不同诊断标准下腹膜透析患者代谢综合征与大动脉僵硬度的关系

Impact of Metabolic Syndrome According to Distinct Definitions on Arterial Stiffness in Peritoneal Dialysis Patients

目的对腹膜透析患者在不同诊断标准下诊断的代谢综合征与大动脉僵硬度的关系进行研究,从而确定一个最适合腹膜透析患者的标准,同时对影响大动脉僵硬度的因素进行分析。方法选取稳定透析的持续不卧床腹膜透析患者155例,测量颈股动脉脉搏波速度作为大动脉僵硬度的评价指标,用WHO 1999、IDF 2007和ATPⅢ2001三个标准分别诊断代谢综合征,比较不同标准下代谢综合征组与非代谢综合征组脉搏波速度有无差别,并对脉搏波速度的相关因素进行分析。结果用WHO 1999、IDF 2007和ATPⅢ2001标准诊断的合并代谢综合征的持续不卧床腹膜透析患者均比无代谢综合征患者有较高的脉搏波速度(P<0.05)。脉搏波速度与持续不卧床腹膜透析患者的年龄、腰围、收缩压及血糖呈正相关(P<0.05或P<0.01),与血高密度脂蛋白胆固醇呈负相关(P<0.05),它们都是脉搏波速度的独立影响因素。结论无论用WHO 1999、IDF 2007和ATPⅢ2001中任何一个代谢综合征标准,合并代谢综合征的持续不卧床腹膜透析患者大动脉僵硬度均较非代谢综合征患者增加。年龄和代谢综合征中多数因子均是脉搏波速度的独立影响因素。经多方考虑,我们推荐在持续不卧床腹膜透析患者用ATPⅢ标准诊断代谢综合征。

Aim To investigate the association of metabolic syndrome（MS） with aortic stiffness according to different definitions in continuous ambulatory peritoneal dialysis（CAPD） patients,in order to find a suitable criterion for CAPD population.At the same time,to analyze the risk factors affecting aortic stiffness. Methods 155 CAPD patients were studied.Arterial stiffness was assessed by measuring carotid-femoral pulse wave velocity（PWV）.Metabolic syndrome was defined by Adult Treatment Panel（ATP） Ⅲ2001,World Health Organization（WHO）1999,and International Diabetes Federation（IDF） 2007 criteria. The PWV values were compared between MS group and non-MS group,and the risk factors associated with PWV were analyzed. Results By all definitions,which include WHO 1999,IDF2007 and ATPⅢ 2001 definition,CAPD patients with MS had higher PWV compared to CAPD without MS（P〈0.05）.An independent association emerged between PWV and age,waist circumference,systolic blood pressure,serum glucose positively（P〈.0.05 or P〈0.01）.And PWV was associated with serum high density lipoprotein cholesterol negatively and independently in CAPD patients（P〈0.05）. Conclusions Arterial stiffness is increased in CAPD patients with metabolic syndrome irrespective of the definition criteria,which includes WHO 1999,IDF 2007,ATPⅢ 2001 criterion.Age and metabolic components affect arterial stiffness independently.Based on all considerations,the ATP criterion of MS was proposed for CAPD patients.