摘要
目的:通过测量非透析慢性肾脏病(CKD)(1-5期)患者的脉搏波传导速度(PWV)和踝-肱指数(ABI)指标及肾小球滤过率的评估值(eGFR),分析PWV和ABI作为评估CKD患者动脉硬化程度的临床意义。
方法:1.本研究为横断面研究,选自我院2008年10月至2009年10月的干部特诊一科和肾内科住院病人118例,诊断明确的非透析CKD(1-5期)患者。2.记录患者性别、年龄、身高、体重、吸烟状况、血压、空腹血糖、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、肾功能。3.通过简化MDRD公式计算eGFR。4.测定baPWV、ABI值。5.检测24小时尿蛋白定量。6.采用SPSS 15.0软件包,单因素方差分析、Spearman相关分析和多元线性回归分析方法等进行统计处理。
结果:
1.共入选118例患者。将研究对象按eGFR水平分为CKD1期组、CKD2期组、CKD3期组、CKD4期组、CKD5期组。
2. ABI值在各组间的差异有统计学意义(F=28.123,p<0.01);与CKD1期组比较,CKD3期组(P<0.01)、CKD4期组(p<0.01)、CKD5期组(p<0.01)患者的ABI值明显降低,但CKD1期组、CKD2期组患者的ABI相比无统计学差异(P >0.05)。在CKD2-5组间随着eGFR降低,ABI值也逐渐下降(P<0.01)。
3. PWV值在各组间的差异有统计学意义(F=141.759,p<0.01);与CKD1期组比较,CKD2期组(p<0.01)、CKD3期组(p<0.01)、CKD4期组(p<0.01)、CKD5期组(p<0.01)患者PWV值明显升高;在CKD2-5组间随着eGFR降低,PWV值也逐渐升高(P<0.01)。
4.多元线性回归分析显示,年龄( p<0.01)、糖尿病(p<0.01)、高血压(p<0.01)和eGFR(p<0.01)为ABI值影响因素;年龄(p<0.01),低HDL (p<0.01),eGFR(p<0.01)为PWV值主要影响因素。
结论:和其它传统危险因素一样,肾功能减退是动脉粥样硬化的独立危险因素,eGFR下降与动脉粥样硬化病变程度密切相关;而ABI和PWV均可作为评估CKD患者动脉硬化程度的重要临床指标。
Objective: To measure the pulse wave velocity(PWV) and ankle-brachial index (ABI) in patients with non-dialysis chronic kidney disease(CKD). To analysis the PWV and ABI as the assessment of the clinical significance of atherosclerosis.
Method: 1.This is a cross-sectional study.118 inpatients with diagnosis of non-dialysis CKD (stage 1-5) were selected in our hospital from October 2008 to October 2009 . 2. Clinical data were recorded,including sex, age, height, weight, smoking status, blood pressure, fasting glucose, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), renal function. 3. eGFR was calculated. 4.baPWV and ABI values were determined. 5.24 hours urinary protein were detected. 6. SPSS 15.0 was used for statistical analysis.
Results:
1. According to eGFR level,a total of 118 patients were divided into 5 groups as CKD stage 1 group to CKD stage 5 group.
2.There were significant differences in ABI value between 5 groups(F = 28.123,P <0.01). Compared with CKD stage 1 group, ABI values were significantly decreased in CKD stage 3 group (P <0.01),stage 4 group (P <0.01) and stage 5 group (P <0.01).There was no difference between CKD stage 1 group and stage 2 group (P >0.05). ABI value was significantly decreased with gradual decline of eGFR level (P<0.01)
3.There were significant differences in PWV value between 5 groups(F = 141.759,P <0.01). Compared with CKD stage 1 group, PWV values were significantly increased in CKD stage 2 group (P <0.01), stage 3 group (P <0.01),stage 4 group (P <0.01) and stage 5 group (P <0.01). PWV value was significantly increased with gradual decline of eGFR level (P<0.01).
4. Multiple regression analysis showed that age (P <0.01), diabetes (P <0.01), hypertension (P <0.01)and CKD stage(P <0.01) were risk factors for the ABI value . Age (p <0.01), low HDL (p <0.01)and CKD stage(p <0.01) were risk factors for the PWV value multiple regression analysis.
Conclusion: Renal dysfunction was independent of other traditional atherosclerosis risk factors. Decline of eGFR was closely related with the degree of atherosclerotic lesions. ABI and PWV can be used as important clinical indicators of atherosclerosis in patients with CKD.
引文
1 Zoccli C.Radditional and emerging cardiovascular and renal risk factors:An epidemiologic perspective[J].Kidney Int,2006,70(1):26-33.
