非透析慢性肾脏病患者大动脉僵硬度的临床研究

Clinical study on arterial stiffness in chronic kidney disease patients without dialysis

目的评估非透析慢性肾脏病(CKD)患者大动脉僵硬度并进行相关因素分析,探讨其意义。方法选取2006年4月～2007年10月在北京大学第三医院肾内科门诊随访的非透析CKD患者378例,测量颈股动脉脉搏波速度(CF-PWV),生化指标并记录一般情况,进行相关分析。结果378例CKD患者的CF-PWV与年龄(r=0.494,P<0.001)、收缩压(r=0.419,P<0.001)、脉压(r=0.471,P<0.001)、血糖(r=0.220,P<0.001)、24h尿蛋白(r=0.245,P=0.003)、代谢综合征(r=0.220,P=0.001)正相关,与肌酐清除率(r=-0.261,P<0.001)血HDL-C(r=-0.136,P=0.018)负相关,没有发现CKD患者CF-PWV与性别(r=0.100,P=0.052)、体重指数(r=-0.082,P=0.156)、血TG(r=0.004,P=0.951)、血钙磷乘积(r=-0.005,P=0.932)相关。回归分析时PWV的独立正相关因素是年龄(B=0.063,P<0.001),脉压(B=0.047,P=0.004),24h尿蛋白量(B=0.6,P=0.001)。结论非透析CKD患者的CF-PWV与传统心血管危险因素及尿蛋白,肌酐清除率相关,可成为早期预测CKD患者CVD发生的检查方法,动脉硬化可能在CKD患者CVD发生中起重要作用。

Objective To assess arterial stiffness, its related risk factors and the roles of these factors in chronic kidney disease （CKD） patients without dialysis. Methods We recruited 378 outpatients with CKD treated in the Renal Clinic of Peking University Third Hospital from March, 2006 to Oct., 2007. Arterial stiffness was evaluated by measuring carotid-femoral artery pulse wave velocity （CF-PWV）. Clinical information and biochemical data were collected. The correlation of these data was then analyzed. Results Among the 378 CKD patients, CFPWV was positively correlated with age （r=0.494, P 〈 0.001）, systolic blood pressure （r=0.419, P 〈 0.001）, pulse pressure （r=0.471,P 〈 0.001）, blood glucose （r=0. 220 P 〈 0.001）, amount of 24 hours urine protein （r = 0.245,P=0.003）, and metabolic syndrome （r=0. 220 P=0.001）, and was negatively correlated with creatinine clearance （r=-0. 261, P〈0.001） and HDL-C （r=-0. 136, P = 0.018）. CF-PWV was unrelated with sex （r =0. 100, P = 0.052）, body mass index （r=0.082,P=0.156）, triglycerides （r=0.004,P=0.951）, and product of calcium and phosphorus （r=-0. 005 P=0.932）. Multiple regression analysis found that CF-PWV was positively and independently associated with age （B=0.063, P 〈 0.001）, pulse pressure （B=0.047, P=0.004） and amount of 24 hours urine protein （B=0.6, P=0.001）. Conclusion In CKD patients without dialysis, CF-PWV correlates with a number of traditional risk factors to cardiovascular disease, urine protein amount, and creatinine clearance. Therefore, CF-PWV may be a useful method to early predict the risk of cardiovascular disease in CKD patients. Arterial stiffness may also play an important role in cardiovascular disease in CKD patients.