老年肾脏病患者临床与病理特征及老年CKD患者LVH危险因素分析

发布时间：2018-05-31 02:17

本文选题：老年 + 肾脏病　；参考：《第三军医大学》2016年硕士论文

【摘要】：目的(1)老年人肾脏病患病率高、病因复杂,且由于各地区老年肾活检指针及肾脏病理参照标准的不同,各地区相关研究存在一定的差异。故本研究拟分析我院老年人肾脏疾病临床与病理特点及其相互关系,为本地区老年肾脏病患者诊治提供重要理论依据。(2)老年CKD患者心血管事件发生率及死亡率极高,LVH是CKD患者心力衰竭与心源性猝死的主要原因,早期发现、干预其心血管疾病对提高老年CKD患者预后十分重要。故本研究拟探讨分析老年透析前CKD患者LVH的危险因素。方法(1)选取我院2006年10月至2014年12月期间年龄≥65岁,临床表现为慢性肾脏疾病和/或急性肾损伤且接受肾活检术的患者共371例,收集其临床表现与病理类型,采用描述性统计方法分析其临床和病理的构成情况。(2)筛选上述病例中同时完善心脏超声及24小时动态血压的老年CKD1~4期患者共88例,通过Devereux公式计算其LVMI,并根据LVMI将其分为LVH组与非LVH组。收集两组患者的24小时动态血压指标(24h-SBP、24h-DBP、24h-MBP、d-SBP、d-DBP、d-MBP、n-SBP、n-DBP、n-MBP)、24小时尿蛋白定量、Hb、PLT、Alb、Scr、UA、Cyc、Ca、P、钙磷乘积、TG、CHOL、HDL、LDL指标;根据CKD-EP公式计算eGFR;对于Alb40g/L者,采用Payne公式校正血钙。通过独立样本T检验、Person卡方检验、秩和检验比较两组间临床指标;Spearman,s单因素相关性分析得出与LVH相关的临床指标;对上述有意义指标进行Logistic二分类分析LVH危险因素。结果(1)老年肾脏病患者临床与病理特征分析结果:(1)371例老年肾脏病患者中,贫血占39.1%(145/371)、高血压占67.4%(250/371)、低白蛋白血症占43.1%(160/371)、糖尿病占19.9%(74/371);临床表现以CKI、NS常见,分别为53.6%(199/371)、33.2%(123/371);原发性肾小球疾病较继发性肾小球疾病多见,前者以MN、IgAN常见,分别占20.2%(75/371)、12.7%(47/371),后者以DN、HTN、肿瘤相关性肾损害多见,各占10.8%(40/371)、6.5%(24/371)、2.7%(10/371)。(2)CKI以MN、Ig AN常见,各占18.1%(36/199)、17.6%(35/199);NS中,MN、DN较为常见,分别为34.9%(43/123)、8.9%(11/123);AKI以及AKI and NS中,ATID为最常见类型,各占75%(18/24)、36.4%(4/11);AUA以MN、Ig AN为主,分别占35.7%(5/14)、21.4%(3/14)。(2)老年CKD1~4期患者LVH危险因素分析结果:88例老年CKD患者中,LVH患者28例,占31.8%,CKD1~4期LVH发生率分别为11.1%(2/18)、30.8%(12/39)、44.4%(12/27)、50.0%(2/4);(2)LVH组患者夜间高血压发生率,24h-SBP、24h-MBP、d-SBP、d-MBP、n-SBP、n-MBP,以及血磷、钙磷乘积显著高于非LVH组患者(P0.05);(3)单因素相关分析显示,LVH与24h-SBP、24h-MBP、d-SBP、d-MBP、n-SBP、n-MBP水平,以及夜间高血压、血磷、钙磷乘积、eGFR60ml/min.1.73m2呈正相关(P0.05);(4)多因素Logistic回归分析显示,高血压、日间收缩压水平、血磷、e GFR60 mL/(min.1.73m2)是老年CKD1~4期患者LVH的危险因素。结论老年人肾脏疾病临床表现以CKI、NS常见,病理类型以原发性肾小球疾病为主,其中MN、Ig AN多见,而继发因素复杂多样,以DN、HTN、肿瘤相关性肾损害常见。老年透析前CKD患者LVH发生率高,血压水平、钙磷代谢紊乱、肾功能损害、高血压是老年CKD1~4期患者LVH的重要原因。
[Abstract]:Objective (1) the incidence of kidney disease in the elderly is high and the cause of the disease is complex, and there are certain differences in the related studies in each region because of the different renal biopsy pointer and renal pathological reference standard in each area. Therefore, this study intends to analyze the clinical and pathological features of renal diseases and their relationship in the elderly in our hospital for the diagnosis and treatment of the elderly renal diseases in the region. Provide important theoretical basis. (2) the incidence of cardiovascular events and mortality of elderly CKD patients is very high. LVH is the main cause of heart failure and sudden cardiac death in CKD patients. Early discovery, the intervention of cardiovascular disease is very important to improve the prognosis of elderly CKD patients. Therefore, this study is to explore and analyze the risk factors of LVH in the elderly patients with CKD before dialysis. Methods (1) 371 cases of chronic renal disease and / or acute renal injury and renal biopsy were selected from October 2006 to December 2014 in our hospital. The clinical and pathological types were collected and the clinical and pathological composition of the