臂踝脉搏波传导速度预测腹膜透析患者心血管事件的价值  

Predictive value of brachial-ankle pulse wave velocity for cardiovascular events in peritoneal dialysis patients

作　　者：苏晓燕[1] 丁苏[1] 郑伟平[1] 李爱婷[1] 梁翔[1] 谢应业 黄辉[2] SU Xiaoyan DING Su ZHENG Weiping LI Aiting LIANG Xiang XIE Yingye HUANG Hui(Department of Nephrology, Donghua Hospital of Sun Yat-sen University, Guangdong Dongguan 523110, China Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou , 510120, China)

机构地区：[1]中山大学附属东华医院肾内科,东莞523110 [2]中山大学孙逸仙纪念医院心内科

出　　处：《肾脏病与透析肾移植杂志》2017年第3期229-234,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家自然科学基金优秀青年科学基金项目(81422011);广东省医学科学技术研究基金面上项目(20161122099434)

摘　　要：目的:评价臂踝脉搏波传导速度(baPWV)对腹膜透析患者主要不良心血管事件(MACE)的预测价值。方法:研究对象为终末期肾病行腹膜透析(PD)治疗>3个月的患者103例,收集患者基础资料、baPWV及各项实验室指标,并对相关指标进行分析。结果:随访期间发生MACE患者为MACE组29例,未发生MACE者(non-MACE组)74例。MACE组患者baPWV、缺血修饰白蛋白(IMA)水平、超敏C反应蛋白(hs CRP)较non-MACE组高,24h尿量、血浆白蛋白、总肌酐清除率(Ccr)、残余肾小球滤过率(r GFR)较non-MACE组低。Logistics分析显示baPWV是重要的心血管事件独立危险因素,OR=1.03(95%CI 1.01,1.11)。baPWV预测腹膜透析患者MACE的曲线下面积(AUC)为0.787(95%CI 0.695,0.862,Z=5.592,P<0.05),最佳截值为1 714 cm/s,灵敏度68.97%,特异度84.93%。以最佳截值将患者分为两组,正常baPWV组(baPWV<1 714 cm/s,71例),高baPWV组(baPWV≥1 714 cm/s,32例),Kaplan-Meier生存分析显示两组无心血管事件存活率存在统计学差异(P<0.000 1),Log-rank检验卡方值为33.07。结论:baPWV是腹膜透析患者发生主要不良心血管事件的良好预测指标。Objective：To evaluate the predictive value of brachial-ankle pulse wave velocity（baPWV） for major adverse cardiovascular events（MACE） in patients with peritoneal dialysis. Methodology：A total of one hundred three end stage renal（ESRD） patients with peritoneal dialysis over 3 months were enrolled into this study. Their baseline characteristics,baPWV and other laboratory measurements were collected and analyzed. According to the patients whether or not suffered from MACE,they were divided into two groups： MACE group（n = 29） and non-MACE group（n = 74）.Results：The patients in MACE group had significantly higher baPWV（1 943±479 cm/s vs 1 542± 325 cm/s,P〈 0. 001）,Ischemia modified albumin（IMA） levels and high sensitivity C-reactive protein（hs-CRP） and lower 24 h urine volume,serum albumin,total creatinine clearance,residual GFR（r GFR）. Multivariable logistic regression analysis results showed that baPWV,IMA and hs-CRP were independent risk factors for MACE. From ROC（receiver operating characteristic）curve analysis,the optimal cut-off of baPWV to predict MACE was 1 714 cm/s,with a sensitivity of 68. 97% and a specificity of 84. 93% [area under the curve,0. 787（95% confidence interval,0. 695,0. 862）; Z = 5. 592,P 〈 0. 05.]Then,two groups were devided. 71 patients had normal baPWV（baPWV 〈 1 714 cm/s） and were assigned the normal baPWV group,and the other 32 patients were assigned to high baPWV group（baPWV≥1 714 cm/s）. Survival analysis showed that there were significant difference between two groups in non-MACE survival（Log rank statistic χ~2= 33. 07,P〈0. 001）. Conclusion：BaPWV can be used as a predictor of peritoneal dialysis patients with MACE.

关 键 词：腹膜透析 臂踝脉搏波传导速度 动脉硬化 心血管事件 

分 类 号：R459.5[医药卫生—治疗学]