维持性血液透析患者中代谢综合征发病情况及危险因素分析

Prevalence of metabolic syndrome and analysis of risk factors among patients with maintenance hemodialysis

目的了解维持性血液透析患者中代谢综合征(MS)的发生情况,并分析相关危险因素。方法收集202例接受维持性血液透析患者的临床资料。根据国际糖尿病联盟MS诊断标准,将患者分为MS组和非MS组,计算MS的发病率;比较两组患者的体格测量数据、实验室指标、透析处方及心血管事件发生情况。对与MS发生可能相关的危险因素进行多因素Logistic回归分析。结果 202例患者中MS发病率为29.2%。两组患者以下指标比较差异均有统计学意义(P<0.05),包括体质量、腰围、体质量指数、血清谷丙转氨酶、胆固醇、三酰甘油、低密度脂蛋白、高密度脂蛋白、空腹血糖、C反应蛋白(CRP)和全段甲状旁腺激素水平(iPTH),尿素下降率、尿素清除指数及透析频率和每周透析时间。MS组与非MS组心血管事件发生率(25.4%vs18.2%)比较差异无统计学意义(P>0.05)。多因素Logistic回归分析表明,体质量(优势比OR=24.625)、女性(OR=8.000)、CRP(OR=4.700)、iPTH(OR=2.525)与MS的发生相关。结论 MS在维持性血液透析患者中并不少见,女性、肥胖、高iPTH和高CRP是MS发生的危险因素。

Objective To investigate the prevalence of metabolic syndrome（MS）in patients with maintenance hemodialysis,and analyse the related risk factors.Methods The clinical data of 202 patients with maintenance hemodialysis were collected.Patients were divided into MS group and non-MS group according to the diagnosis criteria of International Diabetes Federation,and the prevalence of MS was calculated.The demographic data,results of laboratory and anthropometric examinations,dialysis prescription and cardiovascular events were compared among groups.Multivariate Logistic regression analysis was performed to analyse the risk factors for MS.Results The prevalence of MS in 202 patients was 29.2%.There were significant differences in body weight,waist circumference,body mass index,serum levels of glutamate-pyruvate transaminase,cholesterol,triglyceride,low density lipoprotein,high density lipoprotein,fasting blood glucose,C-reactive protein（CRP）and intact parathyroid hormone（iPTH）,urea reduction ratio,urea clearance index,hemodialysis frequency and time of hemodialysis per week between two groups（P0.05）.There was no significant difference in the prevalence of cardiovascular events between MS group and non-MS group（25.4% vs 18.2%,P0.05）.Multivariate Logistic regression analysis revealed that iPTH（OR=2.525）,CRP（OR=4.700）,female（OR=8.000）and body weight（OR=24.625）were related with MS.Conclusion MS is not rarely found in patients with maintenance hemodialysis,and high levels of iPTH and CRP,female and obesity are risk factors for MS.