【作者】 郭太林；

【导师】 朱鹏立；

【作者基本信息】 福建医科大学 ， 老年医学， 2010， 硕士

【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。更多还原

【Abstract】 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.更多还原