营养、炎症状态与血液透析患者冠状动脉粥样硬化性心脏病的关系

Coronary arteriosclerosis morbidity and its related risk factors in maintenance hemodialysis patients

目的 观察维持性血液透析（maintenance hemodialysis,MHD）患者营养、炎症状态水平,并探讨其与冠状动脉粥样硬化性心脏病（coronary arteriosclerosis disease,CAD）的关系. 方法 选取首都医科大学附属北京同仁医院血液透析中心稳定的MHD患者,根据是否患有冠状动脉粥样硬化性心脏病分为CAD组和非CAD组,记录患者一般情况,透析前取血,检测血常规、血生化,应用SPSS18.0软件进行统计学分析,采用卡方检验及独立样本t检验比较2组患者之间一般情况及血液学指标的差异,采取Logistic回归分析患者CAD患病的相关危险因素. 结果 纳入MHD患者68人,其中男性36人,女性32人,年龄（61.3±14.0）岁,CAD组19人（27.94％）,非CAD组49人（72.06％）,CAD与非CAD组患者之间年龄（72.21±7.64比57.04±13.69,t=4.549,P＜0.001）、糖尿病患病率（63.16％比26.53％,x2=7.901,P=0.010）、血白蛋白（33.42±4.22比36.19±3.38,t=-2.825,P=0.007）、血肌酐（754.05±216.86比963.06±240.15,t=-3.305,P=0.002）、高敏C反应蛋白（ii.26±17.05比4.29±5.23,t=2.588,P=0.013）及中性粒细胞淋巴细胞比值（3.65±1.61比2.72±0.90,t=3.027,P=0.002）统计学差异显著.而性别、血三酰甘油、胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇水平无统计学差异（P＜0.05）.Logistic回归分析显示年龄（OR =1.150,95％ CI 1.042～1.257,P=0.010）、糖尿病（OR=9.721,95％ CI 8.006～11.436,P=0.009）与CAD患病独立相关. 结论 在MHD患者,合并CAD及未合并CAD者营养及炎症指标之间存在显著差异,但不是影响CAD的独立危险因素,而年龄、糖尿病与CAD患病独立相关.

Objective To investigate the correlation of nutritional and inflammatory state with coronary arteriosclerosis disease （CAD） in maintenance hemodialysis （MHD） patients. Methods MHD patients treat- ed in Beijing Tongren Hospital for more than 3 months with stable conditions were enrolled in this study. They were divided into CAD group and non-CAD group according to the presence or absence of CAD. Gener- al conditions, blood routine and serum biochemical indexes were compared between the two groups using SPSS18.0 software. Results A total of 68 patients （36 males and 32 females; average age 61.34-14.0 years） were recruited, including 19 patents in CAD group （27.94%）and 49 patients in non-CAD group （72.06%）. Age （72.21±7.64 vs. 57.04±13.69, t=-4.549, P〈0.001）, diabetes （63.16% vs. 26.53%, Z2=7.901, P=0.010）, serum albumin （33.42±4.22 vs. 36.194-3.38, t=-2.825, P=0.007）, serum creatinine （754.05±216.86 vs. 963.06±240.15,t=-3.305, P=0.002）, high sensitive C-reactive protein （11.26±17.05 vs. 4.29±5.23, t=-2.588,P=-0.013） and neutrophil/lymphocyte ratio （3.65±1.61 vs. 2.724-0.90, t=-3.027, P=0.002） differed significantly between the two groups. While gender, serume triglyceride, total cholesterol, low density lipoprotein cholesterol （LDL- C） and high density lipoprotein cholesterol （HDL-C） had no differences between the two groups （P〈0.05）. Logistic regression indicated that age （OR=1.150, 95% CI 1.042-1.257, P=-0.010） and diabetes （OR=9.721, 95% CI 8.006-11.436, P=-0.009） independently correlated with CAD in MHD patients. Conclusion In MHD patients, nutritional and inflammatory indices differed significantly in patients with CAD and those without CAD. However, they were not the independent risk factor for CAD, while age and diabetes independently correlated with CAD.