慢性肾脏病3~5期非糖尿病非透析患者动脉僵硬度及其对预后的影响

Impact of arterial stiffness on prognosis in non-diabetic pre-dialysis patients with stages 3-5 chronic kidney disease

目的检测慢性肾脏病(CKD)3~5期非糖尿病非透析患者动脉僵硬度,并探讨其对患者心脑血管死亡及全因死亡的影响。方法纳入北京大学人民医院2006年4月至2012年11月收治的CKD 3~5期非糖尿病非透析住院患者161例,所有患者住院后检测颈-股动脉脉搏波速度(CFPWV)。根据CFPWV水平,将患者分为CFPWV正常组(CFPWV<12 m/s)和CFPWV升高组(CFPWV≥12 m/s),随访入选患者的生存情况。采用Kaplan-Meier法对患者的生存情况进行评价,Cox比例风险回归对影响患者预后的因素进行分析。结果平均随访时间为(99.15±49.57)个月。CFPWV升高组心脑血管死亡率及全因病死率均明显高于CFPWV正常组[37.6%(19/51)vs 11.0%(9/82),50.7%(26/51)vs 20.7%(17/82),P均<0.05]。Kaplan-Meier曲线显示CFPWV升高组心脑血管病死率及全因病死率均明显高于CFPWV正常组(P<0.05)。多因素Cox回归分析显示,年龄及CFPWV是患者心血管死亡及全因死亡的独立危险因素,此外,白蛋白及血红蛋白还是全因死亡的独立危险因素(P<0.05)。结论高CFPWV的CKD 3~5期非糖尿病非透析患者心脑血管死亡率及全因死亡率均明显高于CFPWV正常的CKD患者,且CFPWV升高是CKD 3~5期非糖尿病非透析患者发生心脑血管死亡及全因死亡的独立危险因素。

Objective To assess the impact of arterial stiffness on prognosis in non-diabetic predialysis patients with stages 3-5 chronic kidney disease(CKD).Methods A total of 161 non-diabetic predialysis patients who suffered from stages 3-5 CKD were enrolled in this study between April 2006 and November 2012.An automatic pulse wave velocity(PWV)measuring system was used to measure carotidfemoral PWV(CFPWV).According to CFPWV level,we divided the patients into a high CFPWV group(CFPWV≥12 m/s)and a normal group(CFPWV<12 m/s).The patients were followed for the occurrence of cardiovascular death and all-cause death.Kaplan-Meier method was used for survival analysis and Cox proportional hazard regression model was used to identify the risk factors.Results The mean follow-up duration was(99.15±49.57)months.The incidence of cardiac-cerebral vascular death and all-cause death was significantly higher in the high CFPWV group than in the control group[37.6%(19/51)vs 11.0%(9/82),50.7%(26/51)vs 20.7%(17/82),P<0.05].Kaplan-Meier curve analysis for overall survival and cardiaccerebral vascular event free survival showed that cardiac-cerebral vascular mortality and all-cause mortality were significantly higher in the high CFPWV group than in the control group(P<0.05).Multivariate Cox regression analysis revealed that increased CFPWV and age were the independent risk factors for cardiaccerebral vascular mortality and all-cause mortality,and decreased albumin and hemoglobin were the independent risk factors for all-cause mortality(P<0.05).Conclusion The incidence of cardiac-cerebral vascular mortality and all-cause mortality is significantly higher in stages 3-5 CKD patients with elevated CFPWV than in those with normal CFPWV.Elevated CFPWV is one of independent risk factors for cardiaccerebral vascular mortality and all-cause mortality in non-diabetic pre-dialysis patients with CKD.