维持性血液透析患者发生心血管疾病的相关危险因素分析

郭佳佳; 马胜银; 刘莉华; 高军; 宫峰

doi:10.16766/j.cnki.issn.1674-4152.002503

维持性血液透析患者发生心血管疾病的相关危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002503

蚌埠医学院第三附属医院肾内科，安徽宿州 234000

基金项目:

安徽省公益性研究联动计划项目 1704f0804050

蚌埠医学院科技项目 2020byzd363

详细信息

通讯作者:
马胜银，E-mail：mashengyin@gmail.com

中图分类号: R459.5 R541
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- 被引次数: 0
出版历程
- 收稿日期: 2021-03-28
- 网络出版日期: 2022-09-21

Risk factors of cardiovascular disease in maintenance haemodialysis patients

Department of Nephrology, the Third Affiliated Hospital of Bengbu Medical College, Suzhou, Anhui 234000, China

摘要

摘要: 目的探讨维持性血液透析患者发生心血管疾病的相关危险因素。方法回顾性收集2019年1月-2020年10月蚌埠医学院第三附属医院血液透析室行维持性血液透析治疗的慢性肾功能不全尿毒症期患者126例作为研究对象, 根据患者是否发生心血管疾病将其分为心血管并发症组(74例)和无心血管并发症组(52例)。比较2组患者一般资料和实验室相关检查指标的差异, 并采用二分类logistic回归法对维持性血液透析患者发生心血管疾病的相关危险因素进行分析。结果与无心血管并发症组比较, 心血管并发症组年龄、透析龄、血尿酸、同型半胱氨酸、超敏C反应蛋白、白介素-6水平较高, 而前白蛋白、高密度脂蛋白胆固醇、血镁水平较低, 差异有统计学意义(均P < 0.05);二分类logistic回归分析显示, 年龄大、透析龄长、高同型半胱氨酸血症、高尿酸血症、高水平的超敏C反应蛋白以及白介素-6是维持性血液透析患者发生心血管疾病的独立危险因素(OR=1.441, P=0.029;OR=2.212, P=0.019;OR=1.384, P=0.030;OR=5.056, P < 0.001;OR=3.163, P=0.013;OR=3.802, P=0.009)。结论年龄大、透析龄长、高同型半胱氨酸血症、高尿酸血症、高水平的超敏C反应蛋白以及白介素-6可能是维持性血液透析患者发生心血管疾病的独立危险因素。
- 血液透析 /
- 心血管疾病 /
- 危险因素
Abstract: Objective To study the risk factors of cardiovascular disease in maintenance haemodialysis patients. Methods A total of 126 patients in the uremic phase of chronic renal insufficiency who underwent maintenance haemodialysis in the haemodialysis unit of the Third Affiliated Hospital of Bengbu Medical College from January 2019 to October 2020 were retrospectively enrolled.They were divided into the cardiovascular complication group (n=74) and group without cardiovascular complications (n=52) according to whether the patients developed cardiovascular disease.The differences of general information and laboratory examination indexes between the two groups were compared, and the risk factors of cardiovascular disease in maintenance haemodialysis patients were analysed by binary logistic regression. Results Age, long dialysis age, serum uric acid, homocysteine, high sensitivity C-reactive protein and interleukin-6 levels were higher, whereas prealbumin, high-density lipoprotein cholesterol and serum magnesium levels were lower in the group with cardiovascular complications than in the group without cardiovascular complications (all P < 0.05).Binary logistic regression analysis showed that age, dialysis age, hyperhomocysteinemia, hyperuricemia, high levels of high-sensitivity C-reactive protein and interleukin-6 were independent risk factors for the development of cardiovascular disease in maintenance haemodialysis patients (OR=1.441, P=0.029;OR=2.212, P=0.019;OR=1.384, P=0.030;OR=5.056, P < 0.001;OR=3.163, P=0.013;OR=3.802, P=0.009). Conclusion Old age, long dialysis age, hyperhomocysteinemia, hyperuricemia, high levels of high-sensitivity C-reactive protein and interleukin-6 may be independent risk factors for cardiovascular disease in maintenance haemodialysis patients.
- Hemodialysis /
- Cardiovascular disease /
- Risk factors

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表 1 CVD组与无CVD组慢性肾功能不全尿毒症期患者的人口统计数据比较

