维持性血液透析患者脑梗死发生状况及危险因素分析

吴晓力; 倪珏民; 陈建娥; 王建; 孔祥栋

doi:10.16766/j.cnki.issn.1674-4152.002389

维持性血液透析患者脑梗死发生状况及危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002389

1.
杭州市富阳区第一人民医院神经内科，浙江杭州 311400
2.
杭州市五云山疗养院内科，浙江杭州 310008
3.
杭州市富阳区第一人民医院肾内科，浙江杭州 311400

基金项目:

浙江省医药卫生科技计划项目 2020KY802

详细信息

通讯作者:
吴晓力，E-mail：zhangcuilan152@163.com

中图分类号: R459.5 R743.33
计量
- 文章访问数: 385
- HTML全文浏览量: 152
- PDF下载量: 5
- 被引次数: 0
出版历程
- 收稿日期: 2021-04-16
- 网络出版日期: 2022-08-13

Analysis of the incidence and risk factors of cerebral infarction on maintenance haemodialysis patients

1.
Department of Neurology, the First People's Hospital of Fuyang District, Hangzhou, Zhejiang 311400, China

摘要

摘要: 目的了解维持性血液透析(maintenance hemodialysis，MHD)患者脑梗死的发生状况，并分析其影响因素。方法选取2018年1月—2020年1月在杭州市富阳区第一人民医院血液净化中心行MHD治疗的尿毒症患者208例为研究对象。根据患者治疗期间是否发生脑梗死分为缺血性脑梗死组23例和非脑梗死组185例。对2组患者的一般临床资料进行比较，并分析MHD患者发生缺血性脑梗死的危险因素。结果 208例患者发生缺血性脑梗死23例，脑梗死发生率为11.06%；对2组患者各临床指标进行比较，结果发现缺血性脑梗死组患者在糖尿病、冠心病、心房颤动、透析前收缩压、透析前舒张压、尿酸(UA)等方面均明显高于非脑梗死组患者(均P＜0.05)，而2组患者在性别、年龄、透析年限、透析频率、高脂血症、吸烟史、肾小球滤过率(glomerular filtration rate，GFR)、口服拜阿司匹林、口服他汀类药物、血磷(phosphorus，P)、血红蛋白(hemoglobin，Hb)、白蛋白(albumin，ALB)等方面比较差异无统计学意义(P＞0.05)；经logistic回归分析显示冠心病、糖尿病、透析前收缩压、透析前舒张压、心房颤动和UA属于MHD患者发生脑梗死的独立危险因素。结论 MHD患者发生缺血性脑梗死的比例较高，其中冠心病、糖尿病、透析前收缩压、透析前舒张压、心房颤动和UA属于MHD患者发生缺血性脑梗死的独立危险因素，在MHD患者治疗中应给予相应的防治措施以降低脑梗死发生的风险。
- 维持性血液透析 /
- 缺血性脑梗死 /
- 尿毒症 /
- 危险因素
Abstract: Objective To understand the incidence of cerebral infarction in maintenance haemodialysis (MHD) patients and analyze its influencing factors. Methods Total 208 uremic patients treated with MHD in the Blood Purification Center of the First People's Hospital of Fuyang District, Hangzhou from January 2018 to January 2020 were selected as the research objects. Patients were divided into the ischemic cerebral infarction group (n=23) and non-cerebral infarction group (n=185) according to whether cerebral infarction occurred during treatment. General clinical data were compared between the two groups, and risk factors for ischemic cerebral infarction in MHD patients were analysed. Results The incidence of ischemic cerebral infarction was 11.06% in 23 of 208 patients. Comparing the clinical indexes of the two groups of patients, the results showed that ischemic cerebral infarction patients in diabetes, coronary heart disease, atrial fibrillation, systolic pressure, diastolic blood pressure before dialysis before dialysis, uric acid were significantly higher than that of the patients in non-cerebral infarction group (all P < 0.05), and two groups of patients in the frequency of sex, age, duration of dialysis, dialysis, hyperlipidaemia, smoking history, glomerular filtration rate, oral aspirin, oral statin drugs, blood phosphorus, haemoglobin and albumin were not statistically significant (P > 0.05). Logistic regression analysis showed that coronary heart disease, diabetes mellitus, pre-dialysis systolic blood pressure, pre-dialysis diastolic blood pressure, atrial fibrillation and UA were independent risk factors for cerebral infarction in MHD patients. Conclusion The proportion of MHD patients with ischemic cerebral infarction is relatively high, amongst which coronary heart disease, diabetes, pre-dialysis systolic blood pressure, pre-dialysis diastolic blood pressure, atrial fibrillation and UA are independent risk factors for the occurrence of ischemic cerebral infarction in MHD patients, and corresponding prevention and treatment measures should be given in the treatment of MHD patients to reduce the risk of cerebral infarction.
- Maintenance haemodialysis /
- Ischemic cerebral infarction /
- Uraemia /
- Risk factors

