CAPD患者血清胱抑素C水平与左心室肥厚的相关性研究

发布时间：2018-07-13 08:29

【摘要】：背景:持续非卧床腹膜透析(Continuous ambulatory peritoneal dialysis,CAPD)是终末期肾病(End stage of renal disease,ESRD)患者肾脏替代治疗方式之一。随着腹膜透析(Peritoneal dialysis,PD)技术的不断完善,CAPD患者生存率提高,但腹膜透析患者心血管病并发症的发生率仍较高,以左心室肥厚(Left ventricular hypertrophy,LVH)及功能障碍最为常见,越来越多的研究证实LVH可独立预测心血管疾病的死亡率。近几年,胱抑素C(Cystatin C,Cys C)与心脏结构及功能的相关性已成为国内外的研究热点,文献报道Cys C在钙化瓣膜及伴有功能障碍的心肌表达增加,但对于CAPD患者,胱抑素C与左心室肥厚的相关研究较少,因此本研究探讨胱抑素C与CAPD患者LVH的相关性,为今后干预腹膜透析患者的危险因素、防治心血管病并发症等方面提供理论依据。目的:研究胱抑素C与CAPD患者LVH的相关性,为早期防治CAPD患者左心室肥厚、降低心血管并发症提供一定的理论依据。方法:选择2016年1月-2016年12月在吉林大学第一医院二部肾内科腹膜透析中心,稳定透析三个月以上的CAPD患者129例,根据左心室质量指数分为LVH组和无LVH组。选取健康对照组63例,均为在本院体检中心就诊的健康体检者,记录体检者的血清胱抑素C水平。收集CAPD患者一般资料、生化指标、超声心动图测量的左心房内径(Left atrial diameter,LAD)、左心室舒张末期内径((Left ventricular end-systolic diameter,LVDd)、室间隔厚度(Interventricular septal thickness,IVST)、左心室后壁厚度(Left ventricular posterior wall thickness,LVPWT)。根据Devereux校正公式计算左心室质量指数(Left ventricular mass index,LVMI),LVH诊断标准为LVMI130g/m2(男性)、LVMI100g/m2(女性)[1]。分析血清Cys C与CAPD患者LVH的相关性。运用社会科学统计软件包(SPSS 20.0)软件包对以上数据进行统计描述和分析。结果:1、129例CAPD患者LVH组和无LVH组的一般资料比较:LVH者60例,发生率为46.5%;LVH组透析龄长于无LVH组,收缩压、脉压高于无LVH组,LVH组患者伴有高血压者达23例,占LVH组总人数的38.3%,无LVH组患者伴有高血压者达11例,占无LVH组总人数的15.9%,两组组间比较差异有统计学意义(P0.05)。2、129例CAPD患者LVH组和无LVH组的生化指标比较:LVH组血清磷、胱抑素C、甲状旁腺激素水平高于无LVH组,血清白蛋白水平低于无LVH组,两组差异有统计学意义(P0.05)。3、采用Logistic回归分析示血清Cys C、甲状旁腺激素、血磷,高血压、收缩压是CAPD患者左心室肥厚的危险因素(P0.01)。4、129例CAPD患者的血清Cys C水平为(6.42±1.29mg/L),健康对照组血清Cys C水平为(0.92±0.23 mg/L),两组组间差异显著、有统计学意义(P0.01);129例CAPD患者血清Cys C与血清SCr、收缩压、脉压正相关,与GFR、Kt/V负相关(P0.05),与其他指标无相关性。5、129例CAPD患者LVH组和无LVH组心脏彩超结果比较:LVH组的LAD、LVDd、LVPWT、IVST、LVMI高于无LVH组,LVH组的LVEF低于无LVH组,两组比较有统计学意义(P0.05)。6、60例CAPD左心室肥厚患者血清Cys C水平与心脏参数的相关性:血清Cys C与LVMI、LVPWT、LVDd正相关,血清Cys C与LVEF负相关(P0.05)。结论:1、CAPD患者血清Cys C水平高于健康人群,CAPD并发左心室肥厚患者血清Cys C水平明显高于无左心室肥厚者。2、CAPD患者血清Cys C与左心室质量指数、收缩压、脉压正相关,Cys C可以作为预测CAPD患者左心室肥厚的生化学指标。
[Abstract]:Background: continuous ambulatory peritoneal dialysis (Continuous ambulatory peritoneal dialysis, CAPD) is one of the renal replacement therapies for patients with end-stage renal disease (End stage of renal disease, ESRD). With the continuous improvement of peritoneal dialysis (Peritoneal) technology, the survival rate of patients is improved, but the patients with peritoneal dialysis are complicated with cardiovascular disease. The incidence of the disease is still high, Left ventricular hypertrophy (LVH) and dysfunction are the most common. More and more studies have shown that LVH can predict the mortality of cardiovascular disease independently. In recent years, the correlation of cystatin C (Cystatin C, Cys C) with cardiac structure and energy has become a hot topic at home and abroad. Literature reports C The expression of YS C increased in calcified valvular and dysfunctional myocardium, but for CAPD patients, the correlation between cystatin C and left ventricular hypertrophy was less. Therefore, this study explored the correlation between cystatin C and LVH in CAPD patients, providing a theoretical basis for the future intervention in the risk factors of peritoneal dialysis patients and the prevention and treatment of cardiovascular complications. To study the correlation between cystatin C and LVH in patients with CAPD, to provide a certain theoretical basis for early prevention and treatment of left ventricular hypertrophy and cardiovascular complications in CAPD patients. Methods: in December -2016 January 2016, two nephrology peritoneal dialysis centers in No.1 Hospital of Jilin University were selected, and 129 cases of CAPD patients who were stable dialysis for more than three months, according to the left heart. The ventricular mass index was divided into LVH group and no LVH group. 