Table 1. Demographic comparison of patients with chronic renal insufficiency uremia in the CVD group and the CVD-free group

项目	CVD组(n=74)	无CVD组(n=52)	统计量	P值
性别(男/女，例)	45/29	31/21	0.018^a	0.893
年龄(x±s, 岁)	53.54±12.39	44.62±12.45	3.972^b	< 0.001
透析龄[M(P₂₅, P₇₅)，月]	48(24，84)	24(12，48)	-3.158^c	0.002
透析前SBP(x±s, mm Hg)	152.11±21.68	154.17±16.98	-0.574^b	0.567
透析前DBP[M(P₂₅, P₇₅)，mm Hg]	89.50(80.00，97.50)	90.00(80.00，99.75)	-1.206^c	0.228
透析后SBP(x±s, mm Hg)	137.72±18.46	140.98±13.37	-1.151^b	0.252
透析后DBP[M(P₂₅, P₇₅)，mm Hg]	81.50(74.00，89.00)	82.00(75.00，88.50)	-0.700^c	0.484
原发病[例(%)]			5.839^a	0.436
糖尿病肾病	12(16.22)	6(11.54)
高血压肾病	24(32.43)	18(34.62)
慢性肾小球肾炎	24(32.43)	15(28.85)
多囊肾	5(6.76)	1(1.92)
狼疮性肾炎	1(1.35)	3(5.77)
梗阻性肾病	1(1.35)	0
不明原因肾病	7(9.46)	9(17.31)
注：^a为χ²值，b为t值，^c为Z值。1 mm Hg=0.133 kPa。

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表 2 CVD组与无CVD组慢性肾功能不全尿毒症期患者的实验室相关指标比较

Table 2. Comparison of laboratory-related indicators in patients with chronic renal insufficiency uremia in the CVD group and the CVD-free group

项目	CVD组(n=74)	无CVD组(n=52)	统计量	P值
iPTH[M(P₂₅, P₇₅)，pg/mL]	350.65(188.75，657.98)	258.00(140.00, 531.20)	-1.425^a	0.154
ALB[M(P₂₅, P₇₅)，g/L]	40.20(37.83，42.80)	41.40(37.83，44.65)	-1.284^a	0.199
PAB(x±s, mg/L)	330.78±92.93	366.88±83.40	-2.238^b	0.027
BUN[M(P₂₅, P₇₅)，mmol/L]	19.86(14.67，26.29)	18.92(15.95，24.78)	-0.109^a	0.913
Scr(x±s, μmol/L)	784.73±248.85	836.62±284.87	-1.085^b	0.280
UA[M(P₂₅, P₇₅)，μmol/L]	433.00(384.50，475.00)	302.00(255.00，359.50)	-8.306^a	< 0.001
Cys-C[M(P₂₅, P₇₅)，mg/L]	7.09(5.77，8.35)	7.04(6.29，8.06)	-0.448^a	0.654
FBG[M(P₂₅, P₇₅)，mmol/L]	4.35(3.95，5.08)	4.27(3.96，5.05)	-0.203^a	0.839
TC[M(P₂₅, P₇₅)，mmol/L]	3.81(3.32，4.89)	4.09(3.39，4.66)	-0.768^a	0.442
TG[M(P₂₅, P₇₅)，mmol/L]	1.50(1.00，2.08)	1.32(0.95，1.70)	-1.105^a	0.269
HDL-C(x±s, mmol/L)	1.12±0.37	1.28±0.32	-2.562^b	0.012
LDL-C[M(P₂₅, P₇₅)，mmol/L]	2.19(1.79，2.84)	2.17(1.87，2.80)	-0.245^a	0.806
LP(a)[M(P₂₅, P₇₅)，mg/L]	286.00(154.75，457.25)	255.00(87.75，457.00)	-1.063^a	0.288
Hcy[M(P₂₅, P₇₅)，μmol/L]	32.00(25.75，38.00)	18.50(13.00，25.00)	-7.401^a	< 0.001
Ca[M(P₂₅, P₇₅)，mmol/L]	2.18(2.04，2.30)	2.23(2.03，2.41)	-1.108^a	0.268
Mg(x±s, mmol/L)	0.98±0.08	1.11±0.10	-7.847^b	< 0.001
P(x±s, mmol/L)	1.96±0.65	1.95±0.59	0.074^b	0.941
Hb(x±s, g/L)	106.59±18.93	106.73±21.26	-0.038^b	0.970
hs-CRP[M(P₂₅, P₇₅)，mg/L]	17.00(14.00，19.25)	7.00(5.00，9.00)	-9.344^a	< 0.001
IL-6[M(P₂₅, P₇₅)，pg/mL]	14.00(12.75，17.00)	3.50(2.00，5.00)	-9.221^a	< 0.001
注：^a为Z值，^b为t值。

