终末期肾病患者发生缺血性心脏病的危险因素分析

Analysis of risk factors of ischemic heart disease（ IHD ） in end stage renal disease（ESRD） patients

目的探讨终末期肾病患者发生缺血性心脏病的危险因素。方法选取终末期肾病患者102例，根据缺血性心脏病确认标准分为缺血性心脏病组52例，无缺血性心脏病组50例。记录两组患者年龄、性别、原发病、透析龄，同时记录血生化指标血尿酸、血红蛋白、血浆白蛋白、总蛋白、胆固醇、甘油三酯、低密度脂蛋白、血钙、血磷、全段甲状旁腺素（iPTH）、25-（OH）D、尿素氮和肌酐水平。结果缺血性心脏病组血浆总蛋白、白蛋白（28．13±1．07比35．44±1．08）、血红蛋白（80．63±3．24比96．54±4．51）、血肌酐、25-（OH）D（9．31±0．64比15．22±1．09）水平均低于无缺血性心脏病组（P〈0．05或P〈0．01）；而年龄、血胆固醇、尿酸（484．27±26．34比365．22±20．76）水平则明显高于无缺血性心脏病组（P〈0．01）。二分类Logistic回归分析显示，血浆白蛋白、胆固醇、血红蛋白、血尿酸、25-（OH）D可能是终末期肾病患者发生缺血性心脏病的危险因素。结论缺血性心脏病是终末期肾病患者常见的并发症之一，血脂异常、营养不良、贫血、高血尿酸、低血25-（OH）D是终末期。肾病患者发生缺血性心脏病的重要危险因素。

Objective To investigate the risk factors of ischemie heart disease （IHD） in end stage renal disease （ESRD） patients. Methods 102 ESRD patients were divided into IHD group（n=52） and no IHD group （n=50） according to confirmation standards of IHD, we IHD group（n=52） and no IHD group（n=50）. Age, gender, primary diseases and dialysis time of two groups were recorded. Serum uric acid, hemoglobin, plasma-albumin, total protein, cholesterol, Triglyeeride, low density lipoprotein, calcium, phosphorus, parathyroid hormone （iPTH）, 25-（OH）D, urea nitrogen, creatinine were recorded, too. Results Plasma-albumin （28.13=1：1.07 vs 35.44±1.08）, total protein, creatinine, hemoglobin （80.63±3.24 vs 96.54±4.51） and 25-（OH）D （9.31±0.64 vs 15.22±1.09） in IHD group were lower than no IHD group（P〈0.05 or P〈0.01 ）, but age, cholesterol and uric acid （484.27±26.34 vs 365.22±20.76） in IHD group were higher than no IHD group （P〈0.01）. Logistic regression analysis showed that plasma-albumin, cholesterol, low density lipoprotein, uric acid,hemoglobin and 25-（OH）D were the significant risk factors of IHD in ESRD patients. Conclusion IHD is the most frequent complication in ESRD patients. Dyslipidemia, malnutrition, high blood uric acid, anemia and low 25-（OH）D are the significant risk factors of IHD in ESRD patients.