代谢综合征对血液透析患者心血管疾病及死亡的影响

The relationship of metabolic syndrome and cardiovascular disease and mortality in maintenance hemodialysis patients

目的调查维持性血液透析患者代谢综合征（MS）的患病情况及其对心血管疾病和死亡的影响。方法将2009年8月在我中心规律血液透析患者201例分为MS组（78例）和非代谢综合征（非MS）组（123例），随访36个月，记录心血管疾病及死亡情况，分析维持性透析患者MS及其各组分对心血管疾病和死亡的影响。结果①维持性血液透析患者MS的患病率为38．8％（78例）。②MS组体重、腰围、TG、TC、LDL—C、空腹血糖值、血尿酸水平及超敏CRP升高比例明显高于非MS组，而透析龄、HDL—C水平明显低于非MS组（P〈0．05）。③随访36个月，维持性血液透析患者MS组心血管疾病发生率、心血管死亡及全因死亡累计发生率分别为41．O％（32例），19．2％（15例），28．2％（22例），非MS组分别为22．8％（28例），10．6％（13例），17．1％（21例）。两组间心血管疾病发生率差异具有统计学意义（X。=7．601，P=0．006）。维持性血液透析患者MS组分数量与心血管疾病相关（r=0．236，P=0．001）。用Kaplan—Meier法比较MS组与非MS组心血管死亡及全因死亡率，组问差异无统计学意义（Х^2=3．193，P=0．074；Х^2=3．523，P=0．061）；而MS各组分中仅高血糖增加透析患者心血管死亡风险（Х^2=4．372，P=0．037）。结论维持性血液透析患者MS的患病率较高，MS增加其心血管疾病发生风险，但短期内（3年）并未增加其心血管死亡及全因死亡风险。

Objective To investigate the potential contributing effects of metabolic syndrome （MS） on cardiovascular events and mortality in maintenance hemodialysis （MHD） patients. Methods According to the diagnostic criteria for MS set by Chinese Diabetes Society, 201 subjects undergoing MHD were assigned into MS group（ n = 78 ） or non-MS group（ n = 123 ）, in August 2009. General and laboratory data were collected for cross-sectional analyses, and the participants were followed up for 36 months. Cardiovascular events, cause of death and time were recorded for longitudinal analyses. Results Prevalence of MS was 38. 8%. Weight, waist circumference, triglyceride, total cholesterol, low density lipoprotein, fasting glucose level, uric acid and high-sensitivity C-reactive protein were significant higher in MS group compared to non-MS group, but duration of dialysis and high-density lipoprotein were lower （ P 〈 0. 05 ）. During the 36 months follow-up, cumulative incidence of cardiovascular events, cardiovascular and all-cause mortality were 41.0% （32/78）, 19. 2% （15/78） , 28.2% （22/78）, in MS group respectively. Those of non-MS group were 22. 8% （28/123）, 10.6% （ 13/123）, 17. 1% （21/123） . There was significant difference between patients with and without MS in cumulative incidence of cardiovascular events （Х^2== 7. 601 ,P = 0. 006）. There was relationship between the number of metabolic syndrome parameters and cardiovascular events （ r = 0. 236, P = 0. 001 ）. Kaplan-Meier curves showed the relationship between two groups did not remained statistically significant in cardiovascular and all-cause mortality. Impaired glycometabolism in 5 parameters of MS was a cardiovascular mortality risk factor in MHD patients. Conclusions The prevalence of MS is high in MHD patients. MS is a risk factor of cardiovascular events, but it is not associated with cardiovascular and all-cause 3-year mortality in patients with MHD.