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表 3 MHD患者发生CVD危险因素的logistic回归分析

Table 3. Logistic regression analysis of risk factors for CVD in patients with MHD

变量	B	SE	Wald χ²	P值	OR值	95% CI
年龄	0.566	0.245	6.358	0.029	1.441	1.025~2.058
透析龄	0.912	0.339	10.560	0.019	2.212	1.385~3.461
PAB	0.295	0.129	4.249	0.535	0.964	0.648~1.579
Mg	0.379	0.011	7.804	0.085	1.204	0.855~1.743
HDL-C	0.342	0.138	4.557	0.476	1.098	0.960~1.858
Hcy	0.469	0.169	5.573	0.030	1.384	1.028~1.624
hs-CRP	1.339	0.578	5.486	0.013	3.163	1.212~6.660
IL-6	1.398	0.614	6.093	0.009	3.802	1.585~6.826
UA	1.654	0.876	5.847	< 0.001	5.056	2.159~10.928

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参考文献(19)

[1]	陈洁, 陈妙, 应一樱, 等. 冠状动脉钙化积分对于透析患者心血管事件发生风险的预测价值[J]. 中华全科医学, 2019, 17(11): 1856-1859. doi: 10.16766/j.cnki.issn.1674-4152.001074 CHEN J, CHEN M, YING Y Y, et al. Predictive value of coronary artery calcification scores on the risk of cardiovascular events in dialysis patients[J]. Chinese Journal of General Practice, 2019, 17(11): 1856-1859. doi: 10.16766/j.cnki.issn.1674-4152.001074
[2]	COZZOLINO M, GALASSI A, PIVARI F, et al. The cardiovascular burden in end-stage renal disease[J]. Contrib Nephrol, 2017, 191(1): 44-57.
[3]	OTSUKA K, NAKANISHI K, SHIMADA K, et al. Associations of sensitive cardiac troponin-I with left ventricular morphology, function and prognosis in end-stage renal disease patients with preserved ejection fraction[J]. Heart Vessels, 2018, 33(11): 1334-1342. doi: 10.1007/s00380-018-1192-7
[4]	张琨, 王少亭, 胡晓舟, 等. 维持性血液透析患者并发心血管疾病危险因素分析[J]. 山东医药, 2017, 57(4): 82-84. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYY201704028.htm ZHANG K, WANG S T, HU X Z, et al. Risk factors for concurrent cardiovascular disease in patients on maintenance hemodialysis[J]. Shandong Medicine, 2017, 57(4): 82-84. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYY201704028.htm
[5]	YU L, LI H, WANG S X. Serum magnesium and mortality in maintenance hemodialysis patients[J]. Blood Purif, 2017, 43(1-3): 31-36. doi: 10.1159/000451052
[6]	WU L, CAI K, LUO Q, et al. Baseline serum magnesium level and its variability in maintenance hemodialysis patients: Associations with mortality[J]. Kidney Blood Press Res, 2019, 44(2): 222-232. doi: 10.1159/000498957
[7]	李清, 姚曦, 陈江华, 等. 血镁水平对维持性血液透析患者死亡率的影响[J]. 中华肾脏病杂志, 2020, 36(11): 817-823. https://www.cnki.com.cn/Article/CJFDTOTAL-SHSB202106003.htm LI Q, YAO X, CHEN J H, et al. Effect of blood magnesium level on mortality in maintenance hemodialysis patients[J]. Chinese Journal of Nephrology, 2020, 36(11): 817-823. https://www.cnki.com.cn/Article/CJFDTOTAL-SHSB202106003.htm
[8]	张艳, 黄琳, 李慧, 等. 维持性血液透析患者血镁水平与心脑血管死亡的关系[J]. 中国血液净化, 2021, 20(11): 732-736. doi: 10.3969/j.issn.1671-4091.2021.11.003 ZHANG Y, HUANG L, LI H, et al. The relationship between blood magnesium level and cardiovascular and cerebrovascular death in maintenance hemodialysis patients[J]. China Blood Purification, 2021, 20(11): 732-736. doi: 10.3969/j.issn.1671-4091.2021.11.003
