IMA对低胆固醇水平的腹膜透析患者心血管事件影响分析

Effect of IMA on cardiovascular events in peritoneal dialysis patients with low level

目的:评价缺血修饰蛋白(IMA)对腹膜透析(PD)患者主要不良心血管事件(MACE)独立于传统因素外的影响。方法:选取PD治疗>3月的终末期肾病患者108例,按照低密度脂蛋白胆固醇(LDLC)水平分为两组,LDL-C<1.8 mmol/L为试验组,LDL-C≥1.8 mmol/L为对照组,收集患者的基础资料、IMA及各项指标并进行随访,观察MACE的发生情况及IMA对MACE事件的影响。结果:试验组共30例患者,随访期间共6例患者发生MACE事件,对照组78例患者,共13例患者发生MACE事件,两组比较无统计学意义(χ2=0.13,t=0.72);试验组hs-CRP水平较对照组高(4.86±2.38 vs.3.53±1.81,t=2.82,P<0.01);logistic回归分析显示IMA(OR=1.30,95%CI 1.08-1.57)、hs-CRP(OR=1.76,95%CI 1.0-2.97)是PD患者MACE事件的独立危险因素。结论:IMA及hs-CRP是PD患者MACE事件的良好预测指标,且独立于传统危险因素之外;相对于普通患者,氧化应激及炎症状态可能是PD患者心血管事件高发的主要原因。

Objective：To evaluate the effect of ischemic modified protein（IMA） on major adverse cardiovascular events（MACE） in patients with peritoneal dialysis（PD） independent of traditional factors.Methods：108 patients with end-stage renal disease who underwent PD treatment were divided into two groups according to low-density lipoprotein cholesterol（LDL-C）,LDL-C1.8 mmol/L for the experimental group,LDL-C≥1.8 mmol/L as the control group.Patient＇s basic data,IMA and the indicators else were collected and followedup to occurrence of MACE.Results：A total of 30 patients were enrolled in the trial group,and 6 patients developed MACE during follow-up.In the control group,13 patients had a MACE event in 78 patients.There was no significant difference between the two groups（χ~2=0.13,t=0.72）.The level of hs-CRP in the test group was higher than that in the control group（4.86±2.38 vs 3.53±1.81,t=2.82,P〈0.01）.Logistic regression analysis showed that IMA（OR=1.30,95%CI 1.08-1.57） and hs-CRP（OR=1.76,95%CI 1.0-2.97） were independent risk factors for MACE patients with PD.Conclusion：IMA and hs-CRP are good predictors of MACE events in PD patients and are independent of traditional risk factors.Oxidative stress and inflammatory status may be the main cause of high cardiovascular events in PD patients compared with normal patients.