维持性血液透析患者并发心脑血管病的危险因素及对患者近期预后的影响
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摘要
目的:探讨维持性血液透析(MHD)患者并发心脑血管病的危险因素及对患者近期预后的影响。方法:选取我院2013年3月至2018年6月行MHD的患者98例作为研究对象,根据是否并发心脑血管疾病划分为并发组和非并发组,对患者的临床信息进行分析,寻找患者并发心脑血管病的危险因素。对患者进行2年的随访,记录患者生存、转归情况。结果:纳入并发组的有35例,MHD患者心脑血管疾病发生率为35.71%;单因素分析结果显示:高血压病史(χ~2=10.671,P=0001)、透析龄(t=4.519,P<0.001)、UA水平(t=21.992,P<0.001)为MHD患者心脑血管疾病的相关因素,而与性别、糖尿病病史、血清白蛋白、Scr、BUN、TG、TC、LDL-C、HDL-C、Hb水平无关,差异无统计学意义(P>0.05);二元Logistic回归分析结果显示,有高血压病史、透析龄长、UA水平高是MHD患者心脑血管疾病发生的危险因素(P均<0.05);随访发现并发组患者2年生存率明显低于非并发组,比较差异具有统计学意义(P<0.05)。结论:MHD患者并发心脑血管疾病预后较差,有高血压病史、透析龄长、UA水平高是MHD患者心脑血管疾病发生的危险因素,临床需引起重视。
Objective: To explore the risk factors of cardiovascular and cerebrovascular diseases in patients with maintenance hemodialysis(MHD) and its influence on short-term prognosis. Methods: 98 patients with MHD in our hospital from March 2013 to June 2018 were selected as the study subjects. According to whether they were complicated with cardiovascular and cerebrovascular diseases, they were divided into concurrent group and non-concurrent group. The clinical information of patients was analyzed to find out the risk factors of cardiovascular and cerebrovascular diseases. The patients were followed up for 2 years, and their survival and prognosis were recorded. Results: 35 cases were included in the concurrent group, and the incidence of cardiovascular and cerebrovascular diseases was 35.71% in MHD patients. Univariate analysis showed that hypertension(χ~2= 10.671, P = 0001), dialysis age(t = 4.519, P<0.001), UA level(t=21.992, P<0.001) were related factors of cardiovascular and cerebrovascular diseases in MHD patients, but not with sex, diabetes history, serum albumin, Scr, BUN, TG, TC, LDL-C, HDL-C and Hb levels. The difference was not statistically significant(P>0.05).The results of binary logistic regression analysis showed that hypertension history, long dialysis age and high UA level were risk factors for cardiovascular and cerebrovascular diseases in MHD patients(P<0.05).The 2-year survival rate of the concurrent group was significantly lower than that of the non-concurrent group(P<0.05). Conclusion: The prognosis of MHD patients complicated with cardiovascular and cerebrovascular diseases is poor. Hypertension history, long dialysis age and high UA level are risk factors for the occurrence of cardiovascular and cerebrovascular diseases in MHD patients.
Objective: To explore the risk factors of cardiovascular and cerebrovascular diseases in patients with maintenance hemodialysis(MHD) and its influence on short-term prognosis. Methods: 98 patients with MHD in our hospital from March 2013 to June 2018 were selected as the study subjects. According to whether they were complicated with cardiovascular and cerebrovascular diseases, they were divided into concurrent group and non-concurrent group. The clinical information of patients was analyzed to find out the risk factors of cardiovascular and cerebrovascular diseases. The patients were followed up for 2 years, and their survival and prognosis were recorded. Results: 35 cases were included in the concurrent group, and the incidence of cardiovascular and cerebrovascular diseases was 35.71% in MHD patients. Univariate analysis showed that hypertension(χ~2= 10.671, P = 0001), dialysis age(t = 4.519, P<0.001), UA level(t=21.992, P<0.001) were related factors of cardiovascular and cerebrovascular diseases in MHD patients, but not with sex, diabetes history, serum albumin, Scr, BUN, TG, TC, LDL-C, HDL-C and Hb levels. The difference was not statistically significant(P>0.05).The results of binary logistic regression analysis showed that hypertension history, long dialysis age and high UA level were risk factors for cardiovascular and cerebrovascular diseases in MHD patients(P<0.05).The 2-year survival rate of the concurrent group was significantly lower than that of the non-concurrent group(P<0.05). Conclusion: The prognosis of MHD patients complicated with cardiovascular and cerebrovascular diseases is poor. Hypertension history, long dialysis age and high UA level are risk factors for the occurrence of cardiovascular and cerebrovascular diseases in MHD patients.
引文
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[2] 李晗,张昆,王晓菁,等.维持性透析患者运动能力降低及其相关因素[J].中华肾脏病杂志,2016,32(6):412～417.
[3] 苏真,陈建梅.左卡尼汀对糖尿病肾病透析病人炎性因子与红细胞免疫的影响[J].蚌埠医学院学报,2017,42(10):1349～1352.
[4] 陈佩玲,龚德华,徐斌,等.维持性血液透析患者心血管钙化进展的相关影响因素分析[J].肾脏病与透析肾移植杂志,2017,26(5):403～407.
[5] Gardner A W,Montgomery P S,Casanegra A I,et al.Association between gait characteristics and endothelial oxidative stress and inflammation in patients with symptomatic peripheral artery disease[J].Age,2016,38(3):64.
[6] 甘林望,李乾程,温向琼,等.维持性血液透析合并高血压患者难治性高血压的影响因素分析[J].中国现代医学杂志,2016,26(5):105～109.
[7] 高丹,白晓莹,娄岩,等.老年维持性血液透析患者死亡相关因素分析[J].中国老年学,2017,37(13):3307～3309.
[8] 闫银坤,侯冬青,段佳丽,等.肥胖儿童尿酸水平与心血管代谢异常及非酒精性脂肪肝的关系[J].中华实用儿科临床杂志,2015,30(13):1000～1003.
[9] Tanja A,Aleksandra S,Marina R,et al.High uric acid and low superoxide dismutase as possible predictors of all-cause and cardiovascular mortality in hemodialysis patients[J].International Urology & Nephrology,2013,45(4):1111～1119.