脉搏波传导速度对慢性肾脏病患者动脉硬化的评价及其影响因素

发布时间：2018-04-02 19:35

本文选题：脉搏波传导速度　切入点：动脉硬化　出处：《大连医科大学》2014年硕士论文

【摘要】：目的：通过观察肱-踝脉搏波传导速度（brachial-ankle pulse wave velocity，baPWV）在慢性肾脏病（chronic kidney disease，CKD）患者中的变化，分析其在评价CKD患者动脉硬化中的意义及其影响因素。方法：选取2013年6月至2014年1月在大连医科大学附属第二医院肾内科住院的CKD患者，共44例。排除标准：严重感染、肝胆疾病、恶性肿瘤、严重心律失常、急性心肌梗死、心力衰竭、脑血管意外、外周血管疾病患者。选取同期在本院体检中心参加体检人员作为对照组，共45例。根据简化肾脏病膳食改良实验（Modification Of Diet InRenal Disease，MDRD）公式计算估计肾小球滤过率（estimated glomerular filtrationrate，eGRF），将CKD患者按照eGFR分为CKD2期6例、CKD3期10例、CKD4期6例、CKD5期22例。收集所有研究对象的年龄、性别、身高、体重等一般临床资料；日立7600自动生化分析仪检测血红蛋白、血清白蛋白、血胆固醇、甘油三酯、低密度脂蛋白胆固醇、血清肌酐、血尿酸、血钙、血磷，计算校正钙、钙磷乘积；免疫化学荧光法检测血全段甲状旁腺激素（intact parathyroid hormone，iPTH）；免疫比浊法测定血C-反应蛋白（C-reactive protein, CRP）；日本COLIN公司VP1000无创动脉硬化检测仪测定baPWV及血压；美国GE LOGIQ7超声诊断仪测量颈动脉内中膜厚度（carotid intima-mediathickness，cIMT）。所有资料的统计和分析采用SPSS17.0软件，P0.05为差异具有统计学意义。结果：1．CKD5期患者的血红蛋白低于对照组及CKD2-4期（P＜0.05），血清白蛋白低于对照组及CKD2期（P＜0.05），血胆固醇和甘油三酯低于CKD3期及CKD4期（P＜0.05），血钙低于对照组及CKD2-4期，血磷高于对照组及CKD2-3期（P＜0.05），血iPTH高于对照组及CKD2-4期（P＜0.05），钙磷乘积低于CKD2期（P＜0.05），血CRP高于对照组及CKD2期（P＜0.05），血尿酸高于对照组及CKD2-4期（P＜0.05）。同时，CKD3-4期患者的血红蛋白和血清白蛋白低于对照组及CKD2期（P＜0.05），CKD4期患者的血甘油三酯高于对照组及CKD2期（P＜0.05）。 2．CKD5期患者的cIMT高于对照组及CKD2期（P＜0.05），斑块检出率高于对照组及CKD2-4期（P＜0.05）。同时，CKD3-4期患者的斑块检出率高于对照组及CKD2期（P＜0.05），CKD2期患者的斑块检出率高于对照组（P＜0.05）。 3．CKD5期患者的baPWV高于对照组及CKD2期（P＜0.05），CKD3-4期患者的baPWV高于对照组（P＜0.05）。CKD3-5期患者的收缩压高于对照组（P＜0.05），CKD3期患者的收缩压高于CKD2期（P＜0.05）。CKD5期患者的舒张压低于CKD3期（P＜0.05）。CKD5期患者的脉压高于对照组及CKD2期（P＜0.05）。 4． baPWV与cIMT的相关分析显示，baPWV与cIMT呈正相关（r=0.341，P=0.024）。将CKD患者分为有斑块组及无斑块组，比较两组间baPWV，，结果有斑块组CKD患者的baPWV为（1864.53±315.31）cm/s，无斑块组的baPWV为（1590.59±243.50）cm/s，两组间差异有统计学意义（P=0.002）。相关分析显示，baPWV与年龄（r=0.313，P=0.039）、收缩压（r=0.790，P=0.000）、脉压（r=0.654，P=0.000）、血CRP（r=0.477，P=0.001）和血尿酸（r=0.543，P=0.000）均呈正相关，而与eGFR（r=-0.374，P=0.012）呈负相关。多元线性回归显示，在校正了年龄、eGFR、CRP影响后，血尿酸(P=0.001)、收缩压(P=0.000)、脉压(P=0.018)均是CKD患者baPWV的独立影响因素。结论：1．肱-踝脉搏波传导速度可作为慢性肾脏病患者动脉硬化的早期评价指标。 2．血尿酸、收缩压、脉压是慢性肾脏病患者动脉硬化的独立危险因素。
[Abstract]:Objective : To observe the changes of brachial - ankle pulse wave velocity ( baPWV ) in patients with chronic kidney disease ( CKD ) , and to analyze the significance of brachial - ankle pulse wave velocity ( baPWV ) in evaluating the arteriosclerosis of CKD patients and their influencing factors .

