珠三角地区血液透析患者糖尿病与血栓栓塞性疾病的相关关系研究  

The association of diabetic mellitus and thromboembolic disease in the hemodialysis patients in the Pearl River Delta Region-A multicenter cross section study

作　　者：陈玉平[1] 伍锦泉[1] 黄宇静[1] 姜宗培[2] 苏宁[2] 

机构地区：[1]广东省肇庆市第一人民医院肾内科,肇庆526000 [2]中山大学附属第六医院肾内一科

出　　处：《临床肾脏病杂志》2017年第12期721-725,共5页Journal Of Clinical Nephrology

基　　金：国家自然科学基金(No.81500552)

摘　　要：目的研究珠三角地区血液透析患者合并血栓栓塞性疾病的特点,分析糖尿病与血栓栓塞性疾病间的相关关系。方法纳入2016年7月1日至2016年9月30日在珠三角地区十家血液透析中心规律血液透析患者1 085例,按既往是否发生过脑梗死或心肌梗死或内瘘栓塞定义为发生血栓栓塞性疾病,将患者分为血栓栓塞组(n=115)及非栓塞组(n=970),收集其人口学资料、透析前后血压、超滤量、透析间期增重率、Kt/V、实验室检查、抗凝剂、铁剂、降压药等数据,比较2组间的差别,通过多因素Logistic回归分析其发生血栓栓塞性疾病的危险因素,并分析其与糖尿病的相关关系。结果共纳入患者1085例,平均年龄(52.7±14.3)岁,男性比例61.1%。与非栓塞组比较,血栓栓塞组患者年龄偏大[(60.1±13.9)岁比(51.8±14.0)岁,P<0.01],透前舒张压偏低[(79.59±10.90)mmHg比(82.79±11.47)mmHg,P=0.005],血小板偏高[(201.77±75.35)×10~9/L比(184.55±64.02)×10~9/L,P=0.008],血肌酐水平偏低[(912.99±283.82)μmol/L比(1 053.65±308.01)μmol/L,P<0.01],糖尿病比率偏高[41.7%比16.0%,P<0.01]。合并糖尿病患者平均年龄偏大[(60.11±10.99)岁比(50.95±14.37)岁,P<0.01];糖尿病患者发生脑梗死(14.3%比2.5%,P<0.01)、心肌梗死(6.4%比1.2%,P<0.01)及内瘘栓塞(7.9%比4.2%,P=0.028)比例均高于非糖尿病组。通过多因素Logistic回归发现:高龄(P=0.004,OR=1.034)、糖尿病(P=0.001,OR=2.648)、血小板增多(P=0.015,OR=1.004)是珠三角地区血液透析患者发生血栓栓塞性疾病的独立危险因素。结论糖尿病、血小板增多、高龄是珠三角血液透析患者发生血栓栓塞性疾病的独立危险因素。Objective To investigate the risk factors of thromboembolic disease and the relationship with diabetic mellitus in the hemodialysis patients（HD）in the Pearl River Delta Region.Methods 1 085 HD patients were enrolled in the study from July 1,2016 to September 30,2016 and assigned into the thrombus group（n=115）and non-thrombus group（n=970）in terms of the presence or absence of stroke or myocardial infarction or thrombus in arteriovenous fistula.The demographic data and blood pressure,ultrafiltration volume,Kt/V,laboratory data were collected and the risk factors of thromboembolic disease and the role of diabetes were analyzed by multiple Logistic regression.Results The patients in thrombus disease group were older[（60.1±13.9）years vs.（51.8±14.0）years,P〈0.01]with lower diastolic blood pressure before dialysis[（79.59±10.90）mmHg vs.（82.79±11.47）mmHg,P=0.005],more blood platelets [（201.77±75.35）×10~9/L vs.（184.55±64.02）×10~9/L,P =0.008）],lower serum creatine[（912.99±283.82）μmol/L vs.（1 053.65±308.01）μmol/L,P〈0.01）]and higher mobility of diabetes（41.7% vs.16.0%,P〈0.01）.The patients with diabetic mellitus were older[（60.11±10.99）years vs.（50.95±14.37）years,P〈0.01）]and higher morbidity of stroke（14.3% vs.2.5%,P〈0.01）,myocardial infarction（6.4% vs.1.2%,P〈0.01）and thrombus in arteriovenous fistula（23.6% vs.7.6%,P=0.028）.The increase of age（P=0.004,OR=1.034）and blood platelets（P=0.015,OR=1.004）and the incidence of diabetes（P=0.001,OR=2.648）were the risk factors of thrombus disease by multiple regression.Conclusions The increase of age and blood platelets and the incidence of diabeteswere the risk factors of thromboembolic disease in the HD patients in the Pearl River Delta Region.

关 键 词：血液透析 血栓栓塞性疾病 糖尿病 

分 类 号：R587.1[医药卫生—内分泌] R692.5[医药卫生—内科学]