维持性血透患者并发脑卒中的相关危险因素分析
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摘要
目的探讨维持性血液透析(MHD)患者并发脑卒中的相关危险因素。方法脑卒中组:MHD并发脑卒中者,共32例。对照组:MHD未并发脑卒中者,共50例。分析比较2组患者的年龄、透析龄、β2-微球蛋白(β2-MG)水平、透析清除指数(Kt/V),平均动脉压(MBP)、透析间期体重、规律透析是否达标,并发心脏病、糖尿病的患病数的差别并分析高危因素。结果与对照组比较,脑卒中组患者的年龄、透析龄、β2-MG均高,MBP、透析间期体重增长,规律透析达标差,并发心脏病、糖尿病患病数多,差异均有统计学意义(P<0.05);Kt/V值2组差异无统计学意义(P>0.05);进一步多重高危因素Logistic回归分析显示,β2-MG(OR值1.376)、MBP(OR值24.545)、并发心脏病(OR值12.666)及糖尿病(OR值11.706)、透析间期体重增长(OR值3.778)较其他因素差异有统计学意义(P<0.05)。结论β2-MG、MBP、透析间期体重控制不达标,并发心脏病、糖尿病均是MHD患者并发脑卒中的独立危险因素。
Objective To explore the related risk factors of patients with maintenance hemodialysis( MHD) complicated stroke. Methods Stroke group: 32 cases were MHD patients complicated with stroke. Control group: 50 cases were MHD patients without stroke. Compared these conditions such as age,maintenance hemodialysis age,β2-MG,Kt/V,arterial blood pressure,heart disease,diabetes mellitus,regular hemodialysis treatment,and the weight gain of hemodialysis interval and compared and analyzed the factors. Results Compared with no stroke group,the age,dialysis time,β2-MG were higher,The MBP,weight gain in hemodialysis interval,and the regular of dialysis were not met targets,and complicated with heart disease diabetes in stroke group,there were significant difference between two groups( P < 0. 05). The Kt/V level in the two groups had no statistically different( P > 0. 05). Multiple factors analysis showed β2-MG( OR: 1. 376),MBP( OR: 24. 545),with heart disease( OR: 12. 666) and diabetes( OR: 11. 706),weight gain of hemodialysis interval( OR: 3. 778). The difference was statistically significant( P < 0. 05). Conclusion High level ofβ2-MG,poor blood pressure control,combined with heart disease and diabetes,excessed weight gain of hemodialysis interval all are the risk factors of maintenance hemodialysis patients complicate with stroke.
Objective To explore the related risk factors of patients with maintenance hemodialysis( MHD) complicated stroke. Methods Stroke group: 32 cases were MHD patients complicated with stroke. Control group: 50 cases were MHD patients without stroke. Compared these conditions such as age,maintenance hemodialysis age,β2-MG,Kt/V,arterial blood pressure,heart disease,diabetes mellitus,regular hemodialysis treatment,and the weight gain of hemodialysis interval and compared and analyzed the factors. Results Compared with no stroke group,the age,dialysis time,β2-MG were higher,The MBP,weight gain in hemodialysis interval,and the regular of dialysis were not met targets,and complicated with heart disease diabetes in stroke group,there were significant difference between two groups( P < 0. 05). The Kt/V level in the two groups had no statistically different( P > 0. 05). Multiple factors analysis showed β2-MG( OR: 1. 376),MBP( OR: 24. 545),with heart disease( OR: 12. 666) and diabetes( OR: 11. 706),weight gain of hemodialysis interval( OR: 3. 778). The difference was statistically significant( P < 0. 05). Conclusion High level ofβ2-MG,poor blood pressure control,combined with heart disease and diabetes,excessed weight gain of hemodialysis interval all are the risk factors of maintenance hemodialysis patients complicate with stroke.
引文
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[7]芮金兵,潘超,苏红,等.维持性血液透析并发脑出血及其相关因素探讨(附37例报告)[J].中国实用内科杂志,2014,26(3):208-209.
[8]Herrington W,Haynes R,Staplin N,et al.Evidence for the prevention and treatment of stroke in dialysis patients[J].Seminars in Dialysis,2015,28(1):35-47.
