维持性血液透析患者心脏瓣膜钙化影响因素的Meta分析

发布时间：2018-01-21 09:20

本文关键词： 维持性血液透析心脏瓣膜钙化影响因素 Meta分析　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:近20年来对慢性肾脏病(Chronic Kidney Disease,CKD)的深入研究,发现随着肾功能下降其心脑血管疾病的发生风险显著增加,包括冠状动脉疾病、心力衰竭、严重心律失常和猝死等。而心脑血管疾病是终末期肾病(End-Stage Renal Disease,ESRD)的首要死亡原因,占所有死因的50%以上。CKD患者的动脉钙化及由此所致的血管硬化也是导致心血管疾病发生和发展的重要因素之一,其中包括心脏瓣膜钙化(Cardiac Valve Calcification,CVC)。心脏瓣膜钙化是瓣膜狭窄的重要原因,常常发生在主动脉瓣和二尖瓣,可以导致心脏瓣膜功能性失调,引起瓣膜狭窄或者关闭不全,进而导致血流动力学改变。虽然心脏瓣膜钙化的发生率较动脉钙化发生率低,但与肾功能正常人群相比,CKD患者心脏瓣膜钙化发生率高出5-10倍。而且透析也是CKD患者心脏瓣膜钙化的危险因素之一,无论是血液透析还是腹膜透析。CKD患者中透析者心脏瓣膜钙化的发生率是非透析者的4-5倍,维持性血液透析(Maintenance Hemodialysis,MHD)患者发生心脏瓣膜钙化更加普遍,且病变进展更快。有关维持性血液透析患者心脏瓣膜钙化的研究较多,但对于其发病机制及治疗等问题仍有较大争议。目前越来越多的证据表明,除了传统的心血管危险因素之外,矿物质代谢异常、炎症反应等也参与CVC的发生和发展。为了更全面地了解并掌握MHD患者心脏瓣膜钙化发生的影响因素、发病机制等问题,据此本文检索了近15年有关维持性血液透析患者心脏瓣膜钙化的病例对照研究的相关文献进行Meta分析,为进一步探讨其治疗及预防措施,最终降低MHD患者的死亡率并提高患者的生活质量做基础。目的:通过Meta分析探讨维持性血液透析患者心脏瓣膜钙化的影响因素。方法:基于观察性研究的Meta分析规范(Meta-analysis Of Observational Studies in Epidemiology,MOOSE)声明进行研究及撰写。计算机检索Embas、Pubmed、Web of Sciences、中国知网、万方、维普、CBMdisc等数据库,收集2000年1月-2015年10月公开发表的有关维持性血液透析患者心脏瓣膜钙化的影响因素的文献,并应用Rev Man5.3软件进行Meta分析,Stata 13.0软件进行偏倚分析。结果:共纳入16篇文献,共纳入研究对象3061例,其中存在心脏瓣膜钙化1541例,无心脏瓣膜钙化1520例。Meta分析结果显示:1)维持性血液透析患者心脏瓣膜钙化与年龄增加[WMD=9.64,95%CI(7.75,11.52),P0.001]、血液透析时间增加[WMD=25.87,95%CI(15.90,35.83),P0.001]、血磷浓度更高[WMD=0.57,95%CI(0.22,0.92),P=0.001]、炎症反应中的C-反应蛋白水平更高[WMD=3.13,95%CI(1.29,4.95),P0.001]、成纤维细胞生长因子-23水平更高[WMD=0.5,95%CI(0.21,0.79),P0.001]相关,差异存在统计学意义(P0.01)。2)维持性血液透析患者心脏瓣膜钙化与血清白蛋白水平降低[WMD=-0.88,95%CI(-1.41,-0.36),P=0.001]、胎球蛋白A水平降低[SMD=-1.24,95%CI(-1.83,-0.65),P0.001]具有相关性,差异存在统计学意义(P0.01)。结论:初步确定年龄、血液透析时间、血磷浓度、成纤维细胞生长因子-23、炎症反应中的C-反应蛋白是影响维持性血液透析患者心脏瓣膜钙化发生的重要危险因素,胎球蛋白A、血清白蛋白是维持性血液透析患者心脏瓣膜钙化的保护性因素。
[Abstract]:Background: in the past 20 years of chronic kidney disease (Chronic Kidney, Disease, CKD) of the study, found that the risk of cardiovascular and cerebrovascular diseases with the decline in renal function increased significantly, including coronary artery disease, heart failure, arrhythmia and sudden death. The cardiovascular disease is the end-stage renal disease (End-Stage Renal Disease. ESRD) the primary cause of death, accounting for more than 50% of all deaths of arterial calcification in.CKD patients and thus induced vascular sclerosis is one of the important factors leading to the occurrence and development of cardiovascular disease, including heart valve calcification (Cardiac Valve, Calcification, CVC). Cardiac valve calcification is an important cause of valvular stenosis, often occurs in the aortic valve and the mitral valve, which can lead to cardiac valvular function disorder, caused by valvular stenosis or insufficiency, leading to hemodynamic changes. Although cardiac valve calcium The incidence of arterial calcification rate is low, but compared with the normal renal function group, CKD patients with heart valve calcification rate is 5-10 times higher. And is also one of the risk factors of dialysis patients with CKD cardiac valve calcification, whether hemodialysis or peritoneal dialysis in patients with.CKD. The analysis of heart valve calcification incidence 4-5 times