持续性非卧床腹膜透析患者容量超负荷与大动脉僵硬度的关系  

Association between fluid overload and arterial stiffness in patients on continuous ambulatory peritoneal dialysis

作　　者：唐利军[1] 陈慧敏[1] 程李涛[1] 顾玥[1] 汪涛[1] 

机构地区：[1]北京大学第三医院肾内科,100083

出　　处：《中华肾脏病杂志》2007年第2期106-109,共4页Chinese Journal of Nephrology

基　　金：教育部长江学者奖励计划和教育部教育振兴行动计划专项基金（985工程）

摘　　要：目的探讨持续性非卧床腹膜透析（CAPD）患者细胞外液（ECW）与总体水（TBW）的比率（E／T）与脉搏波速度（PWV）的关系。方法选取56例CAPD患者为研究对象。自动PWV分析仪测定PWV。多频生物电阻抗分析仪对患者的容量状态进行评估。对相应指标进行相关及多元回归分析，筛选出PWV的影响因素。结果结果显示E／T（β=0．472．P=0．001）、脉压（β=0．442，P=0．001）、C反应蛋白（β=0．246，P=0．05）是PWV增加的独立危险因素。3者一起决定了PWV变化的58．1％，其中E／T决定37．8％。结论在透析患者中容量超负荷可能是通过动脉硬化程度的加重导致心血管疾病发生率和病死率增加的。Objective To investigate the association between E/T （extracellular water to total body water ratio） and pulse wave velocity （PWV） in patients on continuous ambulatory peritoneal dialysis （CAPD）. Methods Clinical stable CAPD patients （n=56,26M/30F） in one single center were included. Carotid-femoral PWV was measured with a validated automatic device and was used as an index of large arterial stiffness. Multiple-frequency bioelectrical impedance analysis was used to record the values for ECW, intracellular water （ICW）, and total body water. Based on these data, E/T was also calculated. In addition, some biochemical indices, such as serum albumin, blood urea nitrogen, serum creatinine, serum triglycerides, total cholesterol lipeprotein, low-density lipoprotein, high-density lipoprotein, alanine and aspartate transaminase, etc were determined with standard methods. Pearson＇s correlation and multiple regression analysis were performed to identify the relationship between E/T and PWV. Results PWV was strongly associated with E/T （r = 0.454, P = 0.001）, E/I（r = 0.456, P = 0.001）, pulse pressure（PP）（r = 0.649, P 〈 0.01 ）,age（r = 0.404, P = 0.002）, serum albumin（r= -0.346, P = 0.01 ）and CRP（r =0.327, P= 0.025）, respectively. Multiple regression analysis showed that PWV was independently determined by E/T（β = 0.472, P = 0.001 ）, PP（β = 0.442, P = 0.001） and CRP（β = 0.246,P = 0.05）. They accounted for 58.1% of the total variance and E/T alone represented 37.8% of the explained variance. Conclusions E/T is closely associated with PWV in CAPD patients. E/T, in addition to PP and CRP, is an independent risk factor for elevating PWV in CAPD patients, suggesting that the increase of arterial stiffness may be the link between fluid overload and cardiovascular events and mortality in CAPD patients.

关 键 词：动脉硬化 心血管疾病 血浆容量 脉搏波速度 细胞外液 

分 类 号：R686[医药卫生—骨科学]