摘要
目的探讨维持性血液透析患者微炎症与心血管事件及存活率的关系。方法回顾性分析广东省人民医院肾内科维持性血液透析患者178例,以超敏C反应蛋白(C-reactive protein,CRP)作为微炎症标志物,按观察开始时血清超敏CRP水平分为2组:超敏CRP正常组87例,超敏CRP升高组91例。定期监测血液透析患者的血压、超敏CRP、血红蛋白(Hb)、白蛋白(Alb)、血脂、血尿素氮(BUN)、肌酐(Scr),计算尿素清除指数(Kt/V),B超测定心脏左心房前后径(LAD)、室间隔厚度(IVST)、左心室前后径(LVD)、左心室重量指数(LVMI)及左心室射血分数(LVEF)。回顾性分析60个月,观察两组心血管事件发生率,心血管疾病致死率和总死亡率的情况。利用统计学分析两组患者CRP与心室结构功能的关系,两组生存曲线及评价微炎症与死亡危险度的关系。结果存在微炎症的超敏C-反应蛋白升高组心室结构指标LAD、IVST、LVD、LVMI均大于正常组(P<0.05);而LVEF低于正常组(P<0.05),血清超敏C反应蛋白水平与LAD、IVST、LVD、LVIM呈正相关(r=0.298,r=0.331,r=0.321,r=0.342,P均<0.05),而与LVEF呈显著负相关(r=-0.343,P<0.01)。超敏C-反应蛋白升高组心血管事件发生率及心血管事件死亡率明显高于正常组(P<0.05);60个月存活率升高组较正常组显著降低(P<0.05)。生存分析显示,血清超敏CRP独立于性别、年龄、维持透析时间、血浆白蛋白、血脂、平均动脉压等因素之外,与死亡危险度显著相关(P<0.05)。结论尿毒症患者存在微炎症时超敏-CRP持续增高,持续增高的超敏-CRP是心血管事件发生率的独立危险因素,也是判断血液透析患者预后的重要预测因子。
Objective In uremic patients undergoing hemodialyis, higher serum high sensitive C-reactive protein （hs-CRP） indicates the presence of micro-inflammation status. Here we studied the micro-inflammation in relation to cardiovascular events and prognosis in these patients. Methods We retrospectively analyzed 178 uremic patients undergoing maintenance hemodialysis. Their serum hs-CRP, hemoglobin, albumin, lipids, urea nitrogen, creatinine, Kt/V and blood pressure were determined at the beginning of study. They were then assigned into high hs- CRP group （hs-CRP 〉3mg/L, n = 91） or normal hs-CRP group （hs-CRP 〈3mg/L, n = 87）. Meanwhile, echocardiography was performed. Total mortality rate, cardiovascular mortality rate and frequency of cardiovascu- lar events were recorded during the follow-up period. Results Echocardiographic studies showed that left atrial diameter （LAD）, interventricular septal thickness （IVST）, left ventricular diameter （LVD）, and left ventricular mass index （LVMI） were higher in the high hs-CRP group （P 〈0.05）, and the left ventricular ejection fraction （LVEF） was lower in the high hs-CRP group （P〈0.05）. Serum hs-CRP was positively correlated with LAD, IVST, LVD, LVMI （r = 0.298, r = 0.331, r = 0.321 and r = 0.342, respectively, P 〈0.05）, and negatively correlated with LVEF （r = -0.343, P 〈0.01 ）. Total mortality rate, cardiovascular mortality rate and frequency of cardiovascular events were higher in the high hs-CRP group than in the normal hs-CRP group （P 〈0.05）. Conclusion In uremic patients undergoing maintenance hemodialysis, persistent increase of hs-CRP indicates the presence of micro-inflammation. The increase of serum hs-CRP is the independent risk factor for cardiovascular events, and is also one of the important issues for the prediction of prognosis.
出处
《中国血液净化》
2008年第5期256-259,共4页
Chinese Journal of Blood Purification
基金
广东省科技计划项目(2007B031507008)
广东省医学科研基金(A2005021)
广州市科技攻关计划项目(2005Z3-E0121)
关键词
尿毒症
心血管并发症
微炎症
超敏CRP
Uremia
Cardiovascular events
High sensitive C-reactive protein
Micro-inflammation
