慢性肾脏病患者心血管疾病的发生规律及相关性研究

发布时间：2018-07-28 20:10

【摘要】：本论文主要包括文献综述和临床研究两个部分。文献综述的题目为慢性肾脏病患者心血管疾病的发生规律及相关性研究,总结了近年来国内外慢性肾脏病对心血管疾病的影响,并分析二者之间的关系。本文从肾脏和心脏的病理、生理机制方面进行系统分析,在临床上从CKD患者的年龄、性别、CKD的分期、高血压病、糖尿病史、蛋白尿及血脂等方面阐述了慢性肾脏病发生心血管疾病的规律,发现早期肾功能异常即对心血管系统造成影响。慢性肾脏病患者可出现冠状动脉硬化性心脏病(CAD)、心肌梗死(MI)、充血性心力衰竭(CHF)、周围血管病变(PVD)等心血管事件。同时阐述了慢性肾脏病和心血管疾病共同的危险因素(高血压病、糖尿病、脂代谢紊乱、蛋白尿、尿毒素、高尿酸、钙磷代谢异常等)对心血管疾病的影响,可见慢性肾脏病与心血管疾病关系十分密切,临床上加强早期防治各种危险因素,可以减少心血管事件的发生。慢性肾脏病在全球范围的发病率呈逐步增加的趋势(10.1%～15.1%),已成为继心脑血管疾病、肿瘤、糖尿病之后又一个威胁健康的重要疾病。慢性肾脏病持续进展,最终将导致终末期肾病(ESRD)及其相关并发症的发生,CKD患者有很高的动脉硬化和心血管事件风险,常合并心血管疾病,而CVD是慢性肾脏病患者最主要的并发症,其死亡率约占慢性肾脏病患者总死亡率的44%～51%,是导致这类患者死亡的首位原因。有文献报道,轻度肾衰竭患者的CVD患病率高于普通人群,且CVD的发生率随着肾功能的进展而逐步升高,至ESRD时达到高峰。我国有关CKD患者CVD患病率的调查多集中在ESRD和透析患者,而对CKD早期患者的调查甚少。本课题临床研究部分回顾分析了2001年7月至2014年6月在北京大学第一医院和山东大学齐鲁医院慢性肾脏病一体化门诊随访1年以上的491例慢性肾脏病患者,结合患者的病历记录、随诊1年以上的新发事件调查问卷以及患者在门诊的实验室检查结果、心电图、彩超等相关辅助检查,得出患者慢性肾脏病的分期、原发病的诊断以及CVD的发生情况,采用SPSS20.0软件进行统计学分析,利用单因素方差分析进行组间均值的比较,采用t检验,对分类变量进行组间的比较,采用X2检验,统计不同年龄、性别、原发病及不同肾脏病分期的患者CVD的患病率情况,并进行多因素的Logistic回归分析,对CKD患者的年龄、血压、血脂、尿蛋白、白蛋白、尿酸、血磷、肾功能、eGFR等危险因素对CKD患者心血管疾病的影响进行分析。结果发现随着CKD的进展,CVD的发生率呈逐步上升趋势,并在CKD3期明显升高,CKD患者发病年龄越大,发生心血管事件的风险越大,且男性患者较女性患者更容易发生CVD。在原发病调查中以糖尿病肾病、高血压肾病为最多,这类患者更易发生CVD。临床调查结果说明慢性肾脏病患者发生心血管疾病的比率较高,年龄、高血压、高血脂、蛋白尿、低蛋白血症、高磷血症是心血管事件的发生的独立危险因素,且高血压、高血磷对CKD患者发生心血管事件影响最大。通过此项研究,提示我们充分认识心血管的相关危险因素,为早期防治CKD患者发生心血管事件,提高患者的生存质量提供理论依据。本研究属于临床调查研究初级阶段,由于病例数偏少,尚待进一步深入研究。
[Abstract]:This paper mainly includes two parts: literature review and clinical research.
The title of the literature review is the study of the regularity and correlation of cardiovascular disease in patients with chronic kidney disease. The effect of chronic kidney disease on cardiovascular disease at home and abroad in recent years is summarized, and the relationship between the two is analyzed. The paper systematically analyzes the pathological and physiological mechanisms of the kidney and heart and the age of the CKD patients. Sex, CKD staging, hypertension, diabetes history, albuminuria, and blood lipid and other aspects of the rules of CVD cardiovascular disease, the early renal dysfunction was found to affect the cardiovascular system. Patients with chronic kidney disease may have coronary atherosclerotic heart disease (CAD), myocardial infarction (MI), congestive heart failure (CHF). Cardiovascular events such as peripheral vascular disease (PVD). The effects of common risk factors (hypertension, diabetes, lipid metabolism disorder, proteinuria, urinary toxin, hyperuricemia, high uric acid, calcium and phosphorus metabolism) on cardiovascular disease in chronic kidney disease and cardiovascular disease are also described. It can be seen that chronic kidney disease is closely related to cardiovascular disease. Strengthening early prevention and treatment of various risk factors can reduce the incidence of cardiovascular events.