of non dialysis, hemodialysis (Maintenance Hemodialysis, MHD) in patients with heart valve calcification is more prevalent, and the lesions progress faster. More research concerning the maintenance of cardiac valve calcification in hemodialysis patients, but for the pathogenesis and treatment of the problem is still controversial. At present more and more evidence that in addition to traditional cardiovascular risk factors, abnormal mineral metabolism, the occurrence and development of inflammatory reaction in CVC. In order to fully understand and master the MHD patients with heart Influence factors of valve calcification occurred, pathogenesis, so this paper retrieval literature comparative study of nearly 15 years concerning the maintenance of cardiac valve calcification in hemodialysis patients were analyzed by Meta, to further explore the treatment and preventive measures, and ultimately reduce the mortality of MHD patients and improve the patient's quality of life based. Through the Meta analysis to evaluate the effect of maintenance of cardiac valve calcification in hemodialysis patients. Methods: standard analysis of observational studies based on Meta (Meta-analysis Of Observational Studies in Epidemiology, MOOSE) to conduct research and write a statement. Retrieved from Embas, Pubmed, Web of Sciences, Chinese CNKI, Wanfang, VIP, CBMdisc and other databases. From January 2000 October -2015 published the effect of maintenance of cardiac valve calcification in hemodialysis patients and the factors of the literature. The application of Rev Man5.3 Meta analysis software, Stata 13 software for bias analysis. Results: a total of 16 articles were included, were included in the study of 3061 cases in which the presence of valvular calcification in 1541 cases, the results showed no cardiac valve calcification in 1520 cases of.Meta: 1) maintenance hemodialysis patients with heart valve calcification and age [WMD=9.64,95%CI (7.75,11.52, P0.001]), hemodialysis time increased by [WMD=25.87,95%CI (15.90,35.83), P0.001], serum phosphate concentration higher [WMD=0.57,95%CI (0.22,0.92), P=0.001], flat water C- reactive protein in inflammation, the higher [WMD=3.13,95%CI (1.29,4.95), P0.001], fibroblast growth factor -23 higher level of [WMD=0.5,95%CI (0.21,0.79), P0.001]. There were statistically significant differences (P0.01).2) in maintenance hemodialysis patients with heart valve calcification and serum albumin level decreased [WMD=-0.88,95%CI (-1.41, -0.36), P=0.001], Reduce the fetuin A level of [SMD=-1.24,95%CI (-1.83, -0.65), associated with P0.001], there were statistically significant differences (P0.01). Conclusion: to determine the initial age, dialysis time, blood phosphorus concentration, fibroblast growth factor -23, C- reaction protein in inflammation is to maintain an important risk of cardiac valve calcification in hemodialysis patients with blood factors, fetuin A, serum albumin is a protective factor of cardiac valve calcification in hemodialysis patients.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5;R542.5

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