慢性肾脏病患者主动脉僵硬度相关指数变化及影响因素分析  

Aortic stiffness and its influencing factors in patients with chronic kidney disease

作　　者：叶彬娴[1] 赵黎[1] 沈维[1] 任燕[1] 林波[1] 陈茂盛[1] 汤俊达[1] 蒋欣欣[1] 李一文[1] 何强[1] 

机构地区：[1]浙江省人民医院肾脏病科

出　　处：《浙江大学学报（医学版）》2016年第5期508-514,共7页Journal of Zhejiang University(Medical Sciences)

基　　金：浙江省重大科技专项计划(2014C03047-2);浙江省医药卫生重大科技计划(WKJ2013-2-002);浙江省卫生高层次医坛新秀人才培养工程(2013)

摘　　要：目的：探讨慢性肾脏病（CKD）患者主动脉僵硬度相关指数的变化及其影响因素。方法：分析浙江省人民医院肾脏病科住院的CKD患者84例，根据是否接受透析治疗分为透析组（CKD5期，48例）和非透析组（CKD3—5期，36例）。收集患者的临床资料、生物化学指标和心脏超声检查结果，通过Sphygmo Cor脉搏分析系统测定动脉僵硬度相关指标中心动脉收缩压（CSP）、中心动脉脉压差（CPP）、反射波强度（AP）、主动脉增益指数（AIX）和心率75校正的增益指数（HR75AIX），并采用Spearman相关性分析和多元回归分析探索动脉僵硬度相关指标的影响因素。结果：非透析组和透析组患者的CSP、CPP、AP、AIX、HR75AIX差异均无统计学意义（均P〉0．05）。Spearman相关性分析结果显示，CSP与收缩压、舒张压、胆固醇、低密度脂蛋白胆固醇、左心房内径（LA）、收缩期左心室内径（LVDs）和舒张期左心室内径（LVDd）呈正相关，与血钙、血红蛋白呈负相关；CPP与收缩压、年龄、LA、LVDd呈正相关，与舒张压、血红蛋白呈负相关；AP与收缩压、年龄、LA、LVDd呈正相关，与血红蛋白呈负相关；AIX与收缩压、年龄、血钠呈正相关，与血磷水平呈负相关；HR75AIX与收缩压、血钠、胆固醇呈正相关，与血红蛋白、白蛋白呈负相关。多元回归分析结果显示，CSP的主要影响因素为收缩压（β=0．944，P〈0．01）；CPP的主要影响因素为收缩压（β=0．939，P〈0．01）、舒张压（β=-1．010，P〈0．01）；AP的主要影响因素为收缩压（β=0．200，P〈0．01）、年龄（β=0．237，P〈0．01）；AIX的主要影响因素为收缩压（β=0．163，P〈0．01）、血钠（β=0．646，P〈0．05）；HR75AIX的主要影响因素为收缩压（β=0．115，P〈0．05）、血钠（β=0．625，P〈0．05）。结论：主动脉僵硬度与CKD分期未见明显相关性．控制血压和Objective： To investigate the changes of aortic stiffness and its influencing factors in patients with chronic kidney diseases （CKD）. Methods： Eightyfour patients with CKD from Department of Nephrology, Zhejiang Provincial People＇ s Hospital were divided into the dialysis group （CKD stage 5, n = 48 ） and non-dialysis group （CKD stage 3 -5, n = 36 ）. Clinical data, biochemical parameters and echocardiography findings were collected. SphygmoCor pulse wave analysis system was used to obtain pulse wave analysis （PWA） parameters including central aortic systolic blood pressure （ CSP）, central pulse pressure （ CPP）, augmented pressure （ AP）, augmentation index （AIX）, and heart rate 75-adjusted augmentation index （HR75AIX）. The influencing factors of aortic stiffness were analyzed by spearman correlation analysis and multiple regression analysis. Results： CSP, CPP, AP, AIX and HR75 AIX in dialysis patients had no significant differences compared with those in non-dialysis group （ all P 〉 0.05）. Spearman correlation analysis showed that CSP was positively correlated with systolic blood pressure, diastolic blood pressure, cholesterol, low-density lipoprotein cholesterol, left atrial diameter （LA）, left ventricular systolic diameter （ LVDs ）, left ventricular diastolic diameter （ LVDd ）, and negatively correlated with calcium and hemoglobin levels. CPP was positively correlated with systolic blood pressure, age, LA, LVDd, and negatively correlated with diastolic blood pressure and hemoglobin levels. AP was positively correlated with systolic blood pressure, age, LA, LVDd, and negatively correlated with hemoglobin levels. AIX was positively correlated with systolic blood pressure, age, sodium, and negatively correlated with phosphorus levels. HR75AIX was positively correlated with systolic blood pressure, sodium, cholesterol, and negatively correlated with hemoglobin and albumin levels. Multiple regression analysis showed that higher systolic blood pressure was t

关 键 词：肾疾病/病理生理学 动脉硬化 血压 

分 类 号：R692[医药卫生—泌尿科学]