腹膜透析患者颈股动脉脉搏波传导速度的影响因素及对预后的预测价值

Influencing factors of carotid-femoral pulse wave velocity and its prognostic value in peritoneal dialysis patients

目的探讨腹膜透析(腹透)患者颈股动脉脉搏波传导速度(carotid-femoral pulse wave velocity,CF-PWV)的影响因素及其对患者预后的预测价值。方法研究对象来自2016年8月至2018年7月期间在上海交通大学医学院附属仁济医院腹透中心接受规律随访的腹透患者。采用自动脉搏波传导速度仪测定CF-PWV,用多频生物电阻抗技术测定超负荷液体量(overhydration,OH)。所有患者随访至死亡或退出腹透或研究终止日期(2020年7月31日)。根据CF-PWV测量值分为CF-PWV≤10 m/s组和CF-PWV>10 m/s组。采用Logistic回归分析法分析腹透患者CF-PWV升高的影响因素,用Kaplan-Meier生存曲线和多因素Cox回归模型比较两组患者全因死亡率和心血管疾病(cardiovascular disease,CVD)病死率的差异。结果224例腹透患者入选本研究,男性133例(59.4%),年龄(55.2±13.4)岁,中位腹透龄22.3(6.5,59.3)个月,合并糖尿病者47例(21.0%),有CVD病史者37例(16.5%)。中位CF-PWV 9.6(8.4,11.4)m/s,其中CF-PWV>10 m/s者105例(46.9%)。与CF-PWV≤10 m/s组相比,CF-PWV>10 m/s组患者年龄、合并糖尿病及有CVD病史者占比较高(均P<0.05)。多因素Logistic回归分析结果显示,年龄增加(OR=1.070,95%CI 1.043~1.099,P<0.001)、合并糖尿病(OR=3.693,95%CI 1.646~8.287,P=0.002)、高OH(OR=1.238,95%CI 1.034~1.483,P=0.020)是腹透患者CF-PWV升高的独立影响因素。至研究终止日期,本组患者中位随访时间为37.4(25.6,41.7)个月,随访期间24例(10.7%)患者死亡,其中19例为CVD相关死亡。Kaplan-Meier生存分析结果显示,与CF-PWV≤10 m/s组相比,CF-PWV>10 m/s组患者的全因死亡率(Log-rankχ^(2)=6.423,P=0.011)和CVD相关病死率(Log-rankχ^(2)=6.243,P=0.012)均显著升高。多因素Cox回归分析结果显示,年龄增加是腹透患者全因死亡(HR=1.057,95%CI 1.010~1.107,P=0.018)及CVD相关死亡(HR=1.062,95%CI 1.009~1.118,P=0.022)的独立影响因素。结论动脉僵硬度升高在腹透患者中较普遍,年龄增加、合并糖尿病及高容量超负荷是CF-PWV升高的独立危险因素,高CF-PWV是腹透患者全因死亡和CVD相关死亡的潜在预测因素。

Objective To evaluate the influencing factors of carotid-femoral pulse wave velocity(CF-PWV)and its value to predict outcomes in peritoneal dialysis(PD)patients.Methods Eligible patients undergoing PD in Renji Hospital of Shanghai Jiao Tong University between August 2016 and July 2018 were recruited and prospectively followed up until death,PD cessation,or to the end of the study.CF-PWV was measured by an arterial pulse wave velocity meter to assess arterial stiffness(July 31,2020).Overhydration was measured by bioimpedance spectroscopy.The patients were divided into CF-PWV≤10 m/s group and CF-PWV>10 m/s group according to the measured value of CF-PWV.The influencing factors of elevated CF-PWV were analyzed by multivariate logistic regression.Survival curves were generated using the Kaplan-Meier method and multivariate Cox proportional hazards models were used to analyze the difference for all-cause mortality and cardiovascular disease(CVD)mortality between the two groups.Results A total of 224 PD patients were enrolled,including 133 males(59.4%).The age was(55.2±13.4)years old,and median PD vintage was 22.3(6.5,59.3)months.Among them,47(21.0%)patients were comorbid with diabetes,and 37(16.5%)patients had CVD history.The median CF-PWV was 9.6(8.4,11.4)m/s for the cohort,and 105(46.9%)participants had CF-PWV over 10 m/s.Compared with CF-PWV≤10 m/s group,CF-PWV>10 m/s group patients had older age,increased percentage of diabetes and CVD(all P<0.05).Multivariate logistic analysis showed that increased age(OR=1.070,95%CI 1.043-1.099,P<0.001),diabetes(OR=3.693,95%CI 1.646-8.287,P=0.002)and higher overhydration(OR=1.238,95%CI 1.034-1.483,P=0.020)were independent influencing factors for elevated CF-PWV in PD patients.After followed up for 37.4(25.6,41.7)months,24 patients died,including 19 cases of CVD-related deaths.Kaplan-Meier survival analysis showed that all-cause mortality and CVD mortality were significantly higher in the CF-PWV>10 m/s group than those in CF-PWV≤10 m/s group(Log-rankχ^(2)=6.423,P=0.011;Log-rankχ^(2)=6.243,P=0.012,respectively).Multivariate Cox proportional hazards models showed that increased age was an independent influencing factor for both all-cause mortality and CVD mortality(HR=1.057,95%CI 1.010-1.107,P=0.018;HR=1.062,95%CI 1.009-1.118,P=0.022).Conclusions Increased arterial stiffness is relatively common in PD patients.Higher CF-PWV in PD patients is associated with increased age,diabetes and higher overhydration,and it is probably a valuable predictor of outcome in PD patients.