[1]杨靖倩,狄亚妮,胡爽爽,等.终末期肾病患者腹膜透析后心血管疾病影响因素分析[J].新乡医学院学报,2023,40(4):333-338.[doi:10.7683/xxyxyxb.2023.04.007]
　YANG Jingqian,DI Yani,HU Shuangshuang,et al.Analysis of influencing factors of cardiovascular disease in patients with end-stage renal disease after peritoneal dialysis[J].Journal of Xinxiang Medical University,2023,40(4):333-338.[doi:10.7683/xxyxyxb.2023.04.007]
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终末期肾病患者腹膜透析后心血管疾病影响因素分析
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
40卷
期数:
2023年4
页码:
333-338
栏目:
临床研究
出版日期:
2023-04-05

文章信息/Info

Title:
Analysis of influencing factors of cardiovascular disease in patients with end-stage renal disease after peritoneal dialysis
作者:
杨靖倩; 狄亚妮; 胡爽爽; 吕玉敏; 刘云; 郭明好; 马东红
（新乡医学院第一附属医院肾脏内科，河南　卫辉　453100）
Author(s):
YANG Jingqian; DI Yani; HU Shuangshuang; LYU Yumin; LIU Yun; GUO Minghao; MA Donghong
(Department of Nephrology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)
关键词:
腹膜透析; 心血管疾病; 影响因素; 终末期肾病
Keywords:
peritoneal dialysis; cardiovascular disease; influencing factor; end-stage renal disease
分类号:
R692
DOI:
10.7683/xxyxyxb.2023.04.007
文献标志码:
A
摘要:
目的探讨接受腹膜透析（PD）治疗的终末期肾病(ESRD)患者发生心血管疾病（CVD）的影响因素。方法选择2018年8月至2020年12月新乡医学院第一附属医院肾脏内科收治的139例行PD置管术的ESRD患者为研究对象，根据PD置管术后 3个月至2021年12月是否发生CVD，将患者分为CVD组(n=30)和非CVD组(n=109)。通过查阅病历资料收集患者的一般临床资料，包括：性别、年龄、体质量指数(BMI)及既往病史。所有患者PD 后 1 a内入院复查2次，每次入院采用腹膜平衡实验检测总尿素清除指数Kt/V；于入院次日清晨收集患者空腹肘静脉血，使用全血细胞自动分析仪检测血红蛋白、红细胞分布宽度(RDW)、中性粒细胞计数、淋巴细胞计数，计算中性粒细胞计数与淋巴细胞计数比值（NLR）；使用全自动生物化学分析仪检测血清磷、血清钙、血清钾、血清肌酐、血尿酸、空腹血糖、血清白蛋白、高密度脂蛋白、丙氨酸转氨酶(ALT)、总胆红素(TBIL)、乳酸脱氢酶(LDH)水平，使用全自动免疫化学发光分析仪检测全段甲状旁腺素(iPTH)水平，使用全自动特种蛋白分析仪检测超敏C反应蛋白(hs-CRP)水平，使用血沉分析仪检测红细胞沉降率(ESR)。采用Spearman相关分析临床指标与ESRD患者PD后发生CVD的相关性；多因素logistic回归分析ESRD患者PD后发生CVD的影响因素；绘制受试者操作特征（ROC）曲线评估NLR、血清磷、血清白蛋白单独及联合检测对ESRD患者PD后发生CVD的预测价值。结果2组患者的年龄、性别、BMI、CVD病史、RDW、尿酸与高密度脂蛋白比值、Kt/V及血红蛋白、血清钾、TBIL、iPTH水平比较差异无统计学意义(P>0.05)；CVD组患者的血清磷、空腹血糖、血清肌酐、ALT、LDH、ESR、hs-CRP水平及NLR显著高于非CVD组，血清钙、血清白蛋白水平显著低于非CVD组 (P<0.05)。Spearman相关分析结果显示，ESRD患者PD后CVD 的发生与NLR、血清磷、空腹血糖、血清肌酐、ALT 、LDH、ESR、hs-CRP 呈正相关（r=0.341、0.199、0.264、0.203、0.205、0.444、0.187、0.290， P<0.05），与血清钙、血清白蛋白水平呈负相关（r=-0.204、-0.235， P<0.05）。Logistic回归分析结果显示，NLR、血清磷是ESRD患者PD后发生CVD的危险因素，血清白蛋白是ESRD患者PD后发生CVD的保护因素(P<0.05)，血清钙、hs-CRP、空腹血糖、血清肌酐、LDH、ESR、ALT与PD患者PD后发生CVD无关（P>0.05）。ROC曲线分析显示，NLR、血清磷、血清白蛋白预测ESRD患者PD后发生CVD的截断值分别为3.925 mmol·L-1、2.105 mmol·L-1、 32.258 g·L-1；NLR、血清磷、血清白蛋白联合检测预测ESRD患者PD后发生CVD的AUC显著高于血清磷、血清白蛋白单独检测，三者联合检测预测的特异度显著高于血清白蛋白单独检测(P<0.05)。结论NLR、血清磷是ESRD患者PD后发生CVD的危险因素，血清白蛋白是ESRD患者PD后发生CVD的保护因素，三者联合检测对ESRD患者PD后发生CVD有较高的预测价值。
Abstract:
ObjectiveTo explore the influencing factors of cardiovascular disease (CVD) in patients with end-stage renal disease (ESRD) treated with peritoneal dialysis (PD).MethodsA total of 139 ESRD patients with PD catheterization admitted at the Department of Nephrology,the First Affiliated Hospital of Xinxiang Medical University from August 2018 to December 2020 were selected as the study subjects.According to whether CVD occurred from 3 months after PD catheterization to December 2021,the patients were divided into the CVD group (n=30) and the non-CVD group (n=109).General clinical data of patients were collected by consulting medical records,including gender,age,body mass index (BMI) and past medical history.All patients were admitted to the hospital for two reexaminations within one year after PD.The total urea clearance index Kt/V was measured by peritoneal balance test for each admission.The fasting elbow vein blood of the