腹膜透析患者并发脑卒中危险因素的临床分析

目的 探讨腹膜透析患者脑卒中的危险因素.方法 回顾性分析2005年1月至2012年1月深圳市第二人民医院肾内科122例腹膜透析患者的临床资料.将患者分为2组：合并脑卒中的患者（A组,n=17）和无并发脑卒中的患者（B组,n=105）.统计腹膜透析患者脑卒中的发生率.观察并比较2组患者血清C反应蛋白（CRP）水平、同型半胱氨酸浓度、血清尿酸浓度的差异.分析年龄、腹膜透析龄、高血压、糖尿病、同型半胱氨酸浓度、CRP水平、血清尿酸浓度、血清N末端脑钠肽前体（BNP）等指标与腹膜透析患者发生脑卒中的相关性.结果 本组患者共发生脑卒17例,发生率为13.9％,其中男性13例（76.5％）,女性4例（23.5％）.60岁以上患者发生脑卒中者共11例（64.7％）,60及岁以下患者发生脑卒中为6例（35.3％）,A组患者平均年龄63.5±10.7岁,B组患者平均年龄52.7±14.9岁,A组患者年龄大于B组患者年龄,差异有统计学意义（K0.05）.血清CRP水平A组（30.1±21.7mg/1）高于B组（12.1±13.3mg/1）、血同型半胱氨酸浓度A组（19.6±4.8umol/1）高于B组（14.8±6.9umol/1）,差异有统计学意义（P＜0.05）.血清尿酸浓度A组（340.4±71.0umol/l）低于B组（418.4±119.1umol/1）,差异有统计学意义（p=户0.01）.多因素非条件Logistic回归分析显示高血压（P=0.026）,糖尿病（P-0.022）,CRP （P=0.001）,BNP（P=0.045）,血清同型半胱氨酸（P=0.017）均为腹膜透析患者发生脑卒中的危险因素.结论 本组腹膜透析患者脑卒中发生率为13.9％.高血压、糖尿病、高CRP浓度、高同型半胱氨酸浓度均是腹膜透析患者发生脑卒中的独立危险因素.

Retrospective analysis of the risk factors for stroke in peritoneal dialysis patients

Objective To explore the risk factors for stroke in peritoneal dialysis patients in a dialysis center.Methods Clinical data of the 122 peritoneal dialysis patients admitted to Shenzheng Second People ＇ s Hospital during the period from January 2005 to January 2012 were collected and retrospectively analyzed.Stroke was found in 17 cases （group A） and was not found in 105 cases （group B）.Correlation of stroke with age,peritoneal dialysis age,Kt/V,hypertension,diabetes,serum homocysteine concentration,CRP,uric acid,and BNP were conducted.Results In the 17 cases with stroke （13.9％）,13 were males and 4 were females,3 cases were hemorrhagic stroke and 14 cases were ischemic stroke,11 cases （64.7％） aged over 60 and 6 cases （35.3％） less than 60 years old.The average age was 63.5±10.7 years in group A and was 52.7±14.9 years in group B （P＜0.05）.Serum CRP and homocysteine levels were significantly higher in group A than in group B （P＜0.05）.Serum uric acid was significamly lower in group A （340.4±71.0 umol/1） than in group B （418.4± 119.1 umol/1,P=0.01）.Multivariate unconditional logistic regression analysis showed that hypertension （P=0.026）,diabetes （P=0.022）,higher serum CRP （P=0.001）,higher serum BNP （P=0.045）,higher serum homocysteine （P=0.017） were the independent risk factors for stroke in peritoneal dialysis patients.Conclusion The incidence of stroke was 13.9％ in this series of peritoneal dialysis patients.Hypertension,diabetes,higher serum CRP,and higher serum homocysteine were the independent risk factors for stroke in peritoneal dialysis patients.