糖尿病肾病非透析患者动脉僵硬度及其对预后的影响

Arterial stiffness in non-dialysis patients with diabetic kidney disease and its influence on prognosis

摘要:

目的：评价糖尿病肾病（diabetic kidney disease，DKD）非透析病人的动脉僵硬度，并探讨其对病人心血管死亡及全因死亡的影响。方法：收集北京大学人民医院2006年4月至2010年11月收治的DKD非透析病人54例，于入院后测患者颈动脉-股动脉脉搏波速度（carotid-femoral pulse wave velocity，CFPWV）。据CFPWV水平，将患者分为CFPWV异常组（CFPWV≥12 m/s）和正常组（CFPWV<12 m/s），随访入选患者的心血管死亡及全因死亡情况。采用Kaplan-Meier法和Cox比例风险模型对影响患者预后的因素进行多因素分析。结果：2组平均随访（79.7±41.3）个月。CFPWV升高组全因死亡发生率明显高于正常组（76.9% vs. 33.3 %，P<0.01）。CFPWV升高组心血管死亡发生率明显高于正常组（58.7% vs. 13.3%，P<0.01）。死亡组CFPWV值明显高于存活组（P<0.01）。CFPWV升高组和正常组患者心血管死亡及全因死亡的Kaplan-Meier曲线有显著分离，CFPWV升高组心血管死亡及全因死亡率明显高于CFPWV正常组。多因素COX回归分析显示，高PWV水平、C反应蛋白升高及校正钙降低是心血管死亡及全因死亡的独立危险因素（P<0.05）。结论：CFPWV升高的糖尿病肾病非透析患者心血管死亡率及全因死亡率高于CFPWV正常者，且CFPWV升高是CKD3-5期非透析的糖尿病肾病患者发生心血管死亡及全因死亡的独立危险因素。

Abstract:

Objective：To investigate arterial stiffness in non-dialysis patients with diabetic kidney disease（DKD） and its influence on cardiovascular death and all-cause death. Methods：A total of 54 non-dialysis DKD patients who were admitted to People’s Hospital，Peking University，from April 2006 to November 2010 were enrolled，and carotid-femoral pulse wave velocity（CFPWV） was measured after admission. According to CFPWV，these patients were divided into increased CFPWV group（CFPWV≥12 m/s） and normal group（CFPWV<12 m/s） and were followed up to observe cardiovascular death and all-cause death. The Kaplan-Meier method and the Cox proportional hazards model were used for the multivariate analysis of influencing factors for prognosis. Results：The mean follow-up time was 79.7±41.3 months for all patients. Compared with the normal group，the increased CFPWV group had significantly higher rates of all-cause death（76.9% vs 33.3%，P<0.01） and cardiovascular death（58.7% vs 13.3%，P<0.01）. The death group had a sig－nificantly higher CFPWV value than the survival group（P<0.01）. The Kaplan-Meier curves of cardiovascular death and all-cause death in the increased CFPWV group were well separated from those in the normal group，and the increased CFPWV group had significantly higher rates of cardiovascular death and all-cause death than the normal group. The multivariate Cox regression analysis revealed that high CFPWV，increase in C-reactive protein，and reduction in corrected calcium were the independent risk factors for cardio－vascular death and all-cause death（P<0.05）. Conclusion：Non-dialysis DKD patients with increased CFPWV have higher rates of cardiovascular death and all -cause death than those with normal CFPWV，and increased CFPWV is an independent risk factor for cardiovascular death and all-cause death in non-dialysis DKD patients with stage 3-5 chronic kidney disease.