维持性血液透析患者发生急性冠脉综合征的危险因素分析

目的 探讨影响维持性血液透析患者发生急性冠脉综合征（ACS）的危险因素。方法 回顾性分析2015年3月至2018年4月在河北省承德市中心医院和滦平县中医院血液净化中心行维持性血液透析的175例患者的临床资料，根据是否发生ACS分成两组，其中发生ACS患者57例（ACS组），未发生ACS的118例（非ACS组）。收集患者的性别、年龄、肾衰竭的基础疾病、透析龄、发生ACS前1个月的收缩压、舒张压、脱水量及发生ACS时的血红蛋白（Hb)、C反应蛋白(CRP)、甲状旁腺素(PTH)、血白蛋白(ALB)、血脂、血尿酸(UA)、肺动脉压(PH)等指标进行比较分析；应用多因素的logistic回归分析导致ACS的危险因素。结果 ACS组的男性居多38例（66.67%）]，而房颤病史、透析前的收缩压和舒张压、超流量、红细胞分布宽度（RDW）、血钾（K⁺）低于非ACS组，ALB高于非ACS组，差异均有统计学意义（均P<0.05）。二元logistic回归分析显示：透析前的收缩压≥160 mmHg（OR=3.240，95%CI：1.255～5.367，P<0.05）和超流量≥3 500 mL/次（OR=2.797，95%CI：1.033～4.574，P<0.05）是影响维持性血液透析患者发生ACS的相关影响因素。结论 透析前血压控制不良（收缩压≥160 mmHg）、超流量过大（超流量≥3 500 mL/次）使维持性血液透析患者发生ACS的风险增加。

Risk factors analysis of acute coronary syndrome in maintenance hemodialysis patients

Objective  To analyze influencing factors of acute coronary syndrome（ACS）in maintenance hemodialysis patient.Methods  The clinical data of 175 patients who underwent maintenance hemodialysis in the blood purification center of Chengde central hospital and Luanping hospital of traditional Chinese medicine from March 2015 to April 2018 were retrospectively analyzed. According to the occurrence of ACS, they were divided into two groups: 57 patients with ACS (ACS group) and 118 patients without ACS (non ACS group). The gender, age, underlying diseases of renal failure, age of dialysis, systolic blood pressure, diastolic blood pressure, dehydration of patients one month before ACS, hemoglobin, C-reactive protein, parathyroid hormone, albumin, blood lipid, blood uric acid and pulmonary artery pressure at ACS were collected for comparative analysis. Multivariate logistic regression analysis was used to screen the risk factors for ACS.Results  The majority of men in ACS Group 38 cases (66.66%)], while the history of atrial fibrillation, systolic and diastolic blood pressure before dialysis, excess flow, red blood cell distribution width (RDW), blood potassium (K⁺)  were lower than those in non ACS group, and ALB was higher than those in non ACS group (all P<0.05). Systolic blood pressure ≥160 mmHg (OR=3.240, 95%CI: 1.255～5.367, P<0.05) and superflow ≥3 500 mL/ time (OR=2.797, 95%CI: 1.033～4.574, P<0.05) were the related influencing factors of ACS in patients with maintenance hemodialysis.Conclusions  Poor pre-dialysis blood pressure control (mean systolic pressure ≥160 mmHg) and excessive  (mean superflow ≥3 500 mL/ time) increase the risk of ACS in maintenance hemodialysis patients.