慢性血液透析患者冠状动脉疾病的患病率及危险因素

Jelena Ljubicic, Andrej Pešić, Nikola Marinković, M. Kravljača
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摘要

导论:心血管疾病(CVD)是慢性肾病(CKD)患者发病和死亡的主要原因(46 - 60%)。终末期肾病患者的肾功能替代有三种方法:血液透析、腹膜透析和肾移植。约40%的透析人群由于慢性代谢和炎症性疾病而发展为冠状动脉疾病(CAD)。这组患者发生冠心病的危险因素包括慢性贫血、继发性甲状旁腺功能亢进、慢性炎症、胰岛素抵抗和容量超载。目的:确定代谢和炎症性疾病对慢性血液透析治疗的CKD患者发生CAD的影响。材料和方法:本病例对照研究纳入塞尔维亚大学临床中心肾内科诊所血液透析病房治疗的115例终末期肾病患者。数据收集时间为2015年1月至2020年12月。选择性冠状造影用于确定冠心病的存在和特征。我们还分析了患者的实验室结果,他们的人口统计学和临床特征,以及导致这些患者CKD发展的原发性肾脏疾病。本研究中使用的其他参数包括糖尿病(DM)的存在和血液透析的持续时间。结果:115例患者中冠状动脉病变19例(16.5%)。CAD患者血清钙水平显著升高(2.3 ~ 2.2 mmol/L) (p = 0.039),而其他实验室参数无显著相关性。19例冠心病患者中男性患者居多(16例,84.3%,p = 0.01), 19例冠心病患者中有6例(31.6%)合并糖尿病(p = 0.009)。结论:糖尿病、高钙血症及男性显著增加慢性血液透析患者发生冠心病的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prevalence and risk factors for coronary artery disease in patients on chronic hemodialysis
Introduction: Cardiovascular diseases (CVD) represent the leading cause of morbidity and mortality (46 - 60%) among patients with chronic kidney disease (CKD). Three methods are used for kidney function replacement in patients with end-stage renal disease: hemodialysis, pertioneal dialysis and kidney transplantation. About 40% of the dialysis population develop coronary artery disease (CAD) due to chronic metabolic and inflammatory disorders. Risk factors for developing CAD in this group of patients include chronic anemia, secondary hyperparathyroidism, chronic inflammation, insulin resistance and volume overload. Aim: To determine the impact of metabolic and inflammatory disorders in developing CAD in patients with CKD that are chronically treated with hemodialysis. Material and methods: This case-control study included 115 patients with end-stage renal disease that were treated in Hemodialysis ward, Clinic for Nephrology, University Clinical Centre of Serbia. Data were collected for the period from January 2015 to December 2020. Elective coronarography was used to determine the presence and the characteristics of CAD. We also analyzed patient's laboratory findings, their demographic and clinical characteristics, as well as primary renal disease that led to the development of CKD in these patients. Additional parameters used in this study included the presence of Diabetes mellitus (DM) and duration of hemodialysis. Results: Coronary artery disease was diagnosed in 19 out of 115 patients (16.5%). Patients with CAD had a significantly higher levels of serum calcium (2.3 to 2.2 mmol/L) (p = 0.039), while other laboratory parameters did not show significant correlation. Most of the patients with CAD were male (16 of 19 patients, 84.3%, p = 0.01), while 31.6% (6 of 19 patients) with CAD were diagnosed with Diabetes mellitus (p = 0.009). Conclusion: The presence of Diabetes mellitus, higher calcium level, as well as male gender signicifantly increase the risk of developing CAD in patients chronically treated with hemodialysis.
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