2 Garg AX,Kiberd BA,Clark WF,et a1.Albuminuria and renal insufficiency Prevalence guides population screening:results from the NHANESM[J].Kidney Int,2002,61(6):2165-2175.
3 Chadban SJ,Briganti EM,Kerr PG,et al.Prevalence of kidney damage in Australian adults:the AusDiab kidney study[J].J Am Soc Nephrol,2003,14: S131-138.
4 Robert N,Foley MB, Patrick S, et al. Cardiovsacular epidemiology-of cardiovasvular disease in chronic renal disease. Am J Kidney 一Dis.1998,32(5 Sul):s113-s119.
5 Folry RN,Parfrey PS,Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal failure. Am J Kidney Dis .1998;32[suppl 5]a112-s119.
6 Naschimento MM,Pecoits Filho R, Lindholm B, et al. Inflammation, malnutrition and atherosclerosis in end-stage renal disease:A global perspective. Blood Purif,2002,20:454-458.
7 Francesco Locatelli, Pietro Pozzoni, Francesca Tentori and Lucia. Epidemiology of cardiovascular risk in patient with chronic kidney disease. Nephrol dial transplant,2003,18(suppl 7):vii2-vii9.
8 Sarnak MJ,Levey AS.Cardiocascular disease and chronic renal disease:A new paradigm. Am J Kidney Dis.2000;35LS117-S131.
9 National Kidney Foundation. K/ DOQI Clinical Practice Guidelines for Chronic Kidney Disease :ecaluation classification ,and stratification. Am J Kidney Dis ,2002 ,39 (2 suppl 1) :S1 - S266.
10 Levey AS , Greene T , Kusek J , et al . A simplified equation to predict glomerular filtration rate from serum creatinine. J Am SocNephrol ,2000 ,11 :A0828.
11 Levey AS,Atkins R,Coresh J,et al.Chronic kidney disease as a global public health problem:approaches and initiatives-a position statement from Kidney Disease Improving Global Outcomes.Kidney Int,2007,72:247-259.
12 Akcakus M, Koklu E, Kurtoglu S, et al. The relationship among intrauterine growth, insulin-like growth factor-I(IGF-I), IGF-binding protein-3,and bone mineral status in newbom infants [J].Am J Perinatol, 2006, 23(8):473-480.
13 value of plasma urea for assessment of renal function.Scand J Urol Nephrol,1978,12:39-44.
14 Anonymous. KDOQI clinical practice guidelines for chronic Kidney disease:evaluation,classification,and stratification Kidney Disease Outcome Quality Initiative. Am J Kidney Dis,2002,39 Suppl2;S1-S246.
15 Anonymous. KDOQI clinical practice guidelines for chronic Kidney disease:evaluation,classification,and stratification Kidney Disease Outcome Quality Initiative. Am J Kidney Dis,2002,39 Suppl 2;S1-S246.
16侯凡凡,慢性肾脏病的心血管病变.∥王海燕主编.肾脏病学第三版.北京:人民卫生出版社,2008: 1886-1888.
17侯凡凡;轻度肾功能减退是心血管疾病的独立危险因素[J].解放军医学杂志, 2004,29(11):944-946.
18陈灏珠,动脉粥样硬化和冠状动脉粥样硬化性心脏病.∥叶任高主编,陆再英副主编.内科学第五版.北京:人民卫生出版社,2001:272-273.
19龚兰生,许玉韵,张维忠,等.中国血管病变早期检测技术应用指南[J].中国健康医学杂志,2006,18(5):323-331.
20 Benetos A,Laurent S,Hoeks AP,et al.Arterial alterations with aging and high blood pressure.Arterioscler Thromb,1993;13:90-97.
21 Benetos A,Asmar R,Gautier S,et a1.Heterogeneity of the arterial tree in essential hypertension:a noninvasive study of the terminal aorta and the common carotid arteryJ Hum Hypertens,1994;8:501-507.
22 Hallock P.Arterial elasticity in man in relation to age as evaluated by the pulse wave velocity method.Arch Int Med,1934;54:770-798.
23 Relf IRN,Lo CS,Myers KA,et al.risk factors for changes in aorto-iliac arterial compliance in healthy men. Artenoscelrosis,1986;6:105一108.
24 Asmar RG,Brunel PC,Pannier BM,et al.Arterial distensibility and ambulatory blood pressure monitoring in essential hypertension.Am J Cardiol,1988;61:1066-1070.
25倪永斌,张维忠,王宏宇,胡大一。高血压脉搏波速度与脉压关系的研究.中华心血管病杂志2003.4; 31 (4): 257-259.
