腹膜透析患者并发脑卒中相关危险因素临床分析  

Risk factors in peritoneal dialysis patients with acute stroke

作　　者：邹芸[1] 周华[1] 

机构地区：[1]常州市第一人民医院苏州大学附属第三医院肾内科,江苏常州213003

出　　处：《临床荟萃》2017年第5期429-431,436,共4页Clinical Focus

摘　　要：目的寻找腹膜透析患者脑卒中并发症的危险因素。方法选取慢性肾衰竭CKD5期接受持续性非卧床腹膜透析患者(透析时间≥3月)129例,根据有无脑卒中并发症分为两组,比较两组年龄、体重指数(BMI)、腹透月龄、平均动脉压、血红蛋白、白蛋白、尿素氮、肌酐、校正钙、磷、全段甲状旁腺激素(iPTH)、胆固醇、甘油三酯、腹透液类型、尿素清除指数(Kt/V),分析其与脑卒中的关系。结果与无脑卒中组比较,脑卒中组年龄较大,白蛋白、尿素氮、iPTH、Kt/V水平低,甘油三酯水平高(P<0.05)。多因素Logistic回归分析显示,高龄、平均动脉压升高、高钙腹膜透析液、高甘油三酯为腹膜透析患者脑卒中独立危险因素,高白蛋白为其保护因素。平均动脉压高、甘油三酯高为腹膜透析患者脑出血或脑血肿的独立危险因素。高龄为腹膜透析患者脑梗死的独立危险因素,高白蛋白为其保护因素。结论腹膜透析患者脑卒中发生率较高,与血压未控制、低白蛋白血症、脂质代谢紊乱、iPTH水平、透析不充分密切相关,低钙透析液能改善终末期肾病患者的钙磷代谢,明显减少腹膜透析患者并发脑卒中的风险。Objective To investigate the risk factors in patients with acute stroke receiving peritoneal dialysis（PD）.Methods The clinical data of 129 cases with end-stage renal disease receiving continuous ambulatory peritoneal dialysis（CAPD）for more than 3months were collected for retrospective analysis.A total of 25 cases in PD with acute stroke were chosen as study group while the other 104 cases in peritoneal dialysis without stroke served as control group.The clinical data included age,body mass index（BMI）,duration of PD,hypertension,hemoglobin,serum albumin（Alb）,blood urea nitrogen（BUN）,serum creatinine（Scr）,corrected serum calcium,serum phosphate,serum intact parathyroid hormone（iPTH）,total cholesterol,triglycerides,PD type and Kt/V and their relationships with stroke were analyzed.Results The levels of Alb,BUN,iPTH and Kt/V in study group were significantly lower than those in control group,while age and triglycerides were significantly higher（P〈0.05）.Multivariate logistic regression analysis showed that age（P =0.044）,hypertension（P =0.007）,Alb（P =0.009）,PD type（P =0.005）and triglycerides（P =0.005）were independent risk or protective factors for stroke in PD patients.Hypertension（P =0.007）and triglycerides（P =0.034）were independent risk factors for cerebral hemorrhage or cerebral hematoma in PD patients.Age（P =0.021）and Alb（P =0.025）were independent risk or protective factors for cerebral infarction in PD patients.Conclusion The high morbidity of stroke in PD patients has close correlation with uncontrolled hypertension,low serum albumin,lipid metabolism disorder,iPTH and incomplete dialysis.Low calcium dialysate improves calcium phosphate metabolism and calcium overload,it can significantly reduce the incidence of stroke in endstage renal patients receiving PD.

关 键 词：肾功能不全 慢性 腹膜透析 卒中 

分 类 号：R692.5[医药卫生—泌尿科学]