CKD患者AASI及Sym-AASI与肾脏动脉阻力指数的相关性研究

发布时间：2018-06-14 00:32

本文选题：慢性肾脏病 + 动态动脉硬化指数　；参考：《昆明医科大学》2015年硕士论文

【摘要】：目的慢性肾脏病(chronic kidney disease, CKD)患者的主要死亡原因是心血管疾病。动脉硬化是心血管疾病发病率和死亡率最强有力的预测因素。来自24h动态血压监测的动态动脉硬化指数(ambulatory arterial stiffness index, AASI)不仅是一项反映机体大动脉硬化的可靠指标,且被证实在不同疾病的人群中可预测心血管风险,而其改良指标对称性动态动脉硬化指数(symmetric Ambulatory arterial stiffness index, Sym-AASI)因消除杓型曲线及相关系数的影响,更有效的预测心血管事件也日渐被关注；肾动脉阻力指数(renal resistive index, RRI)是反映肾脏血流灌注的指标,被证实与CKD病情进展有关。因此,本文对CKD患者AASI及Sym-AASI与RRI的相关性进行探讨。方法收集2012年9月至2014年6月在昆明医科大学第一附属医院肾脏内科住院治疗的CKD患者的数据,根据美国肾脏病基金会(NKF)制定的KDOQI指南对CKD患者的定义,入组CKD患者789名,平均年龄(46.6±17.0)岁,男性432名。对纳入患者详细采集病史,并予24小时动态血压监测,收集患者24h原始血压值,计算AASI及Sym-AASI;行肾脏彩色多普勒超声检查,测双肾段动脉的阻力指数；并收集患者入院后血常规、血生化、24h尿蛋白定量等检查。结果：以RRI为因变量,以年龄、肾小球滤过率(glomerular filtration rate, GFR),血红蛋白(hemoglobin, HGB)、24h尿蛋白定量、尿酸(uric acid, UA)、身体质量指数(body mass index, BMI)、患者每日所用降压药的限定日剂量数(Defined Daily Dose, DDD)、AASI、Sym-AASI为自变量,作单变量相关性分析,结果显示年龄、UA、患者每日所用降压药的限定日剂量数(DDD)、AASI及Sym-AASI均与肾脏段动脉RRI具有线性相关(P值均0.01),且呈正相关性。另外,GFR (p0.01)、HGB (p0.01)与RRI具有负相关性。而24h尿蛋白定量及BMI(P值均0.05)与RRI没有线性相关。而将年龄、GFR、HGB、24尿蛋白定量、UA、BMI、患者每日所用降压药的限定日剂量数(DDD)、AASI、 Sym-AASI及糖尿病史、吸烟情况、高血压病史一起纳入模型,行多元线性逐步回归法后,结果显示GFR、年龄、HGB、性别、糖尿病史、AASI(P值均0.01)与RRI具有独立线性相关,说明上述因素均为RRI的独立影响因素,其中AASI(Beta为0.040)对RRI影响较其他因素大,GFR, HGB对RRI影响均可能较弱,而血UA、BMI、24h尿蛋白定量、吸烟及,患者每日所用降压药的限定日剂量数(DDD)、高血压病史及Sym-AASI进入此多元线性回归分析模型后,均显示与RRI无相关性。结论：CKD患者中,AASI是RRI的独立影响因素,而Sym-AASI与RRI无相关性。提示AASI可能对CKD患者肾脏血流灌注有影响。此外,GFR、年龄、HGB、性别、糖尿病史也是RRI的独立影响因素,这些因素也可能影响CKD患者肾脏血流灌注。
[Abstract]:Objective the main cause of death in patients with chronic kidney disease is cardiovascular disease. Atherosclerosis is the most powerful predictor of cardiovascular disease morbidity and mortality. The ambulatory arterial stiffness index, AASI, which comes from 24-hour ambulatory blood pressure monitoring, is not only a reliable indicator of aortic sclerosis, but has also been shown to predict cardiovascular risk in people with different diseases. And its improved index symmetry dynamic arteriosclerosis index (symmetric Ambulatory arterial stiffness index, Sym-AASI) is more and more effective in predicting cardiovascular events because of eliminating the influence of dipper curve and correlation coefficient. Renal resistive index (RRI) is an index of renal perfusion, which has been proved to be related to the progression of CKD. Therefore, the correlation between AASI, Sym-AASI and RRI in CKD patients was investigated. Methods data of CKD patients hospitalized in Department of Nephrology, first affiliated Hospital of Kunming Medical University from September 2012 to June 2014 were collected. According to the definition of CKD patients according to the KDOQI guidelines developed by the American Nephrology Foundation, 789 patients with CKD were enrolled. The average age was 46.6 卤17.0 years old, 432 males. The patients were collected and monitored 24 hours ambulatory blood pressure (ABBP) for 24 hours to calculate the AASI and Sym-AASI.The renal color Doppler ultrasound was performed to measure the resistance index of the bilateral renal segmental arteries, and the blood routine was collected after admission. Blood biochemistry and 24 hours urine protein quantitative examination. Results: according to age, glomerular filtration rate, hemoglobin, uronic acid acididin, UAA, body mass index (BMI) and body mass index (BMI), the defined daily dose of blood pressure lowering drugs were determined daily. The results of univariate correlation analysis showed that there was a linear correlation between AASI and Sym-AASI and RRI of renal segmental artery (RRI), and there was a positive correlation (P = 0.01). In addition, there was a negative correlation between GFR and RRI. However, there was no linear correlation between 24 h urinary protein quantification and BMIP (0.05). The age of GFRG HGB24 urinary protein quantitative UABMI. the defined daily dose of antihypertensive drugs DDD AASI, Sym-AASI and diabetes history, smoking status, hypertension history were included in the model. The results showed that GFR, age HGBs, sex, age, HGBs, gender, and diabetes history, smoking status and hypertension history were included in the model, and the results showed that GFR, age HGBs, sex, There was an independent linear correlation between AASI P value and RRI, indicating that the above factors were independent factors of RRI, among which AASI Beta (0.040) had greater influence on RRI than other factors, HGB might have weaker effect on RRI, while UAA BMI24 h urinary protein ration, smoking and smoking, The limited daily dose of antihypertensive drugs and the history of hypertension and Sym-AASI showed no correlation with RRI. Conclusion AASI is an independent factor of RRI in patients with CKD, but Sym-AASI has no correlation with RRI. These results suggest that AASI may have an effect on renal perfusion in CKD patients. In addition, GFR, age, sex and history of diabetes were also independent factors of RRI. These factors may also affect renal blood perfusion 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】：2015
【分类号】：R692

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