascular diseases
Stroke
Risk factors
