老年透析患者发生心血管并发症相关危险因素分析

目的探讨老年透析患者心血管并发症发生的相关危险因素。方法对2002年1月至2006年12月在我院接受血液透析（HD）或持续不卧床腹膜透析（CAPD）治疗的患者共118例进行回顾性分析。按年龄和透析方式分为：老年HD组44例，老年CAPD组16例，中青年HD组46例，中青年CAPD组12例。记录临床常用血生化指标，比较组间危险因素差异，并对危险因素进行回归分析。结果与中青年组相比，老年组透析患者脉压差（66±21）mmHg（8．8／2．8kPa）]、甘油三酯（1．28±0．67）mmol／L]、脂蛋白（a）（434±202）mg／L]、C反应蛋白（21±15）mg／L]、血清磷（2．02±0．77）mmol／L]、钙磷乘积（4．3±1．6）mmol^2／L^2]明显升高（t值分别为1．535，1．016，2．154，2．252，4．676，4．534，均P〈0．05）。无论在老年组，还是中青年组患者中，CAPD组患者发生心血管并发症比率都较HD组明显降低（P〈0．05）。年龄、脉压差、脂蛋白（a）、C反应蛋白、钙磷乘积与透析患者心血管并发症呈正相关（P〈0．05），而血清白蛋白与之呈负相关（P〈0．05）。结论老年透析患者存在多种心血管并发症的危险因素，对于老年透析患者需选择合理的透析方式，积极纠正危险因素。

Risk factors for cardiovascular complications in the elderly patients with dialysis

Objective To investigate the risk factors for cardiovascular complications in the elderly persons undergone with dialysis.Methods One hundred and eighteen patients undergone with hemodialysis(HD)or continuous ambulatory peritoneal dialysis(CAPD)at the Eastern Hospital, Tongji University, Shanghai during January 2002 to December 2006 were retrospectively analyzed.They were divided into four groups based oil their age and mode of dialysis, i.e., 44 patients in the elderly HD group(aged over 60years), 16 patients in the elderly CAPD group(aged over 60), 46 patients in medium-age HD group(aged under 60 years)and 12 patients in the medium-age CAPD group(aged under 60).Routine biochemical parameters were measured for all the patients and their difference was compared among the four groups.Logistic regression analysis was performed for the risk factors of cardiovascular complications.Results Pulse pressure(PP)was(66±21)mm Hg, serum level of triglycerides(TG)was(1.28±0.67)mmol/L, serum level of lipoprotein(a)LP(a)]was(434±202)mg/L, C-reactive protein was(CRP)(21±15)mg/L, serum phosphorous(P3-)was(2.02±0.77)mmol/L, and product of serum calcium and phosphorous(Ca×P)was(4.3±1.6)mmol2/L2, respectively, in the elderly group with dialysis, all significantly higher than those in the medium-age group with dialysis(t=1.535, 1.016, 2.154, 2.252, 4.676, and 4.534, respectively, P＜0.05).Incidence of cardiovascular events was markedly lower in the CAPD group than that in the HD group(P＜0.05), either in the elderly or medium-aged patients.And, incidence of cardiovascular complications correlated positively with age, PP, LP(a), CRP and Ca×P of the patients with dialysis, but correlated reversely with serum level of albumin(all with P＜0.05).Conclusions There exist a few risk factors for cardiovascular complications in the elderly patients with dialysis, so proper mode of dialysis should be selected for those who need it and adequate intervention should be implemented for them to correct the risk factors.