中国五省市自治区慢性肾脏病患者心血管疾病的患病率调查

目的了解中国慢性肾脏病(CKD)患者心血管疾病(CVD)的发病规律和发病因素。方法对我国5个省市、自治区7家三级甲等医院2002年至2003年收治的1239例慢性肾脏病患者进行流行病学调查。结果(1)慢性肾脏病患者冠状动脉疾病(CAD)的患病率为16．5％，左心室肥厚(LVH)为58．5％，充血性心力衰竭(CHF)27．7％，脑卒中(CVA)5．6％，大血管动脉粥样硬化性病变31．5％。(2)第2—3期轻度慢性肾脏病患者的CAD(5．9％)和CVA(1．0％)患病率已明显高于同地区一般人群；高达41．2％的轻度肾功能减退患者合并LVH，13．8％有充血性心衰的临床证据；CAD、LVH和CHF的患病率随肾功能恶化而增高。(3)本组透析患者CAD的患病率(20．0％)低于欧美国家，而脑卒中患病率(5．4％)显著高于国外报告；不同年龄组、不同地区和糖尿病与非糖尿病慢性肾脏病之问CAD的患病率存在差异；但男、女两性之间无明显差异，女性LVH的患病率甚至高于男性。结论慢性肾脏病患者是心血管疾病的高发人群，轻度慢性肾脏病患者心血管疾病的危险性已明显增加。本组透析病人CAD的患病率低于欧美国家，发病规律也与一般人群有别，故有必要深入研究慢性肾脏病患病人群心血管疾病的发病机制和危险因素。

Cardiovascular disease in Chinese chronic renal insufficiency patients-epidemiology survey

Objective Cardiovascular (CV) disease (CVD)is the single most important cause of death among Chinese dialysis patients, accounting for 51% of overall mortality. The study was performed to investigate the prevalence and the spectrum of CVD in Chinese chronic kidney disease (CKD) patients.Methods The multicenter Chinese cohort study examined 1239 CKD patients from 7 main medical centers (distributed in 5 regions of China) who were hospitalized between 2002 and 2003. Results~(1)The most prevalent pathological form of CVD was left ventricular (LV)hypertrophy (LVH), accounting for 58.5% of total patients. The prevalence of coronary artery disease (CAD), congestive heart failure (CHF), and cerebrovascular accidents (CVA) was 16.5%, 27.7% and 5.6%, separately. (2) The cohort with minor renal dysfunction (stage 2-3) had higher prevalence of CAD (5.9%) and CVA (1.0%) compared with general population in the same regions. Up to 41.2% of minor CKD patients were complicated with LVH, and 13.8% of them had clinical evidence of CHF. The prevalence of CAD,LVH and CHF increased as glomerular filtration decline. (3) The prevalence of CAD (20.0%) was much lower and the prevalence of CVA (5.4%) was higher in Chinese dialysis patients than that in American dialysis population. There was significant geographical variations in CAD prevalence, but it was not different between genders.Conclusion The CV risk is significantly increased in patients with CKD. Even minor CKD has a major impact on the CV risk. The prevalence of CAD in Chinese dialysis patients is markedly lower than that in American dialysis population.