血液透析患者的动脉僵硬度及相关因素

Arterial stiffness and associated factors in maintenance hemodialysis patients

目的研究维持性血液透析（MHD）患者的动脉僵硬度并探讨相关影响因素。方法采用CompliorSP脉搏波速度（PWV）测定仪测定MHD患者单次透析前后颈动脉-股动脉PwV（CFPWV）和颈动脉-桡动脉PWV（CRPWV）。检测相关血生化指标和全段甲状旁腺素（iPTH）水平。多元逐步回归方法分析影响Pwv的因素。配对t检验比较单次透析前后PWV的变化。36例性别、年龄匹配的健康成人作为对照。结果入选患者90例，男性48例，女性42例，平均年龄（59．8±14．5）岁，平均透析龄（29．4±28．8）个月。CFPWV为（13．22±3．23）m／s，CRPWV为（9．58±1．87）m／s，均高于健康对照（P〈0．05）。多元逐步回归分析结果显示，年龄和脉压是CFPWV的独立影响因素；透析龄、钙磷乘积、iPTH、低密度脂蛋白和平均动脉压是影响CRPWV的因素。单次透析前后PWV差异无统计学意义。结论MHD患者存在大、中动脉弹性的下降，年龄和脉压是大动脉僵硬度的影响因素。中等肌性动脉僵硬度更易受透析相关指标的影响。

Objective To study the arterial stiffness in maintenance hemodialysis （MHD） patients and to explore the associated factors. Methods Ninety MHD patients and 36 healthy controls were enrolled in the study. Automatic pulse wave velocity （PWV） measuring system was applied to examine carotid-femoral pulse wave velocity （CFPWV） and carotid-radial PWV （CRPWV） as the parameters reflecting central elastic large arterial and peripheral muscular medium-sized arterial elasticity respectively. Blood pressure and biochemical parameters were detected. Backward multiple linear regression analysis was used to assess the influencing factors of arterial stiffness. Results CFPWV and CRPWV in MHD patients were greater than those of healthy controls [（13.22±3.23） m/s vs （10. 67±2.11） m/s and （9.58±1.87） m/s vs （8.81±1.09） m/s, all P〈0.05]. Backward muhiple regression analysis demonstrated that age and pulse pressure were positively correlated with CFPWV , while dialysis duration, calcium phosphorus product, parathyroid hormone, low density lipoprotein and mean arterial blood pressure were significantly correlated with CRPWV. Volume reduction after single dialysis session could not improve arterial stiffness of MHD patients. Conclusions Arterial stiffness of large artery and peripheral muscular medium-sized artery increases in MHD patients. Age and pulse pressure are major determinants of large artery stiffness. Peripheral muscular medium-sized arterial stiffness is more easily influenced by dialysis-associated factors.