老年慢性肾脏病患者颈动脉粥样硬化调查及危险因素分析

Investigation of carotid atherosclerosis and analysis of the risk factors in elderly patients with chronic kidney disease

目的探讨老年慢性肾脏病（CKD）患者颈动脉粥样硬化（CAS）的发生率并分析其危险因素。方法选择2013年8月至2014年12月于我院门诊就诊、病情稳定的CKD患者（CKD 2~4期）,年龄≥60岁。收集患者临床资料,测定血清生化指标、超氧化物歧化酶（SOD）、全段甲状旁腺激素（i PTH）,测量颈股脉搏波传导速度（CF-PWV）,颈动脉超声检查观测患者CAS情况。结果入组患者共113例,平均年龄（78.4±8.6）岁,CAS发生率为92.0%。与〈80岁组相比,≥80岁组患者CAS发生率明显增高。Spearman相关分析显示高龄、肥胖与CAS正相关,SOD与CAS负相关。多因素Logistic回归分析发现肥胖为CAS的独立危险因素（OR=9.656,P=0.023）,血清SOD为CAS的保护因素（OR=0.923,P=0.044）。结论随着年龄的增加,老年CKD患者CAS的发生率明显升高,肥胖是老年CKD患者CAS的独立危险因素,SOD为CAS的保护因素。

Objective To investigate the prevalence and the risk factors of carotid atherosclerosis（ CAS） in elderly patients with chronic kidney disease（ CKD）. Methods Elderly（ ≥60 years） patients with stable CKD（ stage 2- 4）in the outpatient clinic of our hospital were enrolled from August 2013 to December 2014. The clinical data were collected.The serum biochemistry parameters,superoxide dismutase（ SOD） and intact parathyroid hormone were detected. Carotidfemoral pulse wave velocity was measured. The occurrences of CAS were observed by carotid artery ultrasonic testing.Results Among the 113 patients,the mean age was 78. 4 ± 8. 6 years old,and the prevalence of CAS was 92. 0%.Compared with patients 80 year-old,the prevalence of CAS in patients≥80 year-old was significantly elevated. Spearman correlation analysis showed advanced age and obesity were positively correlated with CAS,SOD negatively correlated with CAS. It was shown that obesity was the independent risk factor of CAS（ OR = 9. 656,P = 0. 023）,and SOD was the protective factor of CAS by multi-factor Logistic regression analysis（ OR = 0. 923,P = 0. 044）. Conclusions The prevalence of CAS in elderly CKD patients is significantly elevated with age. Obesity is the independent risk factor of CAS,and SOD is the protective factor of CAS.