慢性肾脏病患者颈-股动脉脉搏波速度改变及其影响因素

Changes and influential factors of carotid-femoral pulse wave velocity in patients with chronic kidney disease

背景:有关慢性肾脏病2～5期尚未进入透析阶段患者动脉弹性功能特点的研究较少。有资料表明,颈-股脉搏波传导速度可以评价动脉弹性功能。目的:探讨慢性肾脏病患者颈-股脉搏波传导速度的改变及影响因素。设计、时间及地点:非随机病例对照实验,于2006-01/08在北京大学第三医院肾脏内科完成。对象:北京大学第三医院临床情况稳定的166例慢性肾脏病患者和28名健康人。方法:根据肾脏透析预后质量指南慢性肾脏病分期标准将患者分为轻度肾损伤组(n=38)、中度肾损伤组(n=54)和重度肾损伤组(n=74),28名健康人作对照组。测定各组体质量、血压、颈-股脉搏波传导速度及生化指标,计算肾小球滤过率,比较各组间差异,并采用单因素相关和多因素回归分析探讨颈-股脉搏波传导速度的相关因素。主要观察指标:患者颈-股脉搏波传导速度及影响因素。结果:慢性肾脏病患者收缩压、舒张压、脉压和颈-股脉搏波传导速度明显高于对照组(P<0.05),两组间年龄、身高、体质量、体质量指数无差异。轻、中、重度慢性肾脏病患者年龄、体质量指数、肾小球滤过率、收缩压、脉压存在差异,随着肾脏损伤的加重,颈-股脉搏波传导速度呈明显上升趋势,年龄、收缩压及脉压也随慢性肾脏病分期的进展而增加,体重指数及肾小球滤过率呈下降趋势。除与性别因素相关外(r=2.305,P<0.05),颈-股脉搏波传导速度与年龄(r=0.479,P<0.001)、收缩压(r=0.556,P<0.001)、脉压(r=0.603,P<0.001)、血清肌酐(r=0.287,P<0.001)和超敏C-反应蛋白(r=0.316,P<0.001)存在显著正相关,与肾小球滤过率负相关(r=-0.436,P<0.001)。多元逐步回归分析显示,年龄、肾小球滤过率是颈-股脉搏波传导速度独立的影响因素。结论:慢性肾脏病患者颈-股脉搏波传导速度随着肾脏损伤的加重逐渐升高;年龄和肾小球滤过率是慢性肾脏病患者动脉硬化独立的影响因素。

BACKGROUND： Little data have been available concerning function features of arterial elasticity in patients with chronic kidney disease at 2-5 stage not undergoing dialysis. Studies have demonstrated that carotid-femoral pulse wave velocity （PWVcf） can be used to evaluate arterial elasticity. OBJECTIVE： To explore the changes and influential factors of PWVcf in patients with chronic kidney disease. DESIGN, TIME AND SETTING： A non-randomized controlled experiment was performed at the Department of Nephrology, Peking University Third Hospital from January to August 2006. PARTICIPANTS： 166 patients with chronic kidney disease and 28 health persons were selected from Peking University Third Hospital. METHODS： The patients were divided into 3 groups based on the Kidney/Dialysis Outcomes Quality Initiative （K/DOQI） guideline for chronic kidney disease： mild group （at stage 1 to 2）, moderate group （at stage 3） and severe group （at stage 4 to 5）; the healthy people served as control. Body mass, blood pressure, PWVcf and biochemical indicators were determined to calculate glomerular filtration rate and compare the differences. One-way and multiple regression analyses were used to explore related factors of PWVcf. MAIN OUTCOME MEASURES： PWVcf and influential factors. RESULTS; Compared with control group, the patients had significantly higher levels of systolic blood pressure, diastolic blood pressure, pulse pressure and PWVcf （P 〈 0.05）. There was no difference in terms of age, body height, body mass, and body mass index. The patients with mild, moderate and severe kidney disease displayed differences in age, body mass index, glomerular filtration rate, systolic blood pressure, and pulse pressure. With severity of disease, PWVcf was significantly increased, and age, systolic blood pressure, and pulse pressure were also increased, but body mass index and glomerular filtration rate was decreased Besides gender factor （r = 2.305, P 〈 0.05）, PWVcf was significantly positively correlated with age （r = 0.479, P 〈 0.001 ）, systolic blood pressure （r = 0.556, P 〈 0.001）, pulse pressure （r=0.603, P 〈 0.001）, serum creatinine （r = 0.267, P 〈 0.001） and C-reactive protein （r =0.316, P 〈 0. 001 ）, but negatively correlated with glomerular filtration rate （r = -0.436, P 〈 0.001）. Stepwise multiple regression analysis demonstrated that age and glomerular filtration rate were independently related with PWVcf. CONCLUSION： PWVcf in patients with chronic kidney disease was aggravated with severity of kidney injury; glomerular filtration rate and age were independent factors of arteriosclerosis in patients with chronic kidney disease.