[9]Chien LN,Chou Chulin,Chen HH,et al.Association between stroke risk and metformin use in hemodialysis patients with diabetes mellitus:a nested Case-Control study[J].Journal of the American Heart Association,2017,6(11):61-63.
[10]Findlay MD,Thomson PC,Fulton RL,et al.Risk factors of ischemic stroke and subsequent outcome in patients receiving hemodialysis[J].Stroke,2015,46(9):2477-2481.
[11]Masson P,Webster AC,Hong M,et al.Chronic kidney disease and the risk of stroke:a systematic review and meta-analysis[J].Nephrology,Dialysis,Transplantation,2015,30(7):1162-1169.
[12]Arnold J,Sims D,Ferro C J.Modulation of stroke risk in chronic kidney disease[J].Clinical Kidney Journal,2016,9(1):29-38.
[13]叶红英,黄坚,袁坚列.维持性血液透析并发脑出血患者的危险因素及预后分析[J].中国现代医生,2016,54(19):43-46.
[14]张黎明,夏兰,徐鹏程,等.维持性血液透析并发脑卒中的相关因素分析[J].中国临床保健杂志,2016,19(3):267-270.
[15]罗正茂,刘曼仪,何凤,等.维持性透析患者发生脑卒中的危险因素[J].实用医学杂志,2017,33(1):76-79.
[2]彭爱明,李丽华,杨芦蓉,等.维持性血液透析并发脑出血患者的临床研究[J].医学临床研究,2013,28(11):2078-2080.
[3]Prabhakaran S,Rrff I,Bernstein R A.Acute stroke intervention a systematic review[J].Journal of the American Medical Association,2015,313(14):1451-1462.
[4]Murray AM,Sellger S,Lakshminarayan K,et al.Incidence of stroke before and after dialysis initiation in older patients[J].Journal of the American Society of Nephrology,2013,24(7):1166-1173.
[5]Airy M,Chang TI,Ding VY,et al.Risk profiles for acute health events after incident atrial fibrillation in patients with end-stage renal disease on hemodialysis[J].AJKD,2017,3(69):3-5.
[6]Clanciol G,De Pascalis A,Dilullo L,et al.Folic acid and homocysteine in chronic kidney disease and cardiovascular disease progression:which comes first[J].Cardiorenal Medicine,2017,7(4):255-266.
[7]芮金兵,潘超,苏红,等.维持性血液透析并发脑出血及其相关因素探讨(附37例报告)[J].中国实用内科杂志,2014,26(3):208-209.
[8]Herrington W,Haynes R,Staplin N,et al.Evidence for the prevention and treatment of stroke in dialysis patients[J].Seminars in Dialysis,2015,28(1):35-47.
[9]Chien LN,Chou Chulin,Chen HH,et al.Association between stroke risk and metformin use in hemodialysis patients with diabetes mellitus:a nested Case-Control study[J].Journal of the American Heart Association,2017,6(11):61-63.
[10]Findlay MD,Thomson PC,Fulton RL,et al.Risk factors of ischemic stroke and subsequent outcome in patients receiving hemodialysis[J].Stroke,2015,46(9):2477-2481.
[11]Masson P,Webster AC,Hong M,et al.Chronic kidney disease and the risk of stroke:a systematic review and meta-analysis[J].Nephrology,Dialysis,Transplantation,2015,30(7):1162-1169.
[12]Arnold J,Sims D,Ferro C J.Modulation of stroke risk in chronic kidney disease[J].Clinical Kidney Journal,2016,9(1):29-38.
[13]叶红英,黄坚,袁坚列.维持性血液透析并发脑出血患者的危险因素及预后分析[J].中国现代医生,2016,54(19):43-46.
[14]张黎明,夏兰,徐鹏程,等.维持性血液透析并发脑卒中的相关因素分析[J].中国临床保健杂志,2016,19(3):267-270.
[15]罗正茂,刘曼仪,何凤,等.维持性透析患者发生脑卒中的危险因素[J].实用医学杂志,2017,33(1):76-79.