高踝臂指数与腹膜透析患者心血管事件的相关分析  

Relationship between high ankle-brachial index and cardiovascular events in patients on peritoneal dialysis

作　　者：苏晓燕 郑伟平 李爱婷 梁翔 谢应业 丁苏 黄辉[2] SU Xiao-yan;ZHENG Wei-Pingl;LI Ai- Ting;LIANG Xiang;XIE Ying- Ye;DING Su;HUANG Hui(Department of Nephrology, Donghua Hospital of Sun Yat-sen University, Dongguan 52311 O, Guangdong, C hina;Department of Cardiology, Sun Yat-sen Memorial Hospital, 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,广州510120

出　　处：《中国血液净化》2018年第5期304-307,共4页Chinese Journal of Blood Purification

基　　金：国家自然科学基金优秀青年科学基金项目(项目编号:81422011);广东省医学科学技术研究基金面上项目(编号:A2016248)

摘　　要：目的 评价高踝臂指数(ankle-brachial index,ABI)与腹膜透析患者主要不良心血管事件(major adverse cardiovascular events,MACE)的相关性。方法 研究对象为慢性肾脏病5期行腹膜透析(PD)治疗超过3个月的患者98例,收集患者基础资料、ABI、Framingham心血管疾病风险因素及各项实验室指标,并对相关指标进行分析。结果 单侧或双侧ABI>1.3为高ABI组(33例),0.9<双侧ABI<1.3为正常ABI组(65例),随访期间共发生MACE 28例,高ABI组患者MACE发生率明显较正常ABI组高(15/33比13/65,P=0.008)。高ABI组患者透析龄、血压、钙、缺血修饰白蛋白(ischemia modified albumin,IMA)水平、超敏C反应蛋白(hypersensitive Creactive protein,hs-CRP)较正常ABI组高,血浆白蛋白、残余肾小球滤过率(residual glomerular filtration rate,r GFR)、24h尿量较正常ABI组低,差异有统计学意义。依据Framingham心血管疾病(cardiovascular disease,CVD)风险因素将入组患者分为CVD 0~1组(36例,无风险因素或仅1个CVD风险因素),CVD 2~3组(40例,存在2~3个CVD风险因素),CVD 4组(22例,存在4个以上CVD风险因素),3组高ABI发生率分别为19.444%(7/36)、27.500%(11/40)、68.181%(15/22),3组之间高ABI发生率比较有统计学意义(χ~2=15.676,P<0.001)。Logistic回归分析显示透析龄、钙、IMA、hs-CRP是最主要影响因素。结论 高踝臂指数与腹膜透析患者心血管事件密切相关,透析龄、血钙水平、氧化应激和炎症是高ABI的最主要影响因素。Objective To investigate the relationship between high ankle-brachial index （ABI） and ma-jor adverse cardiovascular events （MACE） in patients on peritoneal dialysis （PD）. Methods A total of 98 chronic kidney disease patients treated with PD over 3 months were recruited. Baseline characteristics, ABI, Framingham cardiovascular risk factors and other laboratory measurements were collected and analyzed. Re-sults Patients were divided into two subgroups according to ABI value. Among these participants, 33 partici-pants （one-side or two-sides ABI-1.3） were assigned in high ABI group and the other 65 participants （0.9〈 two-sides ABI〈 1.3） were assigned in normal ABI group. Twenty-eight patients suffered MACE. PD patients with high ABI had higher incidence of MACE than those with normal ABI （15/33 vs. 13/65, P=-0.008）. Com-pared with normal ABI group, patients in high ABI group had significantly higher dialysis age, blood pres-sure, serum calcium, ischemia modified albumin （IMA） and high sensitivity C-reactive protein （hs-CRP）, and lower serum albumin, residual GFR （rGFR） and 24h urine volume. According to Framingham cardiovascular risk factors, all of the PD patients could be divided into three groups： cardiovascular disease （CVD） 0-1 group （36 participants with 0-1 Framingham cardiovascular risk factor）, CVD 2-3 group （40 participants with 2-3 Framingham cardiovascular risk factors）, CVD 4 group （22 participants with more than 4 Framingham cardio-vascular risk factors）. The prevalence of high ABI was statistically different among the three groups （19.444%, 27.500% and 68.181%; ehi square= 15.676, P=0.000）. Logistic regression analysis showed that dial-ysis age, serum calcium, IMA level and hs-CRP level were the independent risk factors for high ABI. Conclu-sions High ABI was closely related to cardiovascular events in PD patients. Dialysis age, serum calcium, oxi-dative stress and inflammation were the most important factors for high ABI.

关 键 词：踝臂指数 腹膜透析 动脉钙化 主要不良心血管事件 

分 类 号：R459.5[医药卫生—治疗学]