63 healthy controls were selected from the health control group. The serum cystatin C levels were recorded in the physical examination center of the hospital. The general data of the CAPD patients, biochemical indexes, the left atrial diameter (Left atrial diameter, LAD) measured by echocardiography, and the left ventricular end diastolic diameter (Le (Le) were measured (Le). FT ventricular end-systolic diameter, LVDd), interventricular septum thickness (Interventricular septal thickness, IVST), and left ventricular posterior wall thickness (Left ventricular posterior). I100g/m2 (female) [1]. analysis of the correlation between serum Cys C and LVH in CAPD patients. The above data were statistically described and analyzed using the software package (SPSS 20) software package (SPSS 20). Results: the general data of the LVH group and the non LVH group in 1129 CAPD patients were compared with the LVH 60 cases and the incidence rate of 46.5%; the length of the dialysis age of the LVH group was longer than that of no group, systolic pressure, Pulse pressure is higher than no LVH group, group LVH patients with hypertension, 23 cases, accounting for 38.3% of the total number of LVH group, no LVH patients with 11 cases of hypertension, accounting for 15.9% of the total number of LVH group, the two groups were statistically significant (P0.05).2129 cases CAPD patients LVH group and no LVH group biochemical indexes: LVH group serum phosphorus, Cystatin C, a, a, a C, a, a cystatin C, a, a The level of parathyroid hormone was higher than that in no LVH group. The serum albumin level was lower than that without LVH group. The two groups were statistically significant (P0.05).3. The Logistic regression analysis showed that serum Cys C, parathyroid hormone, blood phosphorus, hypertension, and systolic pressure were the risk factors of left ventricular hypertrophy in CAPD patients (P0.01).4129 CAPD patients' serum Cys levels were (6.42 +) 1.29mg/L), the level of serum Cys C in the healthy control group was (0.92 + 0.23 mg/L), and the difference between the two groups was significant (P0.01). The serum Cys C in 129 cases of CAPD patients was positively correlated with the serum SCr, systolic pressure and pulse pressure, and was negatively correlated with GFR, Kt/V (P0.05). The LAD, LVDd, LVPWT, IVST, LVMI in the group H were higher than the non LVH group, and the LVEF in the LVH group was lower than that in the non LVH group. The two groups were statistically significant (P0.05). The level of serum Cys C in patients with CAPD complicated with left ventricular hypertrophy was significantly higher than that of.2 without left ventricular hypertrophy. The serum Cys C in patients with CAPD was positively correlated with left ventricular mass index, systolic pressure and pulse pressure. Cys C could be used as a biochemical indicator for predicting left ventricular hypertrophy in CAPD patients.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5;R542.2

【相似文献】