糖尿病肾脏疾病与其他慢性肾脏疾病腹膜透析患者临床特点及心血管疾病患病率和危险因素的对比分析

Clinical characteristics, prevalence and risk factors for cardiovascular diseases in peritoneal dialysis patients with and without diabetic kidney disease

目的比较DKD与其他慢性肾脏疾病(CKD)腹膜透析(PD)患者临床特点及心血管疾病(CVD)患病率,分析CVD发生的危险因素。方法选取2016年3月至2018年12月于新乡医学院第一附属医院肾内科PD中心规律PD 1年的患者206例。根据原发疾病是否为T2DM,将入选患者分为DKD组81例和CKD组125例,分析其临床特点及发生CVD[包括冠状动脉疾病(CAD)、左心室肥厚(LVH)和充血性心力衰竭(CHF)]与各临床指标的相关性。结果两组患者年龄、性别、BMI比较,差异有统计学意义(P<0.05)。与CKD组比较,DKD组应用高渗腹透液例数、BG、HbA1c、TG、血沉及hsC-RP水平升高(P<0.01),血浆总蛋白(TP)、白蛋白(Alb)、总胆红素(TBIL)、总尿素清除率(Kt/V)、残肾Kt/V降低(P<0.05或P<0.01)。DKD组总CVD患病率为59.26%,其中CAD患病率7.41%,LVH患病率23.46%,CHF患病率46.91%,CKD组总CVD患病率29.60%,其中CAD患病率3.20%,LVH患病率19.20%,CHF患病率24.80%。DKD组总CVD患病率及CHF患病率均高于CKD组(P<0.01)。单因素分析发现,与DKD组未发生CVD患者比较,发生CVD患者年龄大,DM病程长,TP、Alb、TBIL、HbA1c、BG、血磷、全段甲状旁腺素和hsC-RP差异均有统计学意义(P<0.05);多因素Logistic回归分析显示,Alb和TBIL水平是CVD发生的危险因素。结论 DKD腹膜透析患者存在更明显的代谢异常、更低的蛋白水平和相对明显的炎症状态,透析充分性下降,CVD患病率升高。CVD发生与Alb、TBIL水平明显降低密切相关。

Objective To investigate clinical characteristics,prevalence and risk factors for cardiovascular disease in peritoneal dialysis patients with and without diabetic kidney disease.Methods We retrospectively collected 206 patients with peritoneal dialysis in the Nephrology Department in the First Affiliated Hospital of Xinxiang Medical University from March 2016 to December 2018.All the participants were divided into two groups according to whether the renal failure was caused by T2DM:diabetic kidney disease group(DKD,n=81)and non-diabetic kidney disease group(CKD,n=125).The clinical characteristics,prevalence and risk factors for cardiovascular disease(CVD)including coronary artery disease(CAD),left ventricular hypertrophy(LVH)and congestive heart failure(CHF)were analyzed.Results There weresignificant statistical differences in age,gender and BMI between DKD and CKD group(P<0.05).The frequency of hypertonic peritoneal fluid usage,blood glucose(BG),HbA1c,triglyceride(TG),erythrocyte sedimentation rate(ESR),and hypersensitive-C reactive protein(hs C-RP)were higher in DKD group than in CKD group(P<0.01).The serum total protein(TP),albumin(Alb)levels,total bilirubin(TBIL),total Kt/V and residual Kt/V were lower in DKD group than CKD group(P<0.05 or P<0.01).The prevalence of CVD was 59.26% in DKD group,and the prevalence of CAD,LVH and CHF were 7.41%,23.46%,and 46.91%,respectively in DKD group.The prevalence of CVD was 29.60% in CKD group,and the prevalence of CAD,LVH and CHF were 3.20%,19.20%,and 24.80%,respectively in CKD group.The prevalence of CVD and CHF were much higher in DKD group than in CKD group(P<0.01).The univariate analysis showed that in DKD group,patients with CVD had an older age,longer diabetic duration,and significant difference in TP,Alb,TBIL,HbA1c,BG,phosphorus,intact parathyroid hormone and hs C-RP compared with non-CVD patients.Multiple logistic regression analysis showed that Alb and TBIL levels were risk factors for CVD.Conclusion The peritoneal dialysis patients with DKD had more significant metabolic abnormalities,lower serum protein levels,relatively obvious inflammation,lower dialysis adequacy,and higher prevalence of CVD.The occurrence of CVD was closely related to Alb and TBIL.