The global incidence of chronic kidney disease is gradually increasing (10.1% ~ 15.1%). It has become an important health threat after cardio cerebrovascular disease, tumor and diabetes. The continuous progression of chronic kidney disease will eventually lead to the occurrence of end-stage renal disease (ESRD) and its associated complications, and CKD patients have high arterial stiffness. The risk of cardiovascular events and cardiovascular events often combined with cardiovascular disease, and CVD is the most important complication of chronic kidney disease. The mortality rate is about 44% to 51% of the total mortality of chronic kidney disease. It is the leading cause of death in these patients. It is reported that the incidence of CVD in patients with mild renal failure is higher than that of the general population, and the incidence of CVD is higher. As the rate of renal function progresses, the rate reaches the peak at ESRD. The prevalence rate of CVD in CKD patients is mostly concentrated in ESRD and dialysis patients, and the investigation of early CKD patients is very small.
In this study, we reviewed and analyzed 491 cases of chronic kidney disease (CKD) in No.1 Hospital of Peking University and Shandong University from July 2001 to June 2014, who were followed up for more than 1 years in the clinic of chronic kidney disease (CKD) of Shandong University. The results of room examination, electrocardiogram, color Doppler ultrasound and other related auxiliary examinations, the staging of the patients with chronic kidney disease, the diagnosis of the primary disease and the occurrence of CVD were obtained. The SPSS20.0 software was used for statistical analysis. The comparison of the mean values between the groups was carried out by the single factor analysis of variance, and the t test was used to compare the classification variables, and the X2 test was used. The prevalence of CVD in patients with different age, sex, primary disease and different stages of kidney disease was analyzed, and multiple factor Logistic regression analysis was carried out. The effects of risk factors such as age, blood pressure, blood lipid, urine protein, albumin, uric acid, uric acid, blood phosphorus, renal function, eGFR on the cardiovascular disease of the patients with CKD were analyzed. The results were found with C. The results were found with C In the progress of KD, the incidence of CVD is rising gradually, and the higher the age of CKD3, the greater the age of the patients with CKD, the greater the risk of cardiovascular events, and the male patients are more likely to have CVD. in the primary investigation than the female patients with diabetic nephropathy, and the hypertension nephrosis is the most. These patients are more likely to have the CVD. clinical survey. The results indicate that the rate of cardiovascular disease in patients with chronic kidney disease is higher, age, hypertension, hyperlipidemia, proteinuria, hypoproteinemia, hyperphosphoremia, and hyperphosphoremia are independent risk factors for the occurrence of cardiovascular events, and high blood pressure, high blood phosphorus has the greatest impact on the cardiovascular events in CKD patients. The related risk factors of the tube provide a theoretical basis for the early prevention and treatment of cardiovascular events in CKD patients and the improvement of the quality of life of the patients. This study belongs to the primary stage of clinical investigation, and the number of cases is less, and further research has yet to be studied.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5

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