维持性血液透析患者心脏结构及功能改变的危险因素筛选

Screening of risk factors for the structure and function of heart in maintenance hemodialysis patients

目的筛选维持性血液透析患者心脏结构及功能改变的危险因素。方法选择145例维持性血液透析患者，测定其透前白蛋白、前白蛋白、血红蛋白、尿素氮、肌酐、尿酸、钙、磷、碱性磷酸酶、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、全段甲状旁腺素、C反应蛋白、载脂蛋白、脂蛋白、同型半胱氨酸、β2-微球蛋白、硫酸吲哚酚、硫酸对甲酚、血清铁、转铁蛋白、铁蛋白、N-端前脑钠肽等。受试者接受心脏超声检查。结果将心脏结构及功能改变作为因变量进行单因素Cox回归分析显示，随着收缩压、N-端前脑钠肽、硫酸吲哚酚和左心室质量指数的升高，患者心脏结构及功能改变的罹患风险逐渐增加，既往有冠心病史的患者心脏结构及功能改变罹患风险也会增加（P〈0．05）。以收缩压、冠心病史、N-端前脑钠肽、硫酸吲哚酚、左心室质量指数为因变量进行多因素Cox回归分析显示，冠心病史、高左心室质量指数和硫酸吲哚酚是患者并发心脏结构及功能改变发作的独立预测指标。以心血管并发症死亡事件作为因变量进行单因素Cox回归分析显示，年龄增大、透析龄延长、高C反应蛋白和硫酸对甲酚升高的患者罹患心血管并发症死亡的风险上升（P〈0．05）。以心血管并发症死亡事件作为因变量，年龄、透析龄、C反应蛋白和硫酸对甲酚作为协变量进行多因素Cox回归分析，结果显示年龄增加、透析龄增加、高硫酸对甲酚和C反应蛋白的患者罹患心血管并发症死亡风险上升。结论冠心病史、高左心室质量指数、硫酸吲哚酚、收缩压、N-端前脑钠肽、年龄、透析龄、高C反应蛋白、硫酸对甲酚是心脏结构及功能改变的危险因素，硫酸吲哚酚和硫酸对甲酚的血清浓度与其关系最密切。

Objective To investigate the correlations between plasma indoxyl sulfate and p-cresyl sulfate in the pathogenesis of cardiovascular complications in maintenance hemodialysis patients. Methods A total of 145 maintenance hemodialysis patients were selected. The researchers measured the physiological parameters of the subjects, including pre albumin, albumin, hemoglobin, blood urea nitrogen, creatinine, uric acid, calcium, phosphorus, alkaline phosphatase, total cholesterol, triglyceride, low-density lip- oprotein cholesterol, high-density fat cholesterol, intact parathyroid hormone, C-reactive protein, apolipoprotein, lipoprotein, homocysteine, beta 2-microglobulin, sulfuric acid indoxyl, sulfuric acid cresol, serum iron, transferrin, ferritin, and N-terminal pro brain natriuretic peptide carrier. Subjects underwent cardiac ultrasound examination. Results The researchers used heart structure and function as the dependent variable. The single factor Cox regression analysis showed that the risk of heart structure and function chan- ＇ges increased with the increase of systolic blood pressure, N-terminal B-type natriuretic peptide, and left ventricular mass index. This study also showed that the risk of heart structure and function changes in patients with previous history of coronary heart disease also increased. The researchers took the systolic blood pressure, coronary heart disease history, N- terminal brain natriuretic peptide, and the left ventricular mass index as the dependent variables. Multifactor Cox regression analysis showed that the history of coronary heart disease, the high left ventricular mass index and the change of the heart structure and function of the patients with acute coronary heart disease were the independent predictors of the change of heart structure and function. The researchers used cardiovascular complications as the dependent variable. Cox regression analysis showed that, with the increase in patient＇s age, dialysis duration, elevated high C-reactive protein and sulfuric acid p-cresol, patients suffering from the risk of fatal cardiovascular complications rise. The researchers used the complications of cardiovascular deaths as dependent variable, age, duration of dialysis, C-reactive protein, and sulfuric acid p-cresol as covariates, multivariate Cox regression analysis of the re suits showed that with increasing age, dialysis duration increased, high sulfate of cresol and C-reactive pro- tein, patients suffering from the risk of death from cardiovascular complications rise. Conclusions The history of coronary heart disease, left ventricular mass index, systolic blood pressure, indoxyl sulfate, N- terminal brain natriuretic peptide, age, dialysis age, high C-reaction protein, and p-cresol sulfate are the independent risk factors for cardiovascular complications. The relationship between indoxyl sulfate and sulfuric acid serum concentration of p-cresol and adverse cardiovascular events is most closely.