HTML全文

表 1 2组MHD患者发生脑梗死的单因素分析

Table 1. Univariate analysis of cerebral infarction in two groups of MHD patients

组别	例数	性别[例(%)]		透析年限[例(%)]		年龄(x±s，岁)	透析频率(x±s，次/周)	高血压[例(%)]
组别	例数	男	女	≤5年	＞5年	年龄(x±s，岁)	透析频率(x±s，次/周)	高血压[例(%)]
脑梗死组	23	12(52.17)	11(47.83)	21(91.30)	2(8.70)	62.81±2.98	2.82±0.27	17(73.91)
非脑梗死组	185	100(54.05)	85(45.95)	176(95.14)	9(4.86)	62.86±2.87	2.75±0.26	132(71.35)
统计量		0.029^a		0.599^a		0.078^b	1.213^b	0.066^b
P值		0.865		0.439		0.938	0.227	0.797

组别	例数	糖尿病[例(%)]	冠心病[例(%)]	高脂血症[例(%)]	心房颤动[例(%)]	吸烟史[例(%)]	服用拜阿司匹林[例(%)]	服用他汀类药物[例(%)]
脑梗死组	23	12(52.17)	8(34.78)	6(26.09)	7(30.43)	7(30.43)	8(34.78)	6(26.09)
非脑梗死组	185	56(30.27)	15(8.11)	54(29.19)	13(4.86)	57(30.81)	61(32.97)	52(28.11)
统计量		4.460^a	14.723^a	0.096^a	9.872^a	0.001^a	0.399^a	0.042^a
P值		0.035	＜0.001	0.757	0.002	0.971	0.528	0.838

组别	例数	透析前收缩压(x±s，mm Hg)	透析前舒张压(x±s，mm Hg)	ALB (x±s，g/L)	Hb (x±s，g/L)	UA (x±s，μmmol/L)	血磷(x±s，mmol/L)	GFR (x±s，mL/min)
脑梗死组	23	160.78±12.81	92.76±11.72	37.29±2.98	95.15±8.53	367.25±13.78	1.71±0.25	8.22±1.67
非脑梗死组	185	138.85±11.82	78.77±11.75	36.93±2.86	95.21±8.42	358.26±13.81	1.82±0.31	7.98±1.65
统计量		8.314^b	5.387^b	0.567^b	0.032^b	2.945^b	0.657^b	0.657^b
P值		＜0.001	＜0.001	0.571	0.975	0.004	0.103	0.512
注：^a为χ²值，^b为t值；1 mm Hg=0.133 kPa。

下载: 导出CSV

表 2 影响MHD患者发生脑梗死的变量赋值情况

Table 2. The assignment of variables affecting the occurrence of cerebral infarction in MHD patients

变量	赋值方法
糖尿病	无=0，有=1
冠心病	无=0，有=1
心房颤动	无=0，有=1
透析前收缩压	以实际值赋值
透析前舒张压	以实际值赋值
UA	以实际值赋值
脑梗死	无=0，有=1

下载: 导出CSV

表 3 影响MHD患者发生脑梗死的logistic多因素回归分析

Table 3. Multivariate logistic regression analysis the occurrence of cerebral infarction in MHD patients

