慢性肾脏病患者心血管疾病患病率调查

Prevalence of cardiovascular diseases in patients with chronic kidney diseases

目的了解慢性肾脏病(CKD)1～5期的心血管疾病(CVD)患病情况,为更好地防治CKD患者的CVD提供依据。方法对2004年1月—2006年1月在上海交通大学医学院附属瑞金医院肾脏科住院的资料完整的602例CKD患者进行问卷调查,收集患者的病史、实验室检查结果。结果CKD1、2、3、4、5期患者分别有78例(12.96%)、87例(14.45%)、140例(23.26%)、78例(12.96%)和219例(36.38%)。CKD1、2、3、4、5期患者的CVD患病率分别为5.13%(4/78)、17.24%(15/87)、27.86%(39/140)、26.92%(21/78)、47.49%(104/219)。CVD在CKD1期即已出现,且随CKD的进展其患病率逐渐提高(P值均<0.01)。总的冠状动脉疾病(CAD)患病率为8.64%(52/602),左心室肥厚(LVH)为25.58%(154/602),充血性心力衰竭(CHF)为12.96%(78/602)。CKD1、2、3、4、5期患者的CAD患病率分别为1.28%(1/78)、5.75%(5/87)、7.86%(11/140)、10.26%(8/78)、12.33%(27/219),LVH患病率分别为0、11.49%(10/87)、16.43%(23/140)、29.49%(23/78)、44.75%(98/219),CHF患病率分别为0、3.45%(3/87)、3.57%(5/140)、8.97%(7/78)、28.77%(63/219)。随CKD的进展,CAD、LVH、CHF的患病率逐渐提高(P值均<0.01)。行维持性透析治疗的患者伴发和(或)并发CAD40例(33.06%)、LVH65例(53.72%)、CHF55例(45.45%)、心包积液17例(14.05%)和心律失常28例(23.14%)。各种检查异常的阳性率从CKD1期至5期逐步升高(P值均<0.01);各期患者中检查异常的阳性率从高至低依次为超声心动图、心电图、胸部X线摄片(P值均<0.01)。结论CVD在CKD1期即已出现,其患病率随CKD的进展而升高,至维持性透析时达高峰。CKD患者的CVD以LVH为最常见,在CKD2期、3期已明显增加,临床上对CKD2～3期的患者即应进行LVH的防治,从而避免患者在进入透析前发生心血管死亡事件。超声心动图检查可作为各期CKD患者CVD的早期筛查指标,但在确诊CVD时需结合临床及其他检测指标。对CKD人群CVD的筛查、防治应从CKD1期开始。

Objective To investigate the prevalence of cardiovascular diseases （CVD） in patients with chronic kidney disease （CKD） stage 1-5, so as to provide more information for prevention and treatment of CVD in CKD patients. Methods Six hundred and two OKD patients, who were hospitalized in Ruijin Hospital between Jan. of 2004 and Jan. of 2006, were surveyed using questionnaire to collect patients history and laboratory data. Results The ratios of patients at CKD stage 1, 2, 3, 4, and5 were 12.96%, 14.45%, 23.26%, 12.96%, and 36.38%, respectively. The prevalences of CVD in patients with CKD stage 1--5 were 5.13% （4/78）, 17.24% （15/87）, 27.86% （39/140）, 26.92% （21/78）, and 47.49% （104/219）, respectively. The prevalence of coronary artery disease （CAD） in CKD patients was 8.64% （52/602）, of left ventricular hypertrophy （LVH） was 25.58 % （ 154/602）, and of congestive heart failure （CHF） was 12.96 % （78/602）. The prevalences of CAD in patients withCKD stage 1--5 were 1.28%（1/78）, 5.75%（5/87）, 7.86%（11/140）, 10.26%（8/78）, and 12.33%（27/219）;those of LVH were 0,11.49%（10/87）, 16.43%（23/140）, 29.49%（23/78）, and 44.75% （98/219） ;and those of OHF were 0, 3.45% （3/87）, 3.57% （5/140）, 8.97% （7/78）, and 28.77% （63/219）, respectively. The prevalences of CAD, LVH, and CHF were 33.06%, 53.72%, and 45.45%, respectively. Ultrasonic cardiography （UCG）, electrocardiogram （ECG） and chest X-ray showed that the incidence of cardiovascular abnormalities in maintenance dialysis patients increased with the progression of CKD. The abnormal rates of different methods from higher to lower were UCG, ECG and chest X-ray. Conclusion CVD may occur at CKD stage 1, and the incidence increases with the progression of CKD. The most common form of CVD is LVH, which is greatly increased at CKD stage 2 and 3. The prevention and treatment of LVH should begin at CKD stage 2--3 so as to reduce the incidence of cardiovascular events before starting dialysis. UCG should be chosen as an examination for earlier detection of CVD in CKD patients. The screening and prevention of OVD should begin at CKD stage 1. （Shanghai Med J, 2009, 32： 769-773）