腹膜透析患者心血管钙化的演变及临床意义

发布时间：2018-03-31 05:11

  本文选题：腹膜透析　切入点：心血管钙化　出处：《南京大学》2017年硕士论文

【摘要】：目的:动态观察腹膜透析(PD)患者心血管钙化的患病率和演变情况,分析影响钙化的因素及其临床意义。方法:前瞻性观察150名PD患者,评估患者基线临床特征及心血管钙化的患病率,所有患者随访30个月,分别于第0,12和24个月进行1次心血管钙化的影像学评估。利用Logistic回归分析影响心血管钙化及进展的相关因素;利用Kaplan-Meier法计算患者的全因或心血管疾病(CVD)死亡率以及非致死性心血管事件(CVE)的发生率;采用COX回归分析相关危险因素。结果:基线时57.3%的患者存在有钙化,至随访结束,心血管钙化率升至63.2%,在53.5%的患者中观察到钙化进展。随访中5.3%的患者死亡,最常见的死因是CVD(75%),CVE的发生率为19.3%。有临床意义钙化的患者的全因死亡(p=0.004)和CVD死亡(p=0.002)显著高于其他患者。低蛋白血症及二尖瓣钙化是全因死亡和CVD死亡的独立危险因素;年龄46岁、高密度脂蛋白-胆固醇及冠状动脉钙化和心脏瓣膜钙化的合并存在是发生CVE的独立危险因素。结论:PD患者合并心血管钙化的患病率较高,病变进展较快,与CVD的发生有着密切的联系,心血管钙化对整体预后产生不良影响。
[Abstract]:Objective: To observe the peritoneal dialysis (PD) patients with cardiovascular calcification prevalence and evolution, analysis of factors affecting calcification and its clinical significance. Methods: a prospective study of 150 patients with PD, the prevalence rate of assessment of patients with baseline clinical characteristics and cardiovascular calcification, all patients were followed up for 30 months, respectively, 1 times of cardiovascular calcification imaging evaluation on 0,12 and 24 months. Regression analysis of factors related to cardiovascular calcification and progress by Logistic; calculation of patients with all-cause or cardiovascular disease by the method of Kaplan-Meier (CVD) mortality and nonfatal cardiovascular events (CVE) occurrence rate; COX regression was used to analyze the related risk factors. Results: at baseline there were 57.3% patients with calcification, to the end of follow-up, cardiovascular calcification rate rose to 63.2%, was observed in 53.5% of the patients died during the follow-up to the progress of calcification. 5.3% of the patients, the most common cause of death is CV D (75%), the incidence of CVE was 19.3%. with clinical significance of calcification in patients with all-cause death (p=0.004) and CVD (p=0.002) was significantly higher than other patients. Hypoproteinemia and mitral valve calcification was all-cause death and CVD independent risk factors of death; 46 years of age, with high density lipoprotein cholesterol and coronary artery calcification and cardiac valve calcification is an independent risk factor of CVE. Conclusion: PD patients with a high prevalence of cardiovascular calcification lesions, rapid progress, has close relationship with the occurrence of CVD, cardiovascular calcification have adverse effects on the overall prognosis.

【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5
，

本文编号：1689279