糖尿病肾病腹膜透析患者糖化血红蛋白水平与心血管事件的相关性

Correlation between HbA1C Level and Cardiovascular Events in Peritoneal Dialysis Patients with Diabetic Nephropathy

目的:探讨糖尿病肾病(DN)腹膜透析(PD)患者糖化血红蛋白(HbA1C)水平与心血管钙化及心血管事件的相关性.方法:测定65例DN实施PD治疗患者的血糖、血脂、肾功能等指标,以及甲状旁腺素(PTH)、钙(Ca)、磷(P)等指标水平,检测其心血管钙化程度,并随访1年观察其心血管事件的发生情况.按照血清HbA1C水平的平均值7.5%为界,将患者分为高HbA1C组(HbA1C≥7.5%,n=35)、低HbA1C组(HbA1C<7.5%,n=30).分析HbA1C对心血管钙化及心血管事件的影响.结果:与低HbA1C组比较,高HbA1C组透析时间明显更长,SBP、DBP、Scr、BUN、Ca、P、钙磷乘积、PTH水平均明显升高,心血管钙化、心血管事件的发生率亦明显增加(P<0.05).多因素logistics回归分析显示,高龄、高HbAlc、长透析时间及高钙磷乘积是DN患者行PD后心血管钙化的独立危险因素(P<0.05),高龄、高HbAlc、心血管钙化是DN患者行PD后心血管事件的独立危险因素(P<0.05).结论:接受PD治疗的DN患者HbA1c水平与心血管钙化、心血管事件关系密切,HbA1c控制不良可导致DN患者心血管钙化,心血管钙化又将导致心血管事件的高发.

[Objective] To explore the correlation between HbA1 C level and cardiovascular calcification and cardiovascular events in peritoneal dialysis(PD) patients with diabetic nephropathy(DN). [Method] Indicators of blood sugar, blood lipid, kidney function and PTH, Ca, P were detected in 65 PD patients with DN. The degree of cardiovascular calcification was measured and followed up for 1 year. The occurrence of cardiovascular events was observed. These patients were divided into two groups according to the average value of HbAlc including high HbA1 C group(HbA1 C≥7.5%, n=35), low HbA1 C group(HbA1 C<7.5%,n=30). The effect of HbAlc on cardiovascular calcification and cardiovascular events was analyzed. [Result] Compared with low HbA1 C group, HbA1 C group had significantly longer PD time, and significantly higher levels of SBP, DBP, Scr, BUN, Ca, P, calcium phosphorus product and PTH, and the incidence of cardiovascular calcification and cardiovascular events was also significantly increased(P<0.05). Multivariate logistic regression analysis showed that the age, HbAlc, PD time and calcium phosphorus product were independent risk factors for occurrence of cardiovascular calcification for PD patients(P<0.05), and the age, HbAlc, cardiovascular calcification were independent risk factors for occurrence of cardiovascular events for PD patients(P<0.05). [Conclusion] The level of HbA1 c in PD patients with DN is closely related to cardiovascular calcification and cardiovascular events. Poor control of HbA1 c can lead to cardiovascular calcification in DN patients, and cardiovascular calcification will lead to high incidence of cardiovascular events.