腹膜透析患者外周动脉疾病及其相关危险因素分析

Peripheral arterial disease and its related risk factors in patients on continuous ambulatory peritoneal dialysis

目的了解我国腹膜透析患者中外周动脉疾病(PAD)的发病率并分析其相关危险因素。方法选取腹膜透析中心150名临床情况稳定的持续不卧床腹膜透析(CAPD)患者为研究对象。测量踝臂指数(ABI),ABI≤0.9诊断为PAD。收集所有患者的临床生化指标进行Pearson’相关及logistic回归分析以鉴别腹膜透析患者外周动脉疾病的危险因素。结果合并PAD与非PAD腹膜透析患者分组比较显示在糖尿病状态、心脑血管病史、舒张压、脉压、尿素氮、血清白蛋白、血糖、C-反应蛋白(CRP)方面均有显著差异(P<0.05)。Logistic回归分析中显示血清白蛋白、CRP水平独立于其他危险因素而成为影响腹膜透析患者发生外周动脉疾病的主要因素。结论血清白蛋白、CRP水平是影响腹膜透析患者发生PAD的决定因素,临床上营养状况较差和(或)有炎症的腹膜透析患者要注意预防外周动脉疾病的发生和发展。

Objective To study the prevalence of peripheral arterial disease （PAD） and its related risk factorsin patients on continuous ambulatory peritoneal dialysis （CAPD）. Methods We studied 150 CAPD patients with stable clinical status in a single center. Ankle-brachial index （ABI） was measured in these patient, and ABI ≤ 0.9 was considered as having PAD. However, patients with ABI 〉 1.3 were excluded because of the false negative rate. Correlation and logistic regression analysis were performed to disclose the risk factors of PAD in these CAPD patients. Results Significant differences in diabetic status, history of cerebro- and cardiovascular diseases, diastolic blood pressure, blood urea nitrogen, serum albumin, blood sugar and C-reactive protein （CRP） were found between patients with PAD and those without PAD. Logistic regression analysis showed that serum albumin （β= -0.139, P〈0.05） and CRP （β= 0.064, P〈0.05） were the independent determinants of PAD in CAPD patients. Conclusion Serum albumin and CRP were the determinant factors of PAD in CAPD patients. Therefore, care should be paid to the CAPD patients with malnourishment or inflammation for the prevention of PAD.