我国五省市、自治区慢性肾脏病患者心血管疾病的危险因素调查

Epidemiology of cardiovascular risk in Chinese chronic kidney disease patients

目的了解我国慢性肾脏病(CKD)患者心血管疾病(CVD)的危险因素。方法利用我国五个省市、自治区七家三级甲等医院2002至2003年收治的1239例慢性肾脏病病人有关心血管疾病的资料库,用多因素Logistic回归分析该组患者人口学资料、生活方式、疾病和用药史、体检及实验室参数与各类心血管疾病的关系;同时对主要危险因素的普遍性进行分析。结果(1)血清C反应蛋白(CRP)显著增高(>10mg/L)是慢性肾脏病患者发生冠状动脉疾病(CAD)的危险因素(OR2.13,95%可信区间[CI]1.32～3.43);本组慢性肾脏病患者CRP>10mg/L者占21.5%。(2)女性(OR2.99,CI2.09～4.26)、贫血(OR2.06,CI1.19～3.57)和收缩期高血压(OR1.016,CI1.00～1.02)是左心室肥厚(LVH)的主要危险因素;本组慢性肾脏病病人收缩压控制在140mmHg以下者占54.2%,血红蛋白维持≥110g/L者仅15%。(3)钙磷乘积增加与慢性肾脏病患者的充血性心力衰竭(CHF)有关(OR1.023,CI1.01～1.03);本组病人中25.9%钙磷乘积≥55。(4)低白蛋白血症(OR6.01,CI1.25～28.96)和舒张压增高(OR1.049,CI1.00～1.09)是慢性肾脏病合并脑卒中(CVA)的主要危险因素;低白蛋白血症的患病率为37.3%。(5)传统危险因素如糖尿病增加慢性肾脏病患者CAD(OR2.34)、CHF(OR1.97)和脑卒中(OR4.40)的危险性;年龄增加是CAD(OR1.04)和脑卒中(OR1.22)的危险因素;而高血压则与左心室肥厚(OR1.016)、CHF(OR1.02)和脑卒中(OR1.04)的发生有关。结论慢性肾脏病患者具有不同于一般人群的心血管疾病危险因素,探讨对微炎症和营养不良的干预方法,加强对贫血、高血压和钙磷代谢紊乱的控制是改善我国慢性肾脏病患者心血管疾病预后的关键。

Objective To identify the risk factors associated with cardiovascular disease (CVD) in Chinese chronic kidney disease (CKD) patients. Methods As part of a multicenter Chinese cohort study, the clinical data associated with CVD of 1239 patients with CKD (stage 2~5) hospitalized in 7 grade 3A hospitals distributed in 5 regions of China 2002~2003 were collected. Logistic regression model was used uo analyze the association between CVD and the demographic variables, lifestyle, medical history, medication, physical examination, and laboratory variables. Results (1) Increase of serum C-reactive protein (CRP, cut off >10 mg/L) was an independent risk factor for development of coronary artery disease (CAD) (OR 2.13; 95% confidence interval [CI], 1.32~3.43). 21.5% of the patients in this group showed a value of CRP >10mg/L. (2) Being female, anemia, and systolic hypertension were the major determinants of the development of left ventricular hypertrophy (OR 2.99,CI 2.09～4.26; OR 2.66, CI 1.19~3.57; and OR 1.02, CI 1.00^-1.02). 54.2% of the patients in this group had their systolic pressure controlled under 140mmHg, and only 15% of the patients in this group had their hemoglobin remain at the level ≥110 g/L.(3) There was a significant interaction between the calcium-phosphate product and congestive heart failure (CHF) (OR 1.023,CI 1.01～1.03).25.9% of the patients in this cohort had their calcium-phosphate product≥55. (4) Hypoalbuminemia (OR 6.01, CI 1.25-28.96) and diastolic hypertension (OR 1.05, CI 1.00-1.09) played major role in determining cerebrovascular accidents (CVA). In these cohort the prevalence of hypoalbuminemia was 37.3%. (5)Diabetes was associated with CAD (OR 2.34), CHF (OR 1.97), and CVA (OR 4.40), although its prevalence was lower in Chinese CKD patients (20%). Age was the risk factors of CAD (OR 1.04) and CVA (OR 1.22). Hypertension was associated with LVH (OR 1.016), CHF (OR 1.02), and CVA (OR 1.04). Conclusion CKD is associated with nontraditional risk factors for the development of CVD, including chronic inflammation, malnutrition and calcium-phosphate disorders. Particular care must be taken to give optimal treatment for the most important CVD risk factors active in Chinese CKD patients, e.g. anemia and hypertension.