摘要
目的探讨我国维持性血液透析(MHD)患者脂蛋白(a)[Lp(a)]的相关因素及其与心血管疾病的关系。方法选取2020年4月至9月在北京同仁医院透析中心进行规律血液透析的119例患者。Lp(a)正常组84例,Lp(a)升高组35例。收集患者一般资料、实验室检查、透析相关资料以及近6月来新发心血管事件情况。将Lp(a)30 mg/dL为界分为Lp(a)升高组及Lp(a)正常组,应用Spearman相关分析统计与Lp(a)相关的因素,通过多因素logistic回归分析统计心血管事件危险因素。结果Lp(a)升高组相对于Lp(a)正常组血清铁水平低[(9.36±3.81)μmol/L比(12.89±6.01)μmol/L,P<0.001],转铁蛋白饱和度水平低[(21.68±9.32)%比(29.75±14.66)%,P=0.001],差异有统计学意义。Lp(a)升高组新发心血管事件的比例显著升高(31.4%比1.2%,P<0.001)。Lp(a)与血清铁、转铁蛋白饱和度与呈负相关,相关系数分别为-0.350(P<0.001)和-0.312(P=0.001),与血红蛋白及血浆白蛋白水平呈负相关,其相关系数为-0.188(P=0.041)及-0.243(P=0.008)。透析后平均收缩压水平与Lp(a)呈正相关,相关系数为0.208(P=0.025)。logistic回归分析显示Lp(a)、铁蛋白、中心粒细胞升高及尿素下降率(URR)下降是MHD患者新发心血管事件的独立危险因素。Lp(a)、铁蛋白水平及中性粒细胞比例每增加1单位,患者发生心血管事件的风险将分别增加1.074、1.004及1.221倍,而透析充分性URR每升高1单位心血管事件发生风险下降0.854倍。结论Lp(a)是MHD患者发生心血管事件的独立危险因素。
Objective To explore the related factors of Lp(a)and its relationship with cardiovascular disease in maintenance hemodialysis(MHD)patients in China.Methods A total of 119 patients receiving regular hemodialysis in Beijing Tongren Hospital from April to September 2020 were selected.There were 84 cases in the normal Lp(a)group and 35 cases in the elevated Lp(a)group.General information,laboratory examination,dialysis related information and new cardiovascular events in the last 6 months were collected.LP(a)30mg/dL was divided into elevated LP(a)group and normal LP(a)group.Spearman correlation analysis was used to analyze the factors related to LP(a),and multivariate logistic regression analysis was used to analyze the risk factors of cardiovascular events.Results Compared with the normal group,the serum iron level of the elevated group was lower[(9.36±3.81)μmol/L vs.(12.89±6.01)μmol/L,P<0.001],and the transferrin saturation level was lower[(21.68±9.32)%vs.(29.75±14.66)%,P=0.001],and the difference was statistically significant..The proportion of new cardiovascular events was significantly higher in the elevated LP(a)group(31.4%vs.1.2%,P<0.001).Lp(a)was negatively correlated with serum iron and transferrin saturation(r=-0.350,P<0.001 and r=-0.312,P=0.001),respectively,and negatively correlated with hemoglobin and plasma albumin levels(r=-0.188,P=0.041;r=-0.243,P=0.008).The mean systolic blood pressure after dialysis was positively correlated with Lp(a)(=0.208,P=0.025).Logistic regression analysis showed that the increase of Lp(a),ferritin,neutrophils and the decrease of urea rate(URR)were independent risk factors for new cardiovascular events in MHD patients.Each 1 unit increase in Lp(a),ferritin level,and neutrophil ratio was associated with a 1.074,1.004,and 1.221 fold increase in the risk of cardiovascular events,respectively,while each 1 unit increase in dialysis sufficiency URR decreased the risk of cardiovascular events by 0.854 fold.Conclusion Lp(a)is an independent risk factor for cardiovascular events in MHD patients.
作者
梁巧静
张国娟
张梅
陈燊
鲍书敏
Liang Qiaojing;Zhang Guojuan;Zhang Mei;Chen Shen;Bao Shumin(Department of Nephrology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)
出处
《中国临床保健杂志》
CAS
2021年第1期39-44,共6页
Chinese Journal of Clinical Healthcare
关键词
肾透析
脂蛋白(A)
心血管疾病
危险因素
Renal dialysis
Lipoprotein(a)
Cardiovascular diseases
Risk factors