[9]	MAESATO K, OHTAKE T, MOCHIDA Y, et al. Correlation of hippocampal atrophy with hyperhomocysteinemia in hemodialysis patients: An exploratory pilot study[J]. PLoS One, 2017, 12(4): e0175102. doi: 10.1371/journal.pone.0175102
[10]	葛君, 汪朝晖, 宣玲. 高血压患者血清hs-CRP、Hcy及UA水平与颈动脉粥样硬化的相关性研究[J]. 中华全科医学, 2019, 17(7): 1138-1141. doi: 10.16766/j.cnki.issn.1674-4152.000884 GE J, WANG Z H, XUAN L. Correlation between serum hs-CRP, Hcy and UA levels and carotid atherosclerosis in hypertensive patients[J]. Chinese Journal of General Practice, 2019, 17(7): 1138-1141. doi: 10.16766/j.cnki.issn.1674-4152.000884
[11]	EPIFANIO A P S, BALBINO K P, RIBEIRO S M R, et al. Clinical-nutritional, inflammatory and oxidative stress predictors in hemodialysis mortality: A review[J]. Nutr Hosp, 2018, 35(2): 461-468.
[12]	MACHOWSKA A, SUN J, QURESHI A R, et al. Plasma pentosidine and its association with mortality in patients with chronic kidney disease[J]. PLoS One, 2016, 11(10): e0163826. doi: 10.1371/journal.pone.0163826
[13]	朱士彦, 陈剑泉, 罗承志, 等. 维持性血液透析患者微炎症反应及网膜素-1与冠心病的相关性研究[J]. 临床肾脏病杂志, 2017, 17(7): 407-410. https://www.cnki.com.cn/Article/CJFDTOTAL-LCSB201707006.htm ZHU S Y, CHEN J Q, LUO C Z, et al. Microinflammaterial response and correlation between omentosin-1 and coronary heart disease in patients on maintenance hemodialysis[J]. Journal of Clinical Nephrology, 2017, 17(7): 407-410. https://www.cnki.com.cn/Article/CJFDTOTAL-LCSB201707006.htm
[14]	宋培. CysC、IL-6及LVEF对维持性血液透析患者发生不良心血管事件的预测价值[J]. 中国实验诊断学, 2020, 24(11): 1762-1765. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSZD202011002.htm SONG P. Predictive value of CysC, IL-6 and LVEF in the occurrence of adverse cardiovascular events in patients on maintenance hemodialysis[J]. Chinese Journal of Laboratory Diagnostics, 2020, 24(11): 1762-1765. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSZD202011002.htm
[15]	SHEN G, HUANG J Y, YU Y L, et al. J-shaped association between serum uric acid and acute coronary syndrome in patients with essential hypertension[J]. Postgrad Med J, 2020, 96(1132): 73-78. doi: 10.1136/postgradmedj-2019-136650
[16]	李娜. 维持性血液透析患者血尿酸水平与心血管疾病的关系研究[J]. 中国当代医药, 2020, 27(23): 17-20. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGUD202023005.htm LI N. The relationship between blood uric acid level and cardiovascular disease in maintenance hemodialysis patients[J]. Chinese Contemporary Medicine, 2020, 27(23): 17-20. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGUD202023005.htm
[17]	BULBUL M C, DAGEL T, AFSAR B, et al. Disorders of lipid metabolism in chronic kidney disease[J]. Blood Purif, 2018, 46(2): 144-152. doi: 10.1159/000488816
[18]	VOSKAMP P W M, VAN DIEPEN M, DEKKER F W, et al. Dyslipidemia and risk of renal replacement therapy or death in incident pre-dialysis patients[J]. Sci Rep, 2018, 8(1): 3130.
[19]	TAHERI S, BARADARAN A, ALIAKBARIAN M, et al. Level of inflammatory factors in chronic hemodialysis patients with and without cardiovascular disease[J]. J Res Med Sci, 2017, 22(1): 47.