维持性血液透析患者并发脑卒中的临床研究

Clinical study on patients undergoing maintenance hemodialysis complicated with stroke

目的观察维持性血液透析(MHD)并发脑卒中患者相关实验室指标的变化.方法采用回顾性研究方法,选择2016年1月至2018年3月在解放军中部战区总医院血液净化科行MHD的患者50例作为研究对象,其中MHD并发脑卒中者(卒中组)20例,MHD未并发脑卒中者(非卒中组)30例.收集两组患者的基本资料以及实验室相关指标,包括性别、年龄、基础疾病(高血压、糖尿病)、透析龄、收缩压、舒张压、血压波动情况和血清白蛋白(Alb)、血脂、血钙(Ca^(2+))、血磷(P)、甲状旁腺激素(PTH),并比较两组上述指标的差异.结果与非卒中组比较,卒中组患者年龄偏大(岁:61.45±7.19比48.37±13.52),基础疾病为高血压、糖尿病或高血压合并糖尿病患者的比例〔95.00%(19/20)比43.33%(13/30)〕和收缩压〔mmHg(1 mmHg≈0.133 kPa):170.75±19.21比144.63±20.28〕、血压波动(mmHg:39.30±17.81比27.50±11.74)水平均较高,Alb水平更低(g/L:36.28±5.79比41.26±4.06),差异均有统计学意义(均P<0.05).卒中组和非卒中组男性比例〔70.0%(14/20)比70.0%(21/30)〕、透析龄(月:43.70±28.24比47.17±29.98)、舒张压(mmHg:92.50±13.68比88.67±14.32)及总胆固醇〔TC(mmol/L):3.79±1.04比3.93±1.08〕、三酰甘油〔TG(mmol/L):1.49±0.66比1.52±0.87〕、低密度脂蛋白胆固醇〔LDL-C(mmol/L):1.72±0.66比1.81±0.72〕、高密度脂蛋白胆固醇〔HDL-C(mmol/L):0.97±0.31比1.09±0.35〕、Ca^(2+)(mmol/L:2.26±0.29比2.18±0.27)、P(mmol/L:1.89±0.53比1.86±0.60)、PTH(ng/L:322.04±101.46比399.87±111.19)水平比较差异均无统计学意义(均P>0.05).结论MHD并发脑卒中患者的年龄偏大,基础疾病多为糖尿病和(或)高血压,收缩压较高,血压波动较大,血清Alb水平较低.

Objective To observe the changes of related laboratory indexes in patients with maintenance hemodialysis(MHD)complicated with stroke.Methods A retrospective study was conducted on 50 MHD patients admitted in the department of hemopurification of Central Theater General Hospital of the Chinese People's Liberation Army from January 2016 to March 2018,and they were divided into a stroke group(20 MHD cases complicated with stroke)and a non-stroke group(30 MHD cases without stroke).The basic data and related laboratory indicators of the two groups were collected,including gender,age,primary diseases(hypertension,diabetes),dialysis age,systolic blood pressure,diastolic blood pressure,blood pressure fluctuation,serum albumin(Alb),blood lipids,blood calcium(Ca^(2+)),blood phosphorus(P),parathyroid hormone(PTH),and the differences of the above indicators between the two groups were compared.Results Compared with the non-stroke group,the patients in the stroke group were older(years old:61.45±7.19 vs.48.37±13.52),proportion of patients with hypertension and/or diabetes melljtus[95.00%(19/20)vs.43.33%(13/30)],systolic blood pressure[mmHg(1 mmHg~0.133 kPa):170.75±19.21 vs.144.63±20.28],and blood pressure fluctuation(mmHg:39.30±17.81 vs.27.50±11.74)were higher,Alb level was lower(g/L:36.28±5.79 vs.41.26±4.06),the differences being statistically significant(all P<0.05).The comparisons of indicators between the two groups showed that the following indicators had no statistical significant differences(all P>0.05):male ratio[70.0%(14/20)vs.70.0%(21/30)],dialysis age(months:43.70±28.24 vs.47.17±29.98),diastolic blood pressure(mmHg:92.50±13.68 vs.88.67±14.32),total cholesterol[TC(mmol/L):3.79±1.04 vs.3.93±1.08],triglyceride[TG(mmol/L):1.49±0.66 vs.1.52±0.87],low density lipoprotein cholesterol[LDL-C(mmol/L):1.72±0.66 vs.1.81±0.72],high-density lipoprotein cholesterol[HDL-C(mmol/L):0.97±0.31 vs.1.09±0.35],Ca^(2+)(mmol/L:2.26±0.29 vs.2.18±0.27),P(mmol/L:1.89±0.53 vs.1.86±0.60)and PTH(ng/L:322.04±101.46 vs.399.87±111.19).Conclusion The patients with MHD complicated with stroke are older suffering more primary diseases of diabetes and/or hypertension,systolic blood pressure is higher,blood pressure fluctuation is larger and serum Alb level is lower.