临床指标	B	SE	Wald χ²	P值	OR值	95% CI
冠心病	2.152	0.521	16.858	0.012	6.792	2.898~9.931
糖尿病	1.682	0.397	11.297	0.019	3.836	2.164~5.857
透析前收缩压	0.925	0.201	8.568	0.037	2.313	1.949~4.843
透析前舒张压	0.892	0.196	7.572	0.041	1.977	1.593~4.685
心房颤动	1.287	0.317	9.863	0.029	2.279	1.875~5.686
UA	1.054	0.197	8.921	0.020	2.189	1.727~5.597

下载: 导出CSV

参考文献(17)

[1]	王丽娟. 预防性护理对老年肾衰竭透析患者预防感染及提高生活质量的作用[J]. 实用临床护理学电子杂志, 2018, 3(10): 35, 37. https://www.cnki.com.cn/Article/CJFDTOTAL-SLHL201810030.htm WANG L J. Effect of preventive nursing on preventing infection and improving quality of life in elderly patients with renal failure undergoing dialysis[J]. Journal of Clinic Nursing's Practicality, 2018, 3(10): 35, 37. https://www.cnki.com.cn/Article/CJFDTOTAL-SLHL201810030.htm
[2]	周立坤, 惠莉. 维持性血液透析患者预防高血压脑出血的自我管理[J]. 中国疗养医学, 2017, 26(12): 1265-1267. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGLX201712015.htm ZHOU L K, HUI L. Self-management of maintenance hemodialysis patients to prevent hypertensive cerebral hemorrhage[J]. Chinese Journal of Convalescent Medicine, 2017, 26(12): 1265-1267. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGLX201712015.htm
[3]	蒋志玲. 维持性血液透析并发脑出血的危险因素分析[J]. 中国实用神经疾病杂志, 2017, 20(15): 109-111. https://www.cnki.com.cn/Article/CJFDTOTAL-HNSJ201715038.htm JIANG Z L. Analysis of risk factors for intracerebral hemorrhage during maintenance hemodialysis[J]. Chinese Journal of Practical Nervous Diseases, 2017, 20(15): 109-111. https://www.cnki.com.cn/Article/CJFDTOTAL-HNSJ201715038.htm
[4]	WANG I K, LIU C H, YEN T H, et al. Renal function is associated with 1-month and 1-year mortality in patients with ischemic stroke[J]. Atherosclerosis, 2018, 269: 258-259.
[5]	中华医学会神经病学分会. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9): 666-682. https://www.cnki.com.cn/Article/CJFDTOTAL-XDJB201911024.htm Chinese Society of Neurology, Chinese Medical Association. Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2018[J]. Chinese Journal of Neurology, 2018, 51(9): 666-682. https://www.cnki.com.cn/Article/CJFDTOTAL-XDJB201911024.htm
[6]	郑苏平, 解林花, 尚进, 等. 维持性血液透析患者脑梗死发生率及危险因素研究[J]. 中华老年心脑血管病杂志, 2018, 20(7): 724-727. https://www.cnki.com.cn/Article/CJFDTOTAL-LNXG201807013.htm ZHENG, XIE L H, SHANG J, et al. Incidence and risk factors of cerebral infarction in urinemia patients on maintenance hemodialysis[J]. Chinese Journal of Geriatric Heart Brain and Vessel Diseases 2018, 20(7): 724-727. https://www.cnki.com.cn/Article/CJFDTOTAL-LNXG201807013.htm
[7]	黄巧, 刘感哲. 维持性血液透析并发脑卒中的危险因素探讨[J]. 中国地方病防治杂志, 2017, 32(4): 452, 454. https://www.cnki.com.cn/Article/CJFDTOTAL-DYBF201704057.htm HUANG Q, LIU G Z. Risk factors of stroke during maintenance hemodialysis[J]. Chinese Journal of Control of Endemic Diseases, 2017, 32(4): 452, 454. https://www.cnki.com.cn/Article/CJFDTOTAL-DYBF201704057.htm
