腹膜透析患者心脑血管疾病的危险因素分析

目的通过对一些危险因素的分析,为临床寻找腹膜透析（PD）患者心脑血管并发症的预测指标并减少其发生提供依据。方法选择上海交通大学医学院附属瑞金医院肾脏科从2002年1月～2006年12月开始PD治疗的患者163例,根据有无心脑血管病变将这些患者分为3组：第1组为无心脑血管病变、第2组为开始PD时已有心脑血管病变、第3组为开始PD后新发生心脑血管并发症。比较3组患者在PD治疗初始时的体重、血红蛋白（Hb）、血浆白蛋白（Alb）、三酰甘油（TG）、胆固醇（TC）、脂蛋白a（LPa）、超敏C反应蛋白（hs-CRP）、室间隔厚度（IVST）、左心室后壁厚度（LVPWT）、左心室射血分数（EF）以及是否合并糖尿病、高血压等,分析上述因素与心脑血管病变的关系。结果163例PD患者中121例（74.2%）有心脑血管并发症,包括第2组75例和第3组46例。截止2007年3月,共有28例死亡,其中11例（39.3%）死于心脑血管病。第2和第3组患糖尿病、高血压患者多于第1组。3组患者的Hb分别为（94.3±22.4）g/L、（86.2±20.8）g/L和（86.8±18.1）g/L（P〈0.05）;ALB分别为（30.6±6.5）g/L、（27.3±5.1）g/L和（27.0±5.3）g/L（P〈0.01）。Logistic多元回归分析发现置管年龄、糖尿病及射血分数是PD患者新发心脑血管并发症的危险因素。结论PD患者心脑血管病变发生率高,与糖尿病、高血压、贫血、低白蛋白血症、超敏CRP高等密切相关。而置管年龄大、患有糖尿病及左心室射血分数低是PD患者新发心脑血管并发症的危险因素。积极纠正上述因素则可能减少PD患者心脑血管并发症的发生,从而提高其生存率。

Risk factors for cardiocerebral vascular diseases in peritoneal dialysis patients

Objective To investigate the risk factors for cardiocerebral vascular diseases in peritoneal dialysis （PD） patients. Methods One hundred and sixty-three patients who initiated PD during Jan. 2002～Dec. 2006, in our department were recruited in this study and divided into three groups： group 1, without cardiocerebral vascular diseases; group 2, with cardiocerebral vascular diseases before PD; group 3, cardiocerebral vascular diseases developed in the course of PD. Patients＇ body weight, hemoglobin, albumin, triglycerides, total cholesterol, lipoprotein A, high-sensitivity C-reactive protein, interventricular septum thickness （IVST）, left ventricular posterior wall thickness （LVPWT）, ejection fraction （EF）, and their disease history of diabetes and hypertension were collected. Results In the 163 PD patients, cardiocerebral vascular diseases were found in 121 cases （74.2%）, of whom 75 patients were in group 2 and 46 patients in group 3. Before the end of Mar. 2007, 28 patients died, of whom 11 patients （39.3%） died of cardiocerebral vascular diseases. Diabetes and hypertension were found more in group 2 and 3 than in group 1. Hemoglobin were （94.3＋22.4）g/L, （86.2＋20.8）g/L and （86.8＋18.1）g/L in group 1, 2 and 3, respectively （P〈0.05）. Serum albumin were （30.6＋6.5）g/L, （27.3＋5.1）g/L and （27.0＋5.3）g/L in group 1, 2 and 3, respectively （P〈0.01）. Logistic regression analysis showed that diabetes, older catheterization age and lower EF were the risk factors for cardiocerebral vascular diseases in PD patients. Conclusion Diabetes, older catheterization age and lower EF are the risk factors related to cardiocerebral vascular diseases in PD patients. Intervention of these risk factors will improve their survival rate.