糖尿病腹膜透析患者动脉僵硬度及其影响因素

目的探讨糖尿病肾病（DN）腹膜透析（PD）患者动脉僵硬度及其影响因素。方法测定45例DNPD患者白蛋白（ALB）、C反应蛋白（CRP）、血红蛋白（Hb）、三酰甘油（TG）、总胆固醇（TC）、空腹血糖（FPG）、糖化血红蛋白（HbA1c）、全段甲状旁腺素（iPTH）、血钙及血磷水平,计算钙磷乘积（Ca×P）、尿素清除指数（Kt/V）,测定丙二醛（MDA）、晚期氧化蛋白产物（AOPP）、髓过氧化物酶（MPO）及超氧化物歧化酶（SOD）水平,并应用超声测量计算各组颈动脉内中膜复合体厚度（IMT）、弹性指数（Ep）、僵硬指数（SI）。结果DNPD患者分别以EP、SI的中位数为界,分为低EP组、高EP组和低SI组、高SI组。组间各指标比较发现高EP组较低EP组年龄、透析龄、收缩压（SBP）、TG、FPG、HbA1c、MDA、AOPP升高（P〈0.05）,SOD降低（P〈0.05）;高SI组较低SI组年龄、ALB、TG、FPG、HbA1c、MDA、AOPP、MPO升高（P〈0.05）,SOD降低（P〈0.05）。多元逐步回归分析显示年龄、SBP、HbA1c、AOPP、SOD为EP的影响因素（P〈0.05）,年龄、TG、HbA1c、MDA、MPO为SI的影响因素（P〈0.05）。相关性分析表明IMT、Ep、SI各自分别与HbA1c、MDA、AOPP、MPO水平呈正相关关系（P〈0.05）,与SOD水平呈负相关关系（P〈0.05）,HbA1c水平分别与MDA、AOPP、MPO水平呈正相关关系（P〈0.05）,与SOD水平呈负相关关系（P〈0.05）。结论年龄、SBP、TG、HbA1c和氧化应激水平能影响DNPD患者动脉僵硬度,且HbA1c和氧化应激之间存在密切关系。

Arterial Stiffness and its Related Factors in Diabetic Nephropathy Patients with Peritoneal Dialysis

Objective To explore arterial stiffness and its related factors in diabetic nephropathy （DN） patients with peritoneal dialysis（PD）. Methods Serum albumin （ALB）, C reactive protein （CRP）, hemoglobin（Hb）, triglyeride （TG）, total cholesterol （TC）, fast plasma glucose （FPG）, Glycosylated hemoglobin （HbA1c）, immunoreactive parathyroid hormone （iPTH）, calcium-phosphorus product （Ca×P） ,KT/V index, malondialdehyde （MDA）, advanced oxidation protein products（AOPP）, myeloperoxidase （MPO） and superoxide dismutase （SOD） levels were assayed, and the intimamedia thickness（IMT）, pressure-strainelastic modulus （Ep） and stiffness index （SI） were measured and calculated of the carotid artery with ultrasound in 45 DN PD patients. Results 45 DN PD patients were divided into low EP group, high EP group and low SI group, high SI group by the median of EP and SI respectively. Compared to low EP group, age, duration of dialysis, systolic blood pressure （SBP）, TG, FPG, HbAlc, MDA, AOPP were increased （P 〈 0.05）, and SOD was decreased in high EP group （P 〈 0.05）. Compared to low SI group, age, ALB, TG, FPG, HbAlc, MDA, AOPP, MPO were increased （P 〈 0.05）, and SOD was decreased in high SI group （P 〈 0.05）. Multiple linear stepwise regression analysis revealed EP were influenced by age, SBP, HbA1c, AOPP, SOD （P 〈 0.05）, SI were influenced by age, TG, HbA1c, MDA, MPO （P 〈 0.05）. Correlated analysis showed there were positive correlations between IMT, Ep, SI and HbAlc, MDA, AOPP, MPO, negative correlations between IMT, Ep, SI and SOD, positive correlations between HbA1c and MDA, AOPP, MPO, negative correlation between HbAlc and SOD respectively in DN PD patients. Conclusion Age, SBP, HbAlc and oxidative stress showed significant influence on arterial stiffness in DN PD patients, and the close relation between HbA1c and oxidative stress was found existed.