维持性血液透析患者外周动脉疾病与全因死亡的相关性

目的 通过测量踝肱指数（ABI）调查维持性血液透析（MHD）患者下肢外周动脉疾病（PAD）,观察其与透析患者全因死亡的关系.方法 纳入四川省人民医院血液净化中心177例MHD患者,收集其一般资料、透析前血压、实验室检查结果,并测量ABI.以任何一侧ABI＜0.90作为下肢动脉缺血的诊断标准,随访29个月,采用Kaplan-Meier及Cox回归分析下肢动脉疾病与患者全因死亡的关系.结果 下肢缺血PAD的患病率为12.5％ （22/177）,PAD组患者年龄较高[（67±16）岁比（58± 15）岁,P=0.017].Kaplan-Meier分析提示,PAD组患者生存率低于无PAD组（P＜0.001）;Cox分析显示,校正年龄、性别、透析龄、糖尿病、冠心病之后,PAD患者死亡风险是无PAD患者的3.39倍（95％可信区间1.44～7.97,P=0.005）,糖尿病（风险比=2.917,95％可信区间1.280～6.649,P=0.011）和年龄（风险比=1.042,95％可信区间1.007～ 1.077,P=0.018）也是该人群死亡的危险因素.结论 MHD患者外周血管疾病患病率较高,PAD、糖尿病和年龄是MHD患者死亡的独立危险因素.

Peripheral artery disease and all-cause mortality in maintenance hemodialysis patients

Objective To investigate the impact of peripheral artery disease on mortality diagnosed by ankle-brachial index （ABI） in maintenance hemodialysis patients.Methods One hundred and seventyseven MHD patients were enrolled and general information,predialysis brood pressure,laboratory findings and ABI were collected.PAD was diagnosed according to ABI ＜ 0.9.Kaplan-Meier and Cox regression were applied to analyzed the relationship between PAD and patient mortality after 29 months,follow up.Results PAD prevalence among this population was 12.8％ （22/177）.Patients with PAD were older.Kaplan-Meier analysis showed that the survival probability of PAD patients was lower than non-PAD patients.Cox regression showed PAD was independently associated with higher mortality after adjusting for age,gender,hemodialysis vintage,diabetes and coronary artery disease （hazard ratio （HR）） =3.39,95 ％ confidence interval （CI）,1.44-7.97,P =0.005）.Conclusions The prevalence of PAD among MHD patients is relatively high,and PAD is independently associated with lower survival.