维持性血液透析患者发生心脑血管疾病的相关分析

Analysis of Maintenance Hemodialysis Patients With Cardiovascular and Cerebrovascular Diseases

目的维持性血液透析患者的心脑血管事件的患病率远高于一般人群。在文章中分析维持性血液透析(maintenance hemodialysis,MHD)患者心脑血管疾病(cardio-cerebrovascular diseases,CVD)患病的现状,并研究患者发生心脑血管意外的危险因素。方法研究共纳入42名维持性血液透析患者,记录患者既往是否有心脑血管病史等临床病史,完善相关血液检查。参加本研究的患者同时完成动态血压(ambulatory blood pressure,ABP)监测及颈动脉-股动脉脉搏波速度(carotid-femoral pulse wave veloity,cfPWV)测定;根据患者既往是否存在心脑血管意外病史将患者分为发生心脑血管意外组(CVD组)及未发生心脑血管意外组(non-CVD)组,比较两组组间差异,并探讨MHD患者发生心脑血管事件的危险因素。结果研究发现MHD患者心脑血管事件的患病率14.29%,CVD组患者血脂(triglyceride,TG)、cfPWV高于non-CVD组,而24 h动态血压的舒张压(24 h DBP)、白天动态血压的舒张压(d DBP)低于non-CVD组,差异具有统计学意义;通过二元logistic多因素回归分析,研究发现24 h DBP[β=-0.201,P=0.024]及cfPWV[β=0.412,P=0.026]是患者发生心脑血管事件的独立危险因素。结论维持性血液透析患者CVD的患病率高于一般人群,过低的舒张压及过高的cfPWV促进患者心脑血管事件的发生。

Objective It is commonly accepted that prevalence of cardiocerebrovascular diseases(CVD) in maintenance hemodialysis patients is much higher than that in the general population. This study is aimed to analyze the status and explore the risk factors of CVD in MHD patients. Method 42 MHD patients were enrolled in this study while their related clinical date and routine biochemical tests were recorded. All patients also completed ambulatory blood pressure monitoring and carotid–femoral pulse wave velocity measurement. Patients were divided into two group according to their previous history of CVD to compare differences between the two groups and the risk factors of cardio-cerebrovascular diseases in MHD patients were discussed. Results In the study, the prevalence of CVD in MHD patients was 14.29%. TG and cfPWV in CVD group were higher than those in non-CVD group, while 24 h DBP and d DBP were lower than those in non-CVD group. The difference was statistically significant. 24 h DBP [β=-0.201, P=0.024] and cfPWV [β=0.412, P=0.026] were proved to be risk factors for cardiovascular and cerebrovascular events in MHD patients. Conclusion Prevalence of CVD in MHD patients is higher than that in the general population. Lower diastolic blood pressure and higher cfPWV promote cardio-cerebrovascular diseases in MHD patients.