【作者】 王静；

【导师】 孙艳艳；

【作者基本信息】 山西医科大学 ， 内科学（专业学位）， 2018， 硕士

【摘要】 目的:探讨腹膜透析(peritoneal dialysis,PD)患者血红蛋白变异度(hemoglobin variabi lity,Hb-Var)与颈动脉硬化(carotid atherosclerosis,CAS)的关系。方法:选取2015年5月~2017年10月就诊于山西医科大学第一医院肾内科的PD患者68例,应用超声检测患者颈部血管情况,颈动脉内中膜增厚(CIMT值≥1 mm)或者有斑块形成即可诊断为CAS,根据超声结果将PD患者分为CAS组和NCAS组,并收集患者的一般资料及血红蛋白(hemoglobin,Hb)、白蛋白(albumin,ALB)、超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)、β2微球蛋白(β2-micr oglobulin,β2-MG)等临床指标,Hb-Var用剩余标准差(Res-SD)来表示,分析Hb-Va r及各临床指标与CAS的关系。结果:1.68例PD患者中CAS者为36例,其发生比例为52.9%。2.两组间比较,Hb-Var[(4.73±1.96)mmol/L vs(10.91±5.24)mmol/L]、ALB[(41.71±4.07)g/L vs(37.74±3.81)g/L]、hs-CRP[(1.48±0.71)mg/L vs(2.24±1.06)mg/L]、TG[(1.27±0.55)mmol/L vs(1.60±0.55)mmol/L]、TC[(4.45±0.94)mmol/L vs(5.09±1.08)mmol/L]、LDL-C[(2.32±0.63)mmol/L vs(2.79±0.80)mmol/L]以及β2-MG[(12.85±1.82)mg/L vs(14.13±1.91)m g/L]等指标方面的差异具有统计学意义。3.CAS与各因素间的相关分析显示,CAS与H b-Var、hs-CRP、β2-MG呈正相关(r=0.683、0.398、0.323,均P<0.05),与ALB(r=-0.456,P<0.05)呈负相关。4.经logistic逐步回归分析显示,Hb-Var、hs-CRP、ALB为CAS的危险因素。结论:Hb-Var、炎症、营养不良是PD患者CAS的危险因素,维持Hb水平的稳定、改善患者炎症状态及营养状况可能有助于减少动脉硬化的发生,从而减少患者发生心血管事件的机率,改善透析者的预后。更多还原

【Abstract】 Objective:To study the relation between hemoglobin variability and carotid atherosclerosis in peritoneal dialysis patients.Methods:68 cases of peritoneal dialysis in the first hospital affiliated of Shan Xi Medica l University Nephrology were enrolled in this study.And underwent the carotid art ery examination by the high-resolution B-mode ultrasonography.Carotid atheroscle rosis can be diagnosed by thickening(CIMT≥1 mm)or plaque formation in caro tid artery.The patients were divided into two groups.The carotid atherosclerosis gr oup and the non-carotid atherosclerosis group.General data of patients and clinica l indicators of hemoglobin,albumin,high sensitivity C-reactive protein,β2-microgl obulin were collected.Hemoglobin variability was expressed by residual standard d eviation.The relationship between carotid atherosclerosis with hemoglobin variabili ty and blood biochemical indexes was analyzed.Results:In study,carotid atherosclerosis accounted for 52.9% in 68 patients of periton eal dialysis.Two groups of patients on dialysis compared in hemoglobin variabilit y[(4.73±1.96)mmol/L vs(10.91±5.24)mmol/L],albumin[(41.71±4.07)g/L vs(37.74±3.81)g/L],high sensitivity C-reactive protein[(1.48±0.71)mg/L vs(2.24±1.06)mg/L],tr iglyceride[(1.27±0.55)mmol/L vs(1.60±0.55)mmol/L],total cholesterol[(4.45±0.94)mmol/L vs(5.09±1.08)mmol/L],low density lipoprotein cholesterol[(2.32±0.63)mm ol/L vs(2.79±0.80)mmol/L],β2-microglobulin[(12.85±1.82)mg/L vs(14.13±1.91)m g/L],the difference was statistically significant(P<0.05).Between the two groups,carotid atherosclerosis was positively correlated with hemoglobin variability,high sensitivity C-reactive protein,β2-microglobulin(r=0.683,0.398,0.323,P<0.05),and was negatively correlated with albumin(r=-0.456,P<0.05).The logistic regression analysis showed that,the main influencing factors of carotid atherosclerosis are h emoglobin variability,high sensitivity C-reactive protein,albumin.Conclusion:Hemoglobin variability,inflammation and malnutrition are risk factors for carotid atherosclerosis in peritoneal dialysis patients.Maintaining stable hemoglobin levels and improving inflammation and nutritional status may help reduce atherosclerosis,so as to reduce the incidence of cardiovascular events,and improve the prognosis in patients with peritoneal dialysis.更多还原