腹膜透析患者脑小血管病患病状况分析

Prevalence of cerebral small vessel diseases in peritoneal dialysis patients

目的分析腹膜透析患者脑小血管病(CSVD)患病状况。方法连续性纳入2016年3~9月在北京大学第三医院因各种原因导致肾功能衰竭而每月规律进行腹膜透析的患者22例。前瞻性收集入组患者的一般临床资料,并进行头颅MRI检查(含T2*序列),同时进行影像学评价和相应量表评分。结果本组22例腹膜透析患者中,头颅MRI检查(含T2*序列)发现3例(13.6%)存在新发脑梗死,均为小的皮质下梗死,8例(36.4%)存在腔隙,13例(59.1%)存在扩大的血管间隙,21例(95.5%)存在脑白质病变,10例(45.5%)存在脑微出血。糖尿病患者更多存在于CSVD总负荷较低(<2分)的患者中。有卒中史或合并脂代谢紊乱的患者透析时间长于无卒中史或不合并脂代谢紊乱的患者,且差异均有统计学意义(P均<0.05);是否有高血压、冠心病的患者透析时间差异均无统计学意义(P>0.05)。结论CSVD在腹膜透析患者中普遍存在,应引起足够的重视。

Objective To investigate the prevalence of cerebral small vessel disease(CSVD)in peritoneal dialysis patients.Methods We consecutively included 22 patients with renal failure due to various reasons who regularly consulted the peritoneal dialysis clinic in Peking University Third Hospital from 2016.3 to 2016.9.Demographic and clinical data were prospectively collected,magnetic resonance imaging of brain(T2*included)was done.Evaluation of neuroimaging and grading the relevant scales was completed.Results There were 3 patients(13.6%)with acute small subcortical infarction,8 patients(36.4%)with lacune,13 patients(59.1%)with enlarged perivascular spaces,21 patients(95.5%)with white matter hyperintensities,10 patients(45.5%)with cerebral microbleeds among the 22 included patients.More diabetes mellitus was found in patients with lower CSVD burden(<2).Patients with stroke or dyslipidemia presents significant longer dialysis time(P<0.05).No significant effect was found between patients with or without hypertension or cardiovascular disease(P>0.05).Conclusion There is a high prevalence of CVSD in peritoneal dialysis patients,we should pay more attention on it.