维持性血液透析患者脑梗死发生状况及危险因素分析

  目的  了解维持性血液透析(maintenance hemodialysis,MHD)患者脑梗死的发生状况,并分析其影响因素。  方法  选取2018年1月—2020年1月在杭州市富阳区第一人民医院血液净化中心行MHD治疗的尿毒症患者208例为研究对象。根据患者治疗期间是否发生脑梗死分为缺血性脑梗死组23例和非脑梗死组185例。对2组患者的一般临床资料进行比较,并分析MHD患者发生缺血性脑梗死的危险因素。  结果  208例患者发生缺血性脑梗死23例,脑梗死发生率为11.06%;对2组患者各临床指标进行比较,结果发现缺血性脑梗死组患者在糖尿病、冠心病、心房颤动、透析前收缩压、透析前舒张压、尿酸(UA)等方面均明显高于非脑梗死组患者(均P＜0.05),而2组患者在性别、年龄、透析年限、透析频率、高脂血症、吸烟史、肾小球滤过率(glomerular filtration rate,GFR)、口服拜阿司匹林、口服他汀类药物、血磷(phosphorus,P)、血红蛋白(hemoglobin,Hb)、白蛋白(albumin,ALB)等方面比较差异无统计学意义(P＞0.05);经logistic回归分析显示冠心病、糖尿病、透析前收缩压、透析前舒张压、心房颤动和UA属于MHD患者发生脑梗死的独立危险因素。  结论  MHD患者发生缺血性脑梗死的比例较高,其中冠心病、糖尿病、透析前收缩压、透析前舒张压、心房颤动和UA属于MHD患者发生缺血性脑梗死的独立危险因素,在MHD患者治疗中应给予相应的防治措施以降低脑梗死发生的风险。 

Analysis of the incidence and risk factors of cerebral infarction on maintenance haemodialysis patients

  Objective  To understand the incidence of cerebral infarction in maintenance haemodialysis (MHD) patients and analyze its influencing factors.  Methods  Total 208 uremic patients treated with MHD in the Blood Purification Center of the First People's Hospital of Fuyang District, Hangzhou from January 2018 to January 2020 were selected as the research objects. Patients were divided into the ischemic cerebral infarction group (n=23) and non-cerebral infarction group (n=185) according to whether cerebral infarction occurred during treatment. General clinical data were compared between the two groups, and risk factors for ischemic cerebral infarction in MHD patients were analysed.  Results  The incidence of ischemic cerebral infarction was 11.06% in 23 of 208 patients. Comparing the clinical indexes of the two groups of patients, the results showed that ischemic cerebral infarction patients in diabetes, coronary heart disease, atrial fibrillation, systolic pressure, diastolic blood pressure before dialysis before dialysis, uric acid were significantly higher than that of the patients in non-cerebral infarction group (all P < 0.05), and two groups of patients in the frequency of sex, age, duration of dialysis, dialysis, hyperlipidaemia, smoking history, glomerular filtration rate, oral aspirin, oral statin drugs, blood phosphorus, haemoglobin and albumin were not statistically significant (P > 0.05). Logistic regression analysis showed that coronary heart disease, diabetes mellitus, pre-dialysis systolic blood pressure, pre-dialysis diastolic blood pressure, atrial fibrillation and UA were independent risk factors for cerebral infarction in MHD patients.  Conclusion  The proportion of MHD patients with ischemic cerebral infarction is relatively high, amongst which coronary heart disease, diabetes, pre-dialysis systolic blood pressure, pre-dialysis diastolic blood pressure, atrial fibrillation and UA are independent risk factors for the occurrence of ischemic cerebral infarction in MHD patients, and corresponding prevention and treatment measures should be given in the treatment of MHD patients to reduce the risk of cerebral infarction.