Methods : A total of 44 patients with CKD hospitalized in the Second Affiliated Hospital of Dalian Medical University from June 2013 to January 2014 were selected . The criteria were as follows : severe infection , liver and gallbladder diseases , malignant tumor , severe arrhythmia , acute myocardial infarction , heart failure , cerebrovascular accident and peripheral vascular disease .
detecting hemoglobin , serum albumin , blood cholesterol , triglyceride , low - density lipoprotein cholesterol , serum creatinine , blood uric acid , blood calcium , and blood phosphorus by using an automatic biochemical analyzer , and calculating and correcting the product of calcium and phosphorus ;
Whole - segment parathyroid hormone ( PTH ) was detected by immunofluorescence assay .
C - reactive protein ( CRP ) was determined by turbidimetric method .
baPWV and blood pressure were measured by the VP1000 non - invasive arteriosclerosis detector in COLIN Company , Japan ;
The thickness of carotid intima - media thickness ( cIMT ) was measured by GE LOGIQ7 ultrasonic diagnostic instrument . The statistics and analysis of all the data were statistically significant by SPSS 17.0 software , P0.05 .

Results : 1 . Serum albumin was lower than that of control group and CKD2 - 4 stage ( P < 0.05 ) , and serum albumin was higher than that in control group and CKD2 - 4 stage ( P < 0.05 ) . The serum level of serum albumin was higher than that in control group and CKD2 - 4 stage ( P < 0.05 ) . The serum levels of serum albumin were higher than those in control group and CKD2 - 4 period ( P < 0.05 ) .

2 . cIMT of CKD5 patients was higher than that in control group and CKD2 stage ( P < 0.05 ) . The detection rate of plaque in CKD3 - 4 patients was higher than that in control group and CKD2 stage ( P < 0.05 ) .

The systolic blood pressure in CKD3 - 4 patients was higher than that in the control group ( P < 0.05 ) . The systolic blood pressure in CKD3 - 4 patients was higher than that in the control group ( P < 0.05 ) . The systolic blood pressure in patients with CKD3 was higher than that in the control group ( P < 0.05 ) . The diastolic pressure in patients with CKD3 was lower than that in the control group and CKD2 stage ( P < 0.05 ) .

4 . Correlation analysis of baPWV and cIMT showed that baPWV was positively correlated with cIMT ( r = 0.341 , P = 0 . 024 ) . Correlation analysis showed that baPWV and age ( r = 0.313 , P = 0.039 ) , systolic blood pressure ( r = 0.790 , P = 0.000 ) , systolic blood pressure ( r = 0.654 , P = 0.000 ) , blood CRP ( r = 0.477 , P = 0.001 ) and uric acid ( r = 0.543 , P = 0.000 ) were positively correlated .

Conclusion : 1 . The brachial - ankle pulse wave conduction velocity can be used as an early evaluation index of arteriosclerosis in patients with chronic renal disease .

2 . Blood uric acid , systolic pressure and pulse pressure are independent risk factors of arteriosclerosis in patients with chronic kidney disease .

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692

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