血液透析患者的动脉僵硬度不均与全因死亡率和心血管死亡率

Unequal Arterial Stiffness With Overall and Cardiovascular Mortality in Patients Receiving Hemodialysis.

作者信息

Wei Shu-Yi, Huang Jiun-Chi, Chen Szu-Chia, Chang Jer-Ming, Chen Hung-Chun

机构信息

Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan, ROC; Yuh-Ing Junior College of Health Care & Management, Kaohsiung, Taiwan, ROC.

Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC; Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.

出版信息

Am J Med Sci. 2016 Feb;351(2):187-93. doi: 10.1016/j.amjms.2015.11.017.

DOI:10.1016/j.amjms.2015.11.017

PMID:26897274

Abstract

BACKGROUND

Pulse wave velocity is a marker of arterial stiffness. Unequal arterial stiffness has been associated with increased risk of cardiovascular events. This study calculated bilateral brachial-ankle pulse wave velocity (baPWV) differences and investigated the associations of unequal bilateral baPWV with overall and cardiovascular mortality in patients receiving hemodialysis (HD).

MATERIALS AND METHODS

A total of 205 patients receiving HD were enrolled in this study. The mean follow-up period was 4.4 ± 1.5 years. The baPWV was measured using an ankle-brachial index-form device, and bilateral baPWV difference was calculated and defined as ΔbaPWV.

RESULTS

The median value of ΔbaPWV was 88cm/second. ankle-brachial index < 0.95 and high baPWV were independently associated with a ΔbaPWV ≥ 88cm/s. Furthermore, patients with a ΔbaPWV ≥ 88cm/s demonstrated poorer overall (log-rank P = 0.035) and cardiovascular (log-rank P = 0.036) survival than did those with a ΔbaPWV < 88cm/s. After multivariate analysis, this difference was independently associated with overall (hazard ratio = 1.006; 95% CI: 1.001-1.011; P = 0.024) and cardiovascular (hazard ratio = 1.006; 95% CI: 1.000-1.013; P = 0.049) mortality.

CONCLUSIONS

ΔbaPWV was associated with an increased risk of cardiovascular and overall mortality in patients receiving HD. Earlier evaluation of ΔbaPWV may facilitate the identification of patients receiving HD who have an increased risk of cardiovascular and overall mortality.

摘要

背景

脉搏波速度是动脉僵硬度的一个指标。动脉僵硬度不均与心血管事件风险增加有关。本研究计算了双侧臂踝脉搏波速度（baPWV）差异，并调查了双侧baPWV不均与接受血液透析（HD）患者的全因死亡率和心血管死亡率之间的关联。

材料与方法

本研究共纳入205例接受HD的患者。平均随访期为4.4±1.5年。使用踝臂指数仪测量baPWV，并计算双侧baPWV差异，定义为ΔbaPWV。

结果

ΔbaPWV的中位数为88cm/秒。踝臂指数<0.95和高baPWV与ΔbaPWV≥88cm/s独立相关。此外，与ΔbaPWV<88cm/s的患者相比，ΔbaPWV≥88cm/s的患者全因生存（对数秩检验P=0.035）和心血管生存（对数秩检验P=0.036）较差。多因素分析后，这种差异与全因死亡率（风险比=1.006；95%CI：1.001-1.011；P=0.024）和心血管死亡率（风险比=1.006；95%CI：1.000-1.013；P=0.049）独立相关。