持续非卧床腹膜透析和血液透析患者透析治疗一年后脉搏波速度变化的比较。

Comparison of changes in pulse wave velocity in patients on continuous ambulatory peritoneal dialysis and hemodialysis one year after introduction of dialysis therapy.

作者信息

Mimura Taku, Takenaka Tsuneo, Kanno Yoshihiko, Aoki Hiroaki, Ohshima Joji, Suzuki Hiromichi

机构信息

Department of Nephrology, Saitama Medical School, Saitama, Japan.

出版信息

Adv Perit Dial. 2005;21:139-45.

PMID:16686305

Abstract

Damage to large arteries is a major contributory factor to the high cardiovascular morbidity and mortality of patients with end-stage renal disease. Among the methods for assessment of arterial damage, measurements of pulse wave velocity (PWV) are considered to predict cardiovascular risk. In the present study, we compared changes in the PWV of patients on hemodialysis (HD) and on continuous ambulatory peritoneal dialysis (CAPD). Patients were eligible for entry into the study if they had been on HD or CAPD for at least 3 months, but for fewer than 5 months, and if they had had no clinical cardiovascular disease during the 6 months preceding study entry. We followed a total of 22 patients (average age: 57.9 +/- 9.8 years) on HD and 22 patients (average age: 59.7 +/- 11.4 years) on CAPD for 1 year. Baseline PWV was determined, and a second measurement was performed 1 year after the baseline PWV had been obtained. Systolic and diastolic blood pressures in the two groups were similar [144.8 +/- 18.4 mmHg over 83.2 +/- 8.7 mmHg (CAPD) vs. 147.4 +/- 18.8 mmHg over 87 +/- 12.3 mmHg (HD)]. In the patients on CAPD, urine volume was fairly constant at about 546.1 +/- 365 mL daily; however, urine volume for most of the patients on HD was less than 100 mL daily. Although no significant difference was observed in baseline PWV [1726.2 +/- 374 m/s (CAPD) vs. 1774.2 +/- 531.36 m/s (HD)], a significant difference in PWV was seen between the two groups at 1 year [1631.9 +/- 380.8 m/s (CAPD) vs. 1853.2 +/- 434.2 m/s (HD), p < 0.05]. With the exception of level of serum cholesterol [256 + 24 mg/dL (CAPD) vs. 187 + 25 mg/dL (HD), p < 0.05], other laboratory data were not significantly different between the two groups. Despite higher serum cholesterol in the patients on CAPD, PWV was faster in the patients on HD. There may be less arterial damage in patients on CAPD than in patients on HD.

摘要

大动脉损伤是终末期肾病患者心血管疾病高发病率和高死亡率的主要促成因素。在评估动脉损伤的方法中，脉搏波速度（PWV）测量被认为可预测心血管风险。在本研究中，我们比较了血液透析（HD）患者和持续性非卧床腹膜透析（CAPD）患者的PWV变化。如果患者接受HD或CAPD治疗至少3个月但少于5个月，且在研究入组前6个月内无临床心血管疾病，则符合纳入本研究的条件。我们对22例HD患者（平均年龄：57.9±9.8岁）和22例CAPD患者（平均年龄：59.7±11.4岁）进行了1年的随访。测定了基线PWV，并在获得基线PWV后1年进行了第二次测量。两组的收缩压和舒张压相似[CAPD组为144.8±18.4 mmHg/83.2±8.7 mmHg，HD组为147.4±18.8 mmHg/87±12.3 mmHg]。在CAPD患者中，尿量相当稳定，每日约为546.1±365 mL；然而，大多数HD患者的尿量每日少于100 mL。虽然基线PWV无显著差异[CAPD组为1726.2±374 m/s，HD组为1774.2±531.36 m/s]，但两组在1年时的PWV有显著差异[CAPD组为1631.9±380.8 m/s，HD组为1853.2±434.2 m/s，p<0.05]。除血清胆固醇水平[CAPD组为256 + 24 mg/dL，HD组为187 + 25 mg/dL，p<0.05]外，两组的其他实验室数据无显著差异。尽管CAPD患者的血清胆固醇较高，但HD患者的PWV更快。CAPD患者的动脉损伤可能比HD患者少。