不同分期非透析慢性肾脏病患者自主神经功能变化及其影响因素分析  

Changes of autonomic nervous function and its influencing factors in patients with non-dialysis chronic kidney disease at different stages

作　　者：杨正婷 贾乐文[2] YANG Zhengting;JIA Lewen(Intergrated Care Management Center,West China Hospital of Sichuan University,Chengdu,Sichuan 610041,China;Department of Nephrology,First Affiliated Hospital of Dalian Medical University,Dalian,Liaoning 116000,China)

机构地区：[1]四川大学华西医院全程管理中心,四川成都610041 [2]大连医科大学附属第一医院肾内科,辽宁大连116000

出　　处：《检验医学与临床》2024年第4期491-497,502,共8页Laboratory Medicine and Clinic

摘　　要：目的探讨不同分期非透析慢性肾脏病(CKD)患者自主神经功能变化及其影响因素。方法选取2014—2019年于大连医科大学附属第一医院住院治疗并进行动态心电图检查的非透析CKD患者236例为研究对象,根据CKD分期将研究对象分为CKD1~5期组(各49、51、58、40、38例)。比较不同分期患者心率变异性(HRV)时域分析指标[24 h正常R-R间期的标准差(SDNN)、24 h内每5 min R-R间期平均值的标准差(SDANN)、24 h全程相邻R-R间期之差的均方根]、频域分析指标[低频功率(LF)、高频功率(HF)、LF/HF]水平及HRV下降情况;分析各临床指标与HRV的相关性;分析引起非透析CKD患者HRV下降的独立危险因素。结果CKD5期组患者SDNN水平明显低于CKD1~3期组患者,CKD1期组患者SDNN水平明显高于CKD3~4期组患者,CKD5期组患者SDANN水平明显低于CKD1~2期组患者,差异有统计学意义(P<0.05)。CKD5期组患者LF水平明显低于CKD1~2期组患者,LF/HF明显低于CKD1~4期组患者,差异有统计学意义(P<0.05)。CKD1~5期HRV下降患者所占比例分别为14.3%、37.3%、39.7%、60.0%、71.1%,差异有统计学意义(P<0.001)。SDNN与年龄、收缩压、24 h尿蛋白定量、甲状旁腺激素、磷、钾、同型半胱氨酸水平呈负相关(P<0.05),与预估肾小球滤过率(eGFR)、清蛋白、血红蛋白、钙、高密度脂蛋白胆固醇水平呈正相关(P<0.05)。多因素Logistic回归分析结果显示,年龄增长、合并糖尿病、eGFR下降是非透析CKD患者HRV下降的独立危险因素(P<0.05)。结论非透析CKD患者自主神经功能紊乱以交感神经活性增强为主,且随着疾病进展,自主神经功能紊乱发生率逐渐升高;临床应根据危险因素积极采取干预措施,以预防因自主神经功能紊乱导致的不良心血管事件。Objective To explore the changes of autonomic nervous function and its influencing factors in patients with non-dialysis chronic kidney disease(CKD)at different stages.Methods A total of 236 non-dialysis CKD patients who were hospitalized at the First Affiliated Hospital of Dalian Medical University from 2014 to 2019 and underwent dynamic electrocardiogram examinations were selected as the study subjects.The study subjects were divided into CKD1-5 stage groups based on CKD staging(49,51,58,40,38 cases respectively).Compared the levels of time-domain[standard deviation of normal R-R interval at 24 h(SDNN),standard deviation of the mean R-R interval every 5 min in 24 h(SDANN),root mean square of the difference between adjacent R-R intervals throughout 24 h]and frequency-domain[low frequency power(LF),high frequency power(HF),LF/HF]analysis indicators of heart rate variability(HRV)and HRV decline situation in patients with different stages.The correlation between clinical indicators and HRV indicators was analyzed.The independent risk factors for HRV decline in non-dialysis CKD patients were analyzed.Results The SDNN level of patients in CKD5 stage group was significantly lower than that of patients in CKD1-3 stage group,and the SDNN level of patients in CKD1 stage group was significantly higher than that of patients in CKD3-4 stage group,the SDANN level of patients in CKD5 stage group was significantly lower than that of patients in CKD1-2 stage group,and the differences were statistically significant(P<0.05).The LF level of patients in the CKD5 stage group was significantly lower than that of patients in the CKD1-2 stage group,and LF/HF level was significantly lower than that of patients in the CKD1-4 stage group,and the differences were statistically significant(P<0.05).The proportion of patients with decreased HRV in CKD1 to stage 5 were 14.3%,37.3%,39.7%,60.0% and 71.1% respectively,the differences between the groups were statistically significant(P<0.001).SDNN correlated negatively with age,systolic blood pres

关 键 词：慢性肾脏病 自主神经功能 心率变异性 肾小球滤过率 非透析 

分 类 号：R692[医药卫生—泌尿科学]