2021 年第 12 期 第 16 卷

颈总动脉内膜中层厚度和脉搏波传导速度对维持性血液透析患者远期预后的影响

Impact of common carotid artery intima-media thickness and pulse wave velocity on long-term outcome in maintenance hemodialysis patients

作者：贾小月1孙倩美2张利平1李艳春3杨洁1左力4

英文作者：Jia Xiaoyue1 Sun Qianmei2 Zhang Liping1 Li Yanchun3 Yang Jie1 Zuo Li4

单位：1北京积水潭医院肾内科100035；2首都医科大学附属北京朝阳医院综合科100020；3首都医科大学附属北京朝阳医院肾内科100020；4北京大学人民医院肾内科100044

英文单位：1Department of Nephrology Beijing Jishuitan Hospital Beijing 100035 China; 2Department of General Medicine Beijing Chao-yang Hospital Capital Medical University Beijing 100020 China; 3Department of Nephrology Beijing Chao-yang Hospital Capital Medical University Beijing 100020 China; 4Department of Nephrology Peking University People’s Hospital Beijing 100044 China

关键词：维持性血液透析；颈总动脉内膜中层厚度；脉搏波传导速度；预后

英文关键词：Maintenancehemodialysis；Commoncarotidarteryintima-mediathickness；Pulsewavevelocity；Prognosis

• 摘要：

• 目的 探讨颈总动脉内膜中层厚度（CCA-IMT）和颈动脉-股动脉脉搏波传导速度（cfPWV）对维持性血液透析（MHD）患者远期预后的影响。方法 选取2014年1—3月于北京积水潭医院和首都医科大学附属北京朝阳医院治疗的91例MHD患者的临床及随访资料进行回顾性分析。收集患者的基线资料，随访前检测CCA-IMT和cfPWV。随访85个月，记录MHD患者的生存情况，分为存活组（36例）和死亡组（55例）；根据CCA-IMT将患者分为CCA-IMT增厚组（43例，≥0.9 mm）和CCA-IMT正常组（48例，＜0.9 mm）；根据cfPWV将患者分为cfPWV升高组（37例，≥12 m/s）和cfPWV正常组（54例，＜12 m/s）。分析MHD患者全因死亡和心脑血管事件死亡的危险因素。结果  死亡组年龄、糖尿病肾病比例、高敏C反应蛋白水平、血清铁蛋白水平、CCA-IMT均高于/大于生存组（均P＜0.05）。Kaplan-Meier生存曲线分析结果显示，CCA-IMT增厚组全因死亡率和心脑血管事件死亡率均高于CCA-IMT正常组（均Log-rank P＜0.001）；cfPWV升高组全因死亡率和心脑血管事件死亡率均高于cfPWV正常组（Log-rank P=0.017、0.025）。多因素Cox回归分析结果显示，年龄（风险比=1.035，95%置信区间：1.005~1.066，P=0.023）、糖尿病肾病（风险比=3.497，95%置信区间：1.886~6.485，P＜0.001）、CCA-IMT≥0.9 mm（风险比=2.077，95%置信区间：1.114~3.872，P=0.021）、SF（风险比=1.001，95%置信区间：1.000~1.002，P=0.019）是MHD患者全因死亡的独立危险因素；糖尿病肾病（风险比=2.632，95%置信区间：1.202~5.765，P=0.016）、CCA-IMT≥0.9 mm（风险比=6.261，95%置信区间：2.611~15.010，P＜0.001）、cfPWV≥12 m/s（风险比=2.644，95%置信区间：1.253~5.577，P=0.011）是MHD患者心脑血管事件死亡的独立危险因素。结论  CCA-IMT和cfPWV增加是MHD患者远期全因死亡和心脑血管事件死亡的独立危险因素。

• Objective To explore the impact of common carotid artery intima-media thickness （CCA-IMT） and carotid-femoral pulse wave velocity（cfPWV） on the long-term outcome in maintenance hemodialysis（MHD）patients. Methods Clinical and follow-up data of 91 patients who underwent MHD in Beijing Jishuitan Hospital and Beijing Chao-yang Hospital, Capital Medical University from January to March 2014 were retrospectively analyzed. The baseline data of patients was collected, CCA-IMT and cfPWV before follow-up were measured. MHD patients were followed-up for 85 months, survival of patients was recorded, and patients were divided into survival group (36 cases) and death group (55 cases); according to CCA-IMT, patients were divided into CCA-IMT thickening group (43 cases, ≥0.9 mm)and CCA-IMT normal group (48 cases, <0.9 mm); according to cfPWV, patients were divided into cfPWV elevating group (37 cases, ≥12 m/s)and cfPWV normal group (54 cases, <12 m/s). The risk factors of all-cause death and cardiocerebral death in MHD patients were analyzed. Results The age, diabetic nephropathy (DN) rate, high-sensitivity C-reactive protein level, serum ferritin level and CCA-IMT in the death group were higher than those in the survival group(all P<0.05). Kaplan-Meier survival curve analysis showed that the rates of all-cause death and cardiocerebral death in the CCA-IMT thickening group were higher than those in the CCA-IMT normal group(both Log-rank P<0.001); the rates of all-cause death and cardiocerebral death in the cfPWV elevating group were higher than those in the cfPWV normal group (Log-rank P=0.017, 0.025). Multivariate Cox regression analysis showed that age ［hazard ratio (HR)=1.035, 95% confidence interval (CI): 1.005-1.066, P=0.023］, DN (HR=3.497, 95%CI: 1.886-6.485, P<0.001), CCA-IMT≥0.9 mm (HR=2.077, 95%CI: 1.114-3.872, P=0.021) and serum ferritin (HR=1.001, 95%CI: 1.000-1.002, P=0.019) were independent risk factors for all-cause death in MHD patients; DN (HR=2.632, 95%CI: 1.202-5.765, P=0.016), CCA-IMT≥0.9 mm (HR=6.261, 95%CI: 2.611-15.010, P<0.001) and cfPWV≥12 m/s (HR=2.644, 95%CI: 1.253-5.577, P=0.011) were independent risk factors for cardiocerebral death in MHD patients. Conclusion  CCA-IMT and cfPWV elevating are independent risk factors for long-term all-cause death and cardiocerebral death in MHD patients.