维持性血液透析患者心血管疾病死亡的危险因素分析

Risk factors of cardiovascular disease mortality in maintenance hemodialysis patients

目的探讨维持性血液透析(MHD)患者心血管疾病(CVD)死亡的危险因素。方法选取MHD患者452例,测定患者透析前的总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(apo A1)、载脂蛋白B(apo B)、脂蛋白a[Lp(a)]、同型半胱氨酸(Hcy)、氨基末端B型钠尿肽原(NT-proBNP)、心肌肌钙蛋白I(c Tn I)和高敏C反应蛋白(hs-CRP)水平。依据MHD患者是否合并CVD死亡事件分为CVD死亡组和未死亡组,分析MHD患者CVD死亡的危险因素。结果在MHD患者中CVD死亡组NT-proBNP、hs-CRP水平高于未死亡组(P<0.05),TC、LDL-C水平低于未死亡组(P<0.05),其他指标2个组之间差异均无统计学意义(P>0.05)。Logistic回归分析显示,NT-proBNP及hs-CRP是MHD患者CVD死亡的独立危险因素[比值比(OR)=5.698,95%可信区间(CI)1.908~17.014,P=0.002;OR=3.653,95%CI 1.249~10.165,P=0.018]。结论 MHD患者相关CVD死亡危险因素与普通人群不同。NT-proBNP和hs-CRP可能是MHD患者CVD死亡的独立危险因素。

Objective To investigate the risk factors of cardiovascular disease（CVD） mortality in maintenance hemodialysis（MHD） patients.Methods A total of 452 patients with MHD were enrolled. Total cholesterol（TC）,high-density lipoprotein cholesterol（HDL-C）,low-density lipoprotein cholesterol （LDL-C）,apolipoprotein A1（apo A1）,apolipoprotein B（apo B）,lipoprotein a [Lp（a）],homocysteine （Hcy）,N-terminal B-type natriuretic peptide（NT-proBNP）,cardiac troponin I（cTnI） and high-sensitivity C-reactive protein（hs-CRP） were determined before dialysis. According to CVD mortality,MHD patients were classified into mortality group and non-mortality group,and the risk factors of CVD mortality were analyzed.Results The levels of NT-proBNP and hs-CRP in mortality group were higher than those in non-mortality group（P〈0.05）, and the levels of TC and LDL-C were lower（P〈0.05）. There was no statistical significance for the other parameters between the 2 groups（P〉0.05）. Logistic regression analysis showed that NT-proBNP and hs-CRP were risk factors for CVD mortality in MHD patients [odds ratio（OR）=5.698,95% confidence interval（CI）1.908-17.014, P=0.002;OR=3.653,95%CI 1.249-10.165,P=0.018].Conclusions There are some differences for the risk factors of CVD mortality between MHD patients and general population. NT-proBNP and hs-CRP may be independent risk factors for CVD mortality in MHD patients.