patients was collected in the morning of admission,and the hemoglobin,red cell distribution width (RDW),neutrophil count and lymphocyte count were measured by automatic whole blood cell analyzer;the levels of serum phosphorus,serum calcium,serum potassium,serum creatinine,serum uric acid,fasting blood glucose,serum albumin,high-density lipoprotein,alanine transaminase (ALT),total bilirubin (TBIL),lactate dehydrogenase (LDH) were measured by automatic biochemical analyzer,and neutrophil to lymphocyte ratio (NLR) was calculated;the level of whole parathyroid hormone (iPTH) was detected by automatic immunochemi-luminescence analyzer,and neutrophil;the level of hypersensitive C-reactive protein (hs-CRP) was detected by automatic special protein analyzer;the erythrocyte sedimentation rate (ESR) was measured by sedimentation analyzer.The correlation between clinical indicators and CVD in ESRD patients after PD was analyzed by Spearman correlation analysis;the influencing factors of CVD in ESRD patients after PD was analyzed by multivariate logistic regression analysis;the diagnostic value of NLR,serum phosphorus,and serum albumin alone and in combination for CVD after PD in ESRD patients was evaluated by receiver operating characteristic (ROC) curve. ResultsThere was no significant difference in age,sex,BMI,CVD history,RDW,uric acid to high-density lipoprotein cholesterol ratio,total Kt/V,hemoglobin,serum potassium,TBIL and iPTH of patients between the two groups (P>0.05);the levels of serum phosphorus,fasting blood glucose,serum creatinine,ALT,LDH,ESR,hs-CRP and NLR of patients in the CVD group were significantly higher than those in the non-CVD group,while the levels of serum calcium and serum albumin were significantly lower than those in the non-CVD group (P<0.05).The results of Spearman correlation analysis showed that the occurrence of CVD in ESRD patients after PD was positively correlated with NLR,serum phosphorus,fasting blood glucose,serum creatinine,ALT,LDH,ESR and hs-CRP (r=0.341,0.199,0.264,0.203,0.205,0.444,0.187,0.290;P<0.05),and negatively correlated with serum calcium and serum albumin levels (r=-0.204,-0.235;P<0.05).The results of logistic regression analysis showed that NLR,serum phosphorus were the risk factors of CVD in ESRD patients after PD,while the serum albumin was a protective factor of CVD in ESRD patients after PD (P<0.05)；serum calcium,hs-CRP,fasting blood glucose,serum creatinine,LDH,ESR,ALT were not associated with CVD in PD patients after PD (P>0.05).ROC curve analysis showed that the cut-off values of NLR,serum phosphorus and serum albumin in the predicting of CVD in ESRD patients after PD were 3.925 mmol · L-1,2.105 mmol · L-1 and 32.258 g · L-1,respectively;the area under curre of NLR,serum phosphorus and serum albumin combined detection in the predicting of CVD after PD in ESRD patients was significantly higher than that of the single detection of serum phosphorus and serum albumin,and the specificity of the combined predicting of the three indexes was significantly higher than that of the single detection of serum albumin (P<0.05).ConclusionThe NLR,serum phosphorus are the risk factors of CVD in ESRD patients after PD,while the serum albumin was a protective factor of CVD in ESRD patients after PD.The combined detection of these three factors has high predictive value for CVD in ESRD patients after PD.

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更新日期/Last Update: 2023-04-05