非糖尿病腹膜透析患者中心动脉弹性的影响因素

Factors influencing aortic stiffness in non-diabetic peritoneal dialysis patients

目的探讨影响非糖尿病腹膜透析患者中心动脉弹性的临床危险因素。方法选择在第二军医大学附属长征医院腹膜透析中心行持续性非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)治疗的62例非糖尿病的终末期肾衰竭患者,应用SphygmoCor动脉脉搏波分析仪检测其动脉弹性,研究影响动脉弹性[以动脉增强指数(AIx)为指标]的因素。临床资料来自腹膜透析门诊的随访资料,实验室检查选取测量前、后1个月内的结果。结果CAPD患者中,女性的AIx为(27.2±8.9)%,显著高于男性的(15.8±10.5)%,(P<0.05);透析时间≥2年组的AIx为(21.2±14.6)%,显著高于<2年组的(13.8±13.1)%(P<0.05);服用高血压药物≥2种组的AIx为(22.3±9.7)%,显著高于高血压药物<2种组的(12.8±11.1)%(P<0.05)。相关分析表明,AIx与收缩压(r=0.579)、中心动脉收缩压(r=0.727)、钙磷乘积(r=0.451)呈正相关(P值均<0.05),与身高(r=-0.397)、高密度脂蛋白水平(r=-0.424)呈负相关(P值均<0.05),与体重、体质指数、血红蛋白、白蛋白、甲状旁腺素、三酰甘油、胆固醇、低密度脂蛋白不相关(P值均>0.05)。结论行CAPD的非糖尿病的终末期肾衰竭患者中,性别和收缩压是影响中心动脉弹性指标AIx的独立决定因素。身高、高密度脂蛋白及钙磷乘积也是AIx的重要影响因素。

Objective To investigate the risk factors of aortic stiffness in non-diabetic continuous ambulatory peritoneal dialysis （CAPD） patients. Methods A total of 62 stable non-diabetic CAPD patients were included in this study. The radial AIx was evaluated by a newly introduced instrument （SphygmoOor） and its affecting factors were analyzed. Clinical data were collected from data base of peritoneal dialysis patients. All lab data were obtained within a month before or after examination. Results AIx of female patients was markedly higher than that of male patients （[27.2 ± 8.9] % vs. E15.8 ± 10.5] %, P〈0.05）. AIx of patients on dialysis for more than two years was significantly higher than those for less than two years （[21.2± 14.6] % vs. [ 13.8± 13.1] %, P〈0.05）, and that of patients having more than one antihypertensive drugs was markedly higher than those having less than2 drugs （[22.3±9.7]% vs. [12.8± 11.11%, P〈0.05）. We also found that the radial AIx was positively correlated with systolic pressure （ r = 0. 579, P〈0.05）, central systolic pressure （ r = 0. 727, P〈0.05） and calcium-phosphate product （ r = 0.451, P〈0.05）, and negatively correlated with body height （ r = --0. 397, P〈0.05） and HDL （r = -0. 424, P〈0.05）. No association was found between AIx and body weight, body mass index, serum albumin, and other lipid profiles. Conclusion Female gender and systolic pressure are the independent determinants of AIx in non-diabetic CAPD patients. Height, calcium phosphorus metabolism and HDL are also important determinants of AIx. （Shanghai Med J, 2009, 32： 783-786）