Ye Binxian, Zhao Li, Shen Wei, Ren Yan, Lin Bo, Chen Maosheng, Tang Junda, Jiang Xinxin, Li Yiwen, He Qiang
Department of Nephrology, Zhejiang Provincial People's Hospital, Hangzhou 310014, China.
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2016 May 25;45(5):508-514. doi: 10.3785/j.issn.1008-9292.2016.09.09.
To investigate the changes of aortic stiffness and its influencing factors in patients with chronic kidney diseases (CKD). Eightyfour patients with CKD from Department of Nephrology, Zhejiang Provincial People's Hospital were divided into the dialysis group (CKD stage 5, =48) and non-dialysis group (CKD stage 3-5, =36). Clinical data, biochemical parameters and echocardiography findings were collected. SphygmoCor pulse wave analysis system was used to obtain pulse wave analysis (PWA) parameters including central aortic systolic blood pressure (CSP), central pulse pressure (CPP), augmented pressure (AP), augmentation index (AIX), and heart rate 75-adjusted augmentation index (HR75AIX). The influencing factors of aortic stiffness were analyzed by spearman correlation analysis and multiple regression analysis. CSP, CPP, AP, AIX and HR75AIX in dialysis patients had no significant differences compared with those in non-dialysis group (all >0.05). Spearman correlation analysis showed that CSP was positively correlated with systolic blood pressure, diastolic blood pressure, cholesterol, low-density lipoprotein cholesterol, left atrial diameter (LA),left ventricular systolic diameter (LVDs), left ventricular diastolic diameter (LVDd), and negatively correlated with calcium and hemoglobin levels. CPP was positively correlated with systolic blood pressure, age, LA, LVDd, and negatively correlated with diastolic blood pressure and hemoglobin levels. AP was positively correlated with systolic blood pressure, age, LA, LVDd, and negatively correlated with hemoglobin levels. AIX was positively correlated with systolic blood pressure, age, sodium, and negatively correlated with phosphorus levels. HR75AIX was positively correlated with systolic blood pressure, sodium, cholesterol, and negatively correlated with hemoglobin and albumin levels. Multiple regression analysis showed that higher systolic blood pressure was the independent risk factor for CSP (β=0.944, <0.01); lower diastolic blood pressure (β=0.939, <0.01) and higher systolic blood pressure (β=-1.010, <0.01) were the independent risk factors for CPP; older age (β=0.237, <0.01) and higher systolic blood pressure (β=0.200, <0.01) were the independent risk factors for AP; higher systolic blood pressure (β=0.163 and 0.115, <0.05 and <0.01) and higher sodium (β=0.646 and 0.625, all <0.05) were independent risk factors for both AIX and HR75AIX. No significant correlation is observed between aortic stiffness and CKD of different stages. Control blood pressure and restrict sodium intake may be effective means of delaying arterial stiffness in patients with CKD.
探讨慢性肾脏病(CKD)患者主动脉僵硬度变化及其影响因素。选取浙江省人民医院肾内科84例CKD患者,分为透析组(CKD 5期,n = 48)和非透析组(CKD 3 - 4期,n = 36)。收集临床资料、生化参数及超声心动图检查结果。采用SphygmoCor脉搏波分析系统获取脉搏波分析(PWA)参数,包括中心主动脉收缩压(CSP)、中心脉压(CPP)、增强压(AP)、增强指数(AIX)以及心率75校正增强指数(HR75AIX)。通过Spearman相关分析和多元回归分析主动脉僵硬度的影响因素。透析患者的CSP、CPP、AP、AIX和HR75AIX与非透析组相比,差异均无统计学意义(均P > 0.)。Spearman相关分析显示,CSP与收缩压、舒张压、胆固醇、低密度脂蛋白胆固醇、左房内径(LA)、左室收缩内径(LVDs)、左室舒张内径(LVDd)呈正相关,与血钙及血红蛋白水平呈负相关。CPP与收缩压、年龄、LA、LVDd呈正相关,与舒张压及血红蛋白水平呈负相关。AP与收缩压、年龄、LA、LVDd呈正相关,与血红蛋白水平呈负相关。AIX与收缩压、年龄、血钠呈正相关,与血磷水平呈负相关。HR75AIX与收缩压、血钠、胆固醇呈正相关,与血红蛋白及白蛋白水平呈负相关。多元回归分析显示,较高收缩压是CSP的独立危险因素(β = 0.944,P < 0.01);较低舒张压(β = 0.939,P < 0.01)和较高收缩压(β = -1.010,P < 0.01)是CPP 的独立危险因素;年龄较大(β = 0.237,P < 0.01)和较高收缩压(β = 0.200,P < 0.01)是AP的独立危险因素;较高收缩压(β = 0.163和0.115,P < 0.05和P < 0.01)和较高血钠(β = 0.646和0.625,均P <)是AIX和HR75AIX的独立危险因素。未观察到主动脉僵硬度与不同分期CKD之间存在显著相关性。控制血压和限制钠摄入可能是延缓CKD患者动脉僵硬度的有效手段。