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目的:探讨终末期肾病(ESRD)患者动态血压参数与动脉粥样硬化之间的关系,为ESRD患者预测心血管事件、干预及预后评估提供简便易行的参考指标。方法:前瞻性连续收集2012年8月至12月114例ESRD住院患者的临床资料,包括生化指标、动态血压监测、颈动脉超声、二维超声心动图等。结果:(1)一系列动态血压参数与动脉粥样硬化相关性良好(P≤0.05),其中动态动脉硬化指数(AASI)是最具有代表性的、相关性最好的指标(Logistic回归分析,P=0.005)。(2)AASI是一个反映ESRD动脉粥样硬化(P<0.001)、左心室舒张末期内径(P=0.028)及死亡风险的综合指标(P<0.001),其独立危险因素为老龄(P<0.001)、纤维蛋白原增加(P=0.009)、血清白蛋白下降(P=0.022)。结论:以AASI为代表的一系列动态血压参数与动脉粥样硬化相关性良好,可预测心脏结构改变及预后,建议在ESRD患者中广泛开展动态血压监测。
Objective: To investigate the relationship between ambulatory blood pressure (BP) parameters and atherosclerosis in patients with end-stage renal disease (ESRD) and to provide a simple and convenient reference index for predicting cardiovascular events, intervention and prognosis in patients with ESRD. Methods: The data of 114 ESRD inpatients from August to December in 2012 were prospectively and continuously collected, including biochemical parameters, ambulatory blood pