【摘要】 背景:维持性血液透析患者颈-股动脉脉搏波速度改变受多种因素影响。目的:探讨维持性血液透析患者颈-股动脉脉搏波速度改变及其相关因素分析。设计、时间及地点:相关性分析,交叉对照实验,于2006-01/08北京大学第三医院肾脏内科完成。对象:北京大学第三医院临床情况稳定的66例维持性血液透析患者。方法:收集患者一般情况、生化学指标、颈-股动脉脉搏波速度和主观综合营养状态的评估等4个方面资料。根据SGA营养评分将患者分为营养正常组49例、营养不良组17例。比较两组脉搏波速度的差异,采用单因素相关和多因素回归分析探讨脉搏波速度的相关因素。主要观察指标:患者颈-股动脉脉搏波速度,血白蛋白和甲状旁腺激素。结果:血液透析患者颈-股动脉脉搏波速度与年龄(r=0.284,P=0.021)、收缩压(r=0.468,P<0.001)、脉压(r=0.451,P<0.001)存在显著正相关,与透前血清肌酐(r=-0.347,P=0.004)、转铁蛋白(r=-0.284,P<0.05)、血前蛋白(r=-0.318,P<0.05)、血浆白蛋白(r=-0.263,P<0.05)和甲状旁腺激素(r=-0.167,P<0.05)存在负相关。多元逐步回归分析显示脉压和甲状旁腺激素是颈-股动脉脉搏波速度的独立影响因素。采用SGA营养评估营养状态,营养不良组颈-股动脉脉搏波速度明显增快,与营养正常组比较差异有显著性意义(P<0.05)。结论:脉压是维持性血液透析患者颈-股动脉脉搏波速度独立的影响因素。营养不良与动脉粥样硬化是维持性血液透析常见的并发症,两者关系密切,营养不良者脉搏波速度值增高。更多还原

【Abstract】 BACKGROUND: Carotid-femoral pulse wave velocity in hemodialysis patients is influenced by multiple factors. OBJECTIVE: To explore the carotid-femoral pulse wave velocity (PWVcf) changes and related factors in maintenance hemodialysis (MHD) patients. DESIGN, TIME AND SETTING: Non-randomized control experiment was performed at the Third Hospital of Peking University from January to August 2006. PARTICIPANTS: A total of 66 MHD patients were selected from Third Hospital of Peking University. METHODS: General clinical conditions, biochemical indexes, PWVcf and subjective nutritional state were evaluated. MHD patients were divided into two groups according to the state of nutrition evaluated with SGA: non-malnutrition (n=49), malnutrition group (n=17). The PWVcf of two groups was compared, and one-way and multiple regression analyses were performed to explore PWVcf-related factors. MAIN OUTCOME MEASURES: PWVcf, blood albumin and parathyroid hormone. RESULTS: PWVcf was significantly positively correlated with age (r = 0.284, P < 0.05), systolic blood pressure (r = 0.468, P < 0. 001), and pulse pressure (r =0.451, P < 0.001), while negatively correlated with prealbumin (r =-0.318, P < 0. 05), plasma-albumin (r =-0.263, P < 0.05), parathyroid hormone (r =-0.167, P < 0.05), serum creatinine (r =-0.347, P= 0.004) and transferring (r=-0.284, P < 0.05) before dialysis. Multiple regression analysis demonstrated that pulse pressure and parathyroid hormone were independently related with PWVcf. The PWVcf was significantly increased in malnutrition group compared with non-malnutrition group (P < 0.05). CONCLUSION: Pulse pressure is the major clinical determinants of arterial stiffness in patients with MHD independent of conventional risk factors for cardiovascular disease; Malnutrition and atherosclerosis are common complications of MHD, showing close relationship. The PWVcf was significantly increased in malnutrition patients.更多还原