patients were collected by descriptive statistics. (2) screening the above cases. A total of 88 aged CKD1~4 patients with perfect cardiac ultrasound and 24 hour ambulatory blood pressure were used to calculate their LVMI through the Devereux formula, and were divided into LVH and non LVH groups according to LVMI. The 24 hours dynamic blood pressure index of the two groups of patients (24h-SBP, 24h-DBP, 24h-MBP, d-SBP, d-DBP, d-MBP), 24 hour urine protein quantitative UA, Cyc, Ca, P, calcium and phosphorus product, TG, CHOL, HDL, LDL index; calculate eGFR according to the CKD-EP formula; for Alb40g/L, the Payne formula is used to correct the blood calcium. The clinical indicators of the two groups are compared by the independent sample test, the chi square test and the rank sum test. Logistic two classified analysis of LVH risk factors. Results (1) the analysis of clinical and pathological features of elderly renal disease patients: (1) among 371 elderly patients with renal disease, anemia accounted for 39.1% (145/371), hypertension accounted for 67.4% (250/371), hypoalbuminemia accounted for 43.1% (160/ 371), and diabetes accounted for 19.9% (74/371); the clinical manifestations were CKI, NS, 53., respectively. 6% (199/371), 33.2% (123/371); primary glomerular disease is more common than secondary glomerular disease, the former is common in MN, IgAN, 20.2% (75/371), 12.7% (47/371), and the latter is more common in DN, HTN, and tumor related renal damage, each is 10.8% (40/371), 6.5% (24/371), 2.7% (10/371). (2) 18.1% (17.6%); 17.6% (17.6%); 18.1% (17.6%); 17.6% (17.6%); 18.1% MN and DN were more common, 34.9% (43/123), 8.9% (11/123), AKI and AKI and NS, and ATID was the most common type, each accounted for 75% (18/24), 36.4% (4/11), 35.7% (2), 21.4% (2). (2) 88 elderly patients, 28 cases, 31.8% The incidence was 11.1% (2/18), 30.8% (12/39), 44.4% (12/27), 50% (2/4), and (2) the incidence of nocturnal hypertension in the LVH group, 24h-SBP, 24h-MBP, d-SBP, d-MBP, n-SBP, n-MBP, and blood phosphorus, and the product of calcium and phosphorus was significantly higher than that of the non LVH group. Hypertension, blood phosphorus, calcium and phosphorus product, eGFR60ml/min.1.73m2 positive correlation (P0.05); (4) multiple factor Logistic regression analysis showed that hypertension, daytime systolic pressure level, blood phosphorus, e GFR60 mL/ (min.1.73m2) are the risk factors of LVH in elderly patients with CKD1~4 phase. Conclusion the clinical manifestations of renal disease in old people are CKI, NS, and pathological type with primary kidney. MN, Ig AN are more common, and secondary factors are complex and complex. DN, HTN, and tumor related renal damage are common. The incidence of LVH in the elderly CKD patients before dialysis is high, blood pressure level, calcium and phosphorus metabolism disorder, renal function damage, hypertension is an important cause of LVH in elderly CKD1~4 patients.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R692

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