终末期肾病患者动态血压参数与动脉粥样硬化的相关性及危险因素分析

The relationship between ambulatory blood pressure and arterial atherosclerosis in ESRD patients

目的:探讨终末期肾病(ESRD)患者动态血压参数与动脉粥样硬化之间的关系,为ESRD患者预测心血管事件、干预及预后评估提供简便易行的参考指标。方法:前瞻性连续收集2012年8月至12月114例ESRD住院患者的临床资料,包括生化指标、动态血压监测、颈动脉超声、二维超声心动图等。结果:(1)一系列动态血压参数与动脉粥样硬化相关性良好(P≤0.05),其中动态动脉硬化指数(AASI)是最具有代表性的、相关性最好的指标(Logistic回归分析,P=0.005)。(2)AASI是一个反映ESRD动脉粥样硬化(P<0.001)、左心室舒张末期内径(P=0.028)及死亡风险的综合指标(P<0.001),其独立危险因素为老龄(P<0.001)、纤维蛋白原增加(P=0.009)、血清白蛋白下降(P=0.022)。结论:以AASI为代表的一系列动态血压参数与动脉粥样硬化相关性良好,可预测心脏结构改变及预后,建议在ESRD患者中广泛开展动态血压监测。

Objective ：To explore the relationship between ambulatory blood pressure and arterial atheroscierosls in the state of uremia, and provide simple and easy reference indicators for the prediction, prevention and prognosis of cardiovascular events in end-stage renal disease （ESRD） patients. Methodology： This prospective study consecutively collected clinical data of 114 ESRD patients in-hospital cases in the department of nephrology,the first affiliated hospital of Nanjing medical university during August 2012 to December 2012. The data included laboratory data, the ambulatory blood pressure monitoring（ABPM） , carotid ultrasound, two-dimensional echocardiography, and the prognosis scores of the death risk. Results： 1. A series of ABPM parameters were related with atherosclerosis （P≤0.05 ）. Ambulatory arterial stiffness index （AASI） was the most representative parameter of ambulatory blood pressure, which was also the best indicator for atherosclerosis （ logistic regression analysis, P = 0.005 ）. 2. AASI was a comprehensive index of atherosclerosis （ P 〈 0.001 ） ,left ventrieular end diastolic diameter （ P = 0.028 ） and risk of death （ P 〈 0.001 ）. The independent risk factors were age increase （ P 〈 0.001 ） , fibrinogen increase （ P = 0.009 ） , and serum albumin decline （ P = 0.022 ）. Conclusion ： AASI, as the representative of ABPM parameters, related well with atherosclerosis, heart remodelling and poor prognosis, whch implied a broader application of ABPM in ESRD patients.