慢性肾脏病患者心功能状况和心血管疾病危险因素分析

发布时间：2018-05-17 11:04

本文选题：慢性肾脏病 + 心功能　；参考：《上海医学》2017年01期

【摘要】：目的分析上海崇明地区慢性肾脏病(CKD)患者的心功能状况,探讨CKD患者发生心血管疾病(CVD)的危险因素,为临床早期干预后降低CKD患者CVD的致残率和致死率提供理论依据。方法回顾性分析上海交通大学医学院附属新华医院崇明分院100例CKD患者的临床资料,比较不同CKD分期、有无行透析治疗、不同透析方式(血液透析和腹膜透析)、原发性或继发性CKD患者的心功能指标[脑利钠肽(BNP)水平、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)]和CVD发生的危险因素[血红蛋白(Hb)、血β2微球蛋白(β2-M)、甲状旁腺激素(PTH)和电解质(血钾、血钙、血磷)水平]。结果不同CKD分期、有无行透析治疗、不同透析方式的CKD患者性别构成和年龄的差异均无统计学意义(P值均0.05);继发性CKD患者的年龄显著大于原发性CKD患者(P0.05),两者间性别构成的差异无统计学意义(P0.05)。CKD 4至5期患者的血磷、BNP、血β2-M、PTH水平均显著高于CKD 1至3期患者(P值均0.05),LVEDD显著大于CKD1至3期患者(P0.05),Hb水平显著低于CKD 1至3期患者(P0.05);两者间血钾、血钙、LVEF的差异均无统计学意义(P值均0.05)。透析患者的血磷、BNP、血β2-M、PTH水平均显著高于未透析患者(P值均0.05),LVEF显著低于未透析患者(P0.05);两者间血钾、血钙、Hb水平和LVEDD的差异均无统计学意义(P值均0.05)。腹膜透析患者的血钾水平显著低于血液透析患者(P0.05),血β2-M水平显著高于血液透析患者(P0.05),LVEDD显著小于血液透析患者(P0.05);两者间血钙、血磷、BNP、Hb、PTH水平和LVEF的差异均无统计学差异(P值均0.05)。继发性CKD患者的Hb水平显著低于原发性CKD患者(P0.05);两者间血钾、血钙、血磷、BNP、血β2-M、PTH水平,以及LVEDD、LVEF的差异均无统计学意义(P值均0.05)。结论对于不同CKD分期、有无行透析治疗、不同透析方式(血液透析和腹膜透析)、原发性或继发性CKD患者,积极改善CVD发生相关的危险因素,如纠正贫血、改善矿物质和骨代谢异常、延缓肾功能减退、合理选择透析方式等,可能有助于CVD的防治。
[Abstract]:Objective to analyze the cardiac function of patients with chronic kidney disease (CKD) in Chongming district of Shanghai, and to explore the risk factors of cardiovascular disease in patients with CKD, so as to provide a theoretical basis for reducing the rate of disability and mortality of CVD in patients with CKD after early intervention. Methods the clinical data of 100 patients with CKD in Chongming Branch of Xinhua Hospital affiliated to Shanghai Jiaotong University Medical College were retrospectively analyzed. Different dialysis methods (hemodialysis and peritoneal dialysis), cardiac function index [brain natriuretic peptide] in patients with primary or secondary CKD, Left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDDD)] and risk factors of CVD [hemoglobin Hbn, serum 尾 _ 2-microglobulin (尾 _ 2-M _ 2, parathyroid hormone CVD) and electrolyte (serum potassium, blood calcium, blood phosphorus)]. Results there were different CKD stages. There was no significant difference in sex composition and age of CKD patients with different dialysis methods (P < 0.05), and the age of secondary CKD patients was significantly larger than that of primary CKD patients (P 0.05), and there was no significant difference in sex composition between them (P 0.05, P 0.05, P < 0.05), and the age of secondary CKD patients was significantly higher than that of primary CKD patients (P 0.05, P < 0.05). The serum levels of 尾 _ 2-MCKD and 尾 _ 2-MN in patients with stage 5 were significantly higher than those in patients with CKD from stage 1 to stage 3 (P < 0.05), and the levels of Hb in patients with CKD1 from stage 1 to stage 3 were significantly lower than those in patients with CKD from stage 1 to stage 3, and the levels of serum potassium between the two groups were significantly lower than those in patients with stage 1 to stage 3 of CKD. There was no significant difference in LVEF between two groups (P = 0.05). The levels of serum P and 尾 2-MN in dialysis patients were significantly higher than those in patients without dialysis (P < 0.05), but there was no significant difference in serum potassium, calcium, HB and LVEDD between the two groups (P < 0.05). The serum potassium level in peritoneal dialysis patients was significantly lower than that in hemodialysis patients, and the serum 尾 2-M level was significantly higher than that in hemodialysis patients. The HB level in secondary CKD patients was significantly lower than that in primary CKD patients (P 0.05). Conclusion for patients with different CKD stages, with or without dialysis treatment, with different dialysis methods (hemodialysis and peritoneal dialysis, primary or secondary CKD), the risk factors associated with CVD, such as correcting anemia, are positively improved. It may be helpful to prevent and cure CVD by improving abnormal mineral and bone metabolism, delaying renal dysfunction and selecting dialysis methods reasonably.
【作者单位】：上海交通大学医学院附属新华医院崇明分院肾内科;
【基金】：上海交通大学医学院科技基金项目资助(14XJ22016)
【分类号】：R692;R54

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