[8]	CHINE L N, CHOU C, CHEN H H, et al. Association between stroke risk and metformin use in hemodialysis patients with diabetes mellitus: A nested Case-Control study[J]. J Am Heart Assoc, 2017, 6(11): 61-63.
[9]	马成虹, 张危, 赵睿, 等. 2型糖尿病合并脑梗死的发病机制研究进展[J]. 现代医药卫生, 2020, 36(22): 3571-3574. https://www.cnki.com.cn/Article/CJFDTOTAL-XYWS202022010.htm MA C H, ZHANG W, ZHAO R, et al. Advances in the pathogenesis of type 2 diabetes mellitus complicated with cerebral infarction[J]. Journal of Modern Medicine & Health, 2020, 36(22): 3571-3574. https://www.cnki.com.cn/Article/CJFDTOTAL-XYWS202022010.htm
[10]	冉茜. 住院2型糖尿病肾病患者中早发糖尿病与动脉粥样硬化的关系研究[D]. 重庆: 重庆医科大学, 2019. RAN Q. Relationship between early onset diabetes mellitus and atherosclerosis in patients with type 2 diabetic kidney disease[D]. Chongqing: Chongqing Medical University, 2019.
[11]	李清, 杜祥颖. 冠状动脉粥样硬化性心脏病与缺血性脑卒中相关性研究进展[J]. 中国动脉硬化杂志, 2019, 27(10): 905-909. https://www.cnki.com.cn/Article/CJFDTOTAL-KDYZ201910014.htm
[12]	TONE L M, KARU S A, THADHANI R. Epidemiology and mechanisms of uremia-related cardiovascular disease[J]. Circulation, 2016, 133(5): 518-536.
[13]	苗原溢, 陈育青. 血液透析患者心房颤动患病率的横断面调查研究[J]. 中国血液净化, 2018, 17(11): 721-726. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGJH201811001.htm MIAO Y Y, CHEN Y Q. A cross-sectional study on the prevalence of atrial fibrillation in hemodialysis patients[J]. Chinese Journal of Blood Purification, 2018, 17(11): 721-726. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGJH201811001.htm
[14]	张智斌, 吴文芳, 胡瑞敏, 等. 心房颤动与脑梗死的相关性研究进展[J]. 临床合理用药杂志, 2017, 10(12): 167-169. https://www.cnki.com.cn/Article/CJFDTOTAL-PLHY201712085.htm ZHANG Z B, WU W F, HU R M, et al. Research progress on the correlation between atrial fibrillation and cerebral infarction[J]. Chinese Journal of Clinical Rational Drug Use, 2017, 10(12): 167-169. https://www.cnki.com.cn/Article/CJFDTOTAL-PLHY201712085.htm
[15]	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. https://www.cnki.com.cn/Article/CJFDTOTAL-LZBJ201603014.htm ZHANG L M, XIA L, XU P C, et al. Study on the stroke-related factors in patients undergoing maintenance hemodialysis[J]. Chinese Journal of Clinical Healthcare, 2016, 19(3): 267-270. https://www.cnki.com.cn/Article/CJFDTOTAL-LZBJ201603014.htm
[16]	崔英, 眭建. 维持性血液透析患者并发心脑血管疾病的危险因素研究[J]. 中国中西医结合肾病杂志, 2016, 17(11): 1006-1007. https://www.cnki.com.cn/Article/CJFDTOTAL-JXSB201611026.htm CUI Y, SUI J. Risk factors of cardiovascular and cerebrovascular diseases in maintenance hemodialysis patients[J]. Chinese Journal of Integrated Traditional and Western Nephrology, 2016, 17(11): 1006-1007. https://www.cnki.com.cn/Article/CJFDTOTAL-JXSB201611026.htm
[17]	CLANCIOL G, PASCALIS A, DILULLOL L, et al. Folic acid and homocysteine in chronic kidney disease and cardiovascular disease progression: Which comes first[J]. Cardiorenal Med, 2017, 7(4): 255-266.