26 Roland Asmar.Arterial Stiffnenss and Pluse Wave Velocity clinical applications.动脉僵硬度和脉搏波速度的临床应用.王宏宇主译.
27 Curb JD,Masaki K,Rodriguez BL,et al.Peripheral artery disease and cardiovascular risk factors in the elderly.The Honolulu Heart Program[J]. Arterioscler Thromb Sasc Biol,1996;16(12):1495-500.
28 Papamichael CM,Lekakis JP,Stamatelopoulos KS,et al.Ankle-brachial index as a predictor of the extent of coronary atherosclerosis and cardiovascular events in patients with coronary artery disease[J].AM J Cardiol,2000;86(6):615-618.
29 Vicente I,Lahoz C,Taboada M,et al.Prevalence of an abnormal ankle- brachial index in relation to the cardiovascular risk estimated by the Framingham function[J].Med Clin(Barc),2005;124(17):641-4.
30 Murabito JM,Evans Jane C,Nieto Kenneth,et al.Prevalence and clinical correlates of peripheral arterial disease in the Framingham Offspring Study[J].AM HeartJ,2002;143:961.
1 Zoccli C.Radditional and emerging cardiovascular and renal risk factors:An epidemiologic perspective[J].Kidney Int,2006,70(1):26-33.
2 Garg AX,Kiberd BA,Clark WF,et a1.Albuminuria and renal insufficiency prevalence guides population screening:results from the NHANESM[J].Kidney Int,2002,61(6):2165-2175.
3 Chadban SJ,Briganti EM,Kerr PG,et al.Prevalence of kidney damage in Australian adults:the AusDiab kidney study[J].J Am Soc Nephrol,2003,14: S131-138.
4王海燕,王梅.慢性肾脏病及透析的临床实践指南(附评述)[M].北京:人民卫生出版社, 2003: 1-301.
5 National Kidney Foundation. K/ DOQI Clinical Practice Guidelines for Chronic Kidney Disease :ecaluation classification ,and stratification. Am J Kidney Dis ,2002 ,39 (2 suppl 1) :S1 - S266.
6 K/DOQI clinicalpractice guidelines for chronic kidney disease: e- valuation, classification, and stratification.KidneyDiseaseOutcome Quality Initiative[J].Am JKidneyDis, 2002, 39(Suppl2): S1-S246.
7 Obrador GT,Pereira BJ,Kausz AT.Chronic kidney disease in the United States:an underrecognized problem.Semin Nephrol,2002,22:441-448.
8 Day JC.Population Projections of the United States by Age,Sex,Race and Hispanic Origin:1995 to 2050.Washington,DC:US Government Printing Office,1996.
9 Profiles of General Demorgraphic Characteristics:2000 Census of Population and Hospitals:United States.Washington,DC :US Government Printing Office,2001.
10龚智峰,张文欣,彭小梅,等.慢性肾脏疾病防治思考.内科,2009,2:169-172.
11马骥.慢性肾功能衰竭.∥陈灏珠主编.实用内科学第12版.北京:人民卫生出版社,2005:2078-2094.
12α酮酸制剂在肾内科应用专家协作组.慢性肾脏病蛋白营养治疗共识.《中华肾脏病杂志》2005,7(21):421～424页.
13马骥.慢性肾功能衰竭.∥陈灏珠主编.实用内科学第12版.北京:人民卫生出版社,2005:2078-2095.
14 Klag MJ,Whelton PK,Randall BL,et al.Blood pressure and end-stage renal disease in men[J].N Engl J Med,1996,334(1):13–18.
15徐杰,梁美荣,李洪军,等.高血压对慢性肾衰竭患者肾功能影响的研究[J].吉林大学学报,2006,6(10):77-79.
16 Bakris GL, WeirMR, Shanifar S, et al.Effects of blood pressure level on progression of diabetic nephropathy: Results from the RENAAL study[J].Arch Intern Med, 2003, 63(12):1555~65.
17高瑞通,李学旺.控制血压对慢性肾脏疾病的作用.实用医院临床杂志.2005,2:8-12.
18顾勇,赖凌云.糖尿病肾病.∥陈灏珠主编.实用内科学第12版.北京:人民卫生出版社,2005:2195-2201.
19 Kasiske BL.Hyperlipidemia in patients with chronic renal disease[J].Am J Kidney Dis,1998,32(5 Suppl 3):S142-S156.
20李学旺,张国娟,李航.血脂异常对慢性肾脏疾病患者的影响及他汀类药物防治策略.内科理论与实践2007,6:391-394.
21 Khosla UM, Zharikov S, Finch JL, et a.l Hyperuricemia induces endothelial dysfunction. Kidney Int, 2005, 67(5): 1739-1742.
22 Johnson RJ, KangDH, FeigD, eta.l Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease Hypertension, 2003, 41: 1183-1190.