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中华临床医师杂志(电子版) ›› 2020, Vol. 14 ›› Issue (03) : 170 -174. doi: 10.3877/cma.j.issn.1674-0785.2020.03.004

所属专题: 文献

医疗援藏·临床研究

慢性肾脏病3~5期非糖尿病非透析患者动脉僵硬度及其对预后的影响
王宓1, 张昕1, 隋准1,(), 白丽1, 王琰1, 左力1, 王梅1   
  1. 1. 100044 北京大学人民医院肾内科
  • 收稿日期:2020-02-17 出版日期:2020-03-15
  • 通信作者: 隋准
  • 基金资助:
    中华医学会临床医学科研专项资金(09010050160); 首都卫生发展科研专项项目(首发2011-4022-04)

Impact of arterial stiffness on prognosis in non-diabetic pre-dialysis patients with stages 3-5 chronic kidney disease

Mi Wang1, Xin Zhang1, Zhun Sui1,(), Li Bai1, Yan Wang1, Li Zuo1, Mei Wang1   

  1. 1. Department of Nephrology, People's Hospital of Peking University, Beijing 100044, China
  • Received:2020-02-17 Published:2020-03-15
  • Corresponding author: Zhun Sui
  • About author:
    Corresponding author: Sui Zhun, Email:
引用本文:

王宓, 张昕, 隋准, 白丽, 王琰, 左力, 王梅. 慢性肾脏病3~5期非糖尿病非透析患者动脉僵硬度及其对预后的影响[J/OL]. 中华临床医师杂志(电子版), 2020, 14(03): 170-174.

Mi Wang, Xin Zhang, Zhun Sui, Li Bai, Yan Wang, Li Zuo, Mei Wang. Impact of arterial stiffness on prognosis in non-diabetic pre-dialysis patients with stages 3-5 chronic kidney disease[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2020, 14(03): 170-174.

目的

检测慢性肾脏病(CKD)3~5期非糖尿病非透析患者动脉僵硬度,并探讨其对患者心脑血管死亡及全因死亡的影响。

方法

纳入北京大学人民医院2006年4月至2012年11月收治的CKD 3~5期非糖尿病非透析住院患者161例,所有患者住院后检测颈-股动脉脉搏波速度(CFPWV)。根据CFPWV水平,将患者分为CFPWV正常组(CFPWV<12 m/s)和CFPWV升高组(CFPWV≥12 m/s),随访入选患者的生存情况。采用Kaplan-Meier法对患者的生存情况进行评价,Cox比例风险回归对影响患者预后的因素进行分析。

结果

平均随访时间为(99.15±49.57)个月。CFPWV升高组心脑血管死亡率及全因病死率均明显高于CFPWV正常组[37.6%(19/51) vs 11.0%(9/82),50.7%(26/51) vs 20.7%(17/82),P均<0.05]。Kaplan-Meier曲线显示CFPWV升高组心脑血管病死率及全因病死率均明显高于CFPWV正常组(P<0.05)。多因素Cox回归分析显示,年龄及CFPWV是患者心血管死亡及全因死亡的独立危险因素,此外,白蛋白及血红蛋白还是全因死亡的独立危险因素(P<0.05)。

结论

高CFPWV的CKD 3~5期非糖尿病非透析患者心脑血管死亡率及全因死亡率均明显高于CFPWV正常的CKD患者,且CFPWV升高是CKD 3~5期非糖尿病非透析患者发生心脑血管死亡及全因死亡的独立危险因素。

Objective

To assess the impact of arterial stiffness on prognosis in non-diabetic pre-dialysis patients with stages 3-5 chronic kidney disease (CKD) .

Methods

A total of 161 non-diabetic pre-dialysis patients who suffered from stages 3-5 CKD were enrolled in this study between April 2006 and November 2012. An automatic pulse wave velocity (PWV) measuring system was used to measure carotid-femoral PWV (CFPWV). According to CFPWV level, we divided the patients into a high CFPWV group (CFPWV≥12 m/s) and a normal group (CFPWV<12 m/s). The patients were followed for the occurrence of cardiovascular death and all-cause death. Kaplan-Meier method was used for survival analysis and Cox proportional hazard regression model was used to identify the risk factors.

Results

The mean follow-up duration was (99.15±49.57) months. The incidence of cardiac-cerebralvascular death and all-cause death was significantly higher in the high CFPWV group than in the control group [37.6% (19/51) vs 11.0% (9/82), 50.7% (26/51) vs 20.7% (17/82), P<0.05]. Kaplan-Meier curve analysis for overall survival and cardiac-cerebral vascular event free survival showed that cardiac-cerebralvascular mortality and all-cause mortality were significantly higher in the high CFPWV group than in the control group (P<0.05). Multivariate Cox regression analysis revealed that increased CFPWV and age were the independent risk factors for cardiac-cerebralvascular mortality and all-cause mortality, and decreased albumin and hemoglobin were the independent risk factors for all-cause mortality (P<0.05).

Conclusion

The incidence of cardiac-cerebral vascular mortality and all-cause mortality is significantly higher in stages 3-5 CKD patients with elevated CFPWV than in those with normal CFPWV. Elevated CFPWV is one of independent risk factors for cardiac-cerebral vascular mortality and all-cause mortality in non-diabetic pre-dialysis patients with CKD.

表1 CFPWV升高组、CFPWV正常组患者心脑血管死亡率及全因死亡率比较[%(例)]
图1 2组患者心血管死亡率的Kaplan-Meier曲线
图2 2组患者全因死亡的Kaplan-Meier曲线
表2 CKD 3~5期非糖尿病非透析患者发生心血管死亡的多因素Cox分析结果
表3 CKD 3~5期非糖尿病非透析患者全因死亡的多因素Cox分析结果
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