慢性肾脏病患者腹型肥胖与动脉硬化的相关性研究

发布时间：2018-04-29 15:15

本文选题：慢性肾脏病 + 高甘油三酯腰围　；参考：《昆明医科大学》2014年硕士论文

【摘要】：目的：慢性肾脏病患者死亡风险增加,而心血管疾病是导致慢性肾脏病患者死亡的主要原因。高甘油三酯腰围表型是一个简单而有效的预测心血管风险的指标,因此,本研究以慢性肾脏病患者为研究对象,探讨高甘油三酯腰围表型与亚临床动脉粥样硬化的相关性。方法：收集785名慢性肾脏病患者病史、各项检查结果,根据高甘油三酯腰围表型的诊断标准将患者分成三组,第1组为高甘油三酯腰围表型组、第3组为正常甘油三酯腰围组,其余患者纳入第2组,测量三组患者的颈动脉内中膜厚度,分析高甘油三酯腰围表型与动脉粥样硬化的相关性。结果：在纳入的785名慢性肾脏病患者中,慢性肾脏病组患者占13.9%。高甘油三酯腰围表型组甘油三酯、低密度脂蛋白胆固醇、颈动脉内中膜厚度均高于正常甘油三酯腰围组。Logistic回归分析显示,肾小球滤过率、糖尿病病史、IMT与高甘油三酯腰围表型正相关,是高甘油三酯腰围表型的独立危险因素。结论：高甘油三酯腰围表型组患者的LDL-C、TG、IMT均显著高于正常甘油三酯腰围表型组,高甘油三酯腰围与IMT正相关,IMT增加是高甘油三酯腰围的独立危险因素。高甘油三酯腰围表型可作为慢性肾脏病患者心血管风险的预测指标。目的：腹型肥胖(abdominal obesity, AO)的发病率逐年升高,而AO是导致CKD患者病情加重、使慢性肾脏病患者心血管发病率和死亡风险增加的危险因素。本研究以能够很好地反映腹型肥胖的指标—脂质沉积指数作为切入点,探讨它与亚临床动脉硬化的相关性。方法：收集778名慢性肾脏病患者的身高、体重、腰围、临床病史、各项空腹血脂指标、颈动脉内膜中层厚度,根据公式：(WC-65)×TG(男性)或(WC-58)×TG(女性)计算出患者的脂质沉积指数,用单因素相关分析方法分析部分临床及生化指标与颈动脉硬化相关的变量,并用多元回归分析找出颈动脉硬化的预测指标。结果：在纳入的778名慢性肾脏病患者中,单因素相关分析显示：与颈动脉硬化相关的变量包括：年龄、GFR、血红蛋白、尿酸、BMI、LAP,其中年龄、尿酸、血红蛋白、BMI、LAP与颈动脉硬化呈正相关,GFR、血红蛋白与颈动脉硬化呈负相关。多变量回归分析显示：颈动脉IMT的预测指标包括：年龄(P0.01)、高血压史(P0.01)、BMI(P0.05)、性别(P0.01)和logLAP (P0.05),其中年龄、高血压史、BMI、logLAP与颈动脉IMT正相关,性别与颈动脉IMT负相关。结论：LAP与颈动脉IMT呈显著正相关关系,LAP增加将引起IMT增加,进一步加重动脉硬化,导致CKD患者心血管风险增加,LAP可作为CKD患者心血管风险的有效预测指标。
[Abstract]:Objective: to increase the risk of death in patients with chronic kidney disease, and cardiovascular disease is the leading cause of death in patients with chronic kidney disease. High triglyceride waistline phenotype is a simple and effective predictor of cardiovascular risk. Therefore, we studied the relationship between high triglyceride waist circumference phenotype and subclinical atherosclerosis in patients with chronic kidney disease. Methods: 785 patients with chronic kidney disease were collected and examined. According to the diagnostic criteria of high triglyceride waist circumference phenotype, the patients were divided into three groups: the first group was the high triglyceride waistline phenotype group, the third group was the normal triglyceride waist circumference group. The other patients were included in the second group. The carotid intima-media thickness was measured and the correlation between the phenotype of high triglyceride waist circumference and atherosclerosis was analyzed. Results: of the 785 patients with chronic kidney disease, 13.9 were in the chronic kidney disease group. High triglyceride waist circumference phenotype group, triglyceride, low density lipoprotein cholesterol, carotid artery internal media thickness were higher than normal triglyceride waist circumference group. Logistic regression analysis showed that glomerular filtration rate was higher than that of normal triglyceride waist circumference group. IMT was positively correlated with high triglyceride waist circumference phenotype and was an independent risk factor for high triglyceride waist circumference phenotype. Conclusion: high triglyceride waist circumference phenotype group had significantly higher LDL-C TGG IMT than normal triglyceride waist circumference phenotype group. The increase of high triglyceride waist circumference and IMT positive correlation was the independent risk factor of high triglyceride waist circumference. High triglyceride waistline phenotype can be used as a predictor of cardiovascular risk in patients with chronic kidney disease. Objective: the incidence of abdominal obesity is increasing year by year, and AO is the risk factor of increasing cardiovascular morbidity and death risk in patients with CKD. In this study, the index of lipid deposition, which can well reflect abdominal obesity, was used as a starting point to explore the relationship between lipid deposition index and subclinical arteriosclerosis. Methods: the height, weight, waist circumference, clinical history, fasting blood lipid index and carotid intima-media thickness of 778 patients with chronic kidney disease were collected. The index of lipid deposition was calculated according to the formula: WC-65) 脳 TG (male) or WC-58 脳 TG (female). Single factor correlation analysis was used to analyze some clinical and biochemical variables related to carotid atherosclerosis, and multiple regression analysis was used to find out the predictors of carotid atherosclerosis. Results: among the 778 patients with chronic kidney disease, univariate correlation analysis showed that the variables associated with carotid arteriosclerosis included age GFR, hemoglobin, uric acid BMI-LAPs, among which age, uric acid, uric acid, Hemoglobin BMILAP was positively correlated with carotid arteriosclerosis, and hemoglobin was negatively correlated with carotid atherosclerosis. Multivariate regression analysis showed that the predictors of carotid IMT were: age (P 0.01), hypertension (P 0 01), sex (P 0 05) and logLAP (P 0 05). Age, hypertension history and history of hypertension were positively correlated with carotid IMT, and gender was negatively correlated with carotid IMT. Conclusion there is a significant positive correlation between the ratio of% lap and carotid IMT. The increase of lap may lead to the increase of IMT and further increase of arteriosclerosis. Lap can be used as an effective predictor of cardiovascular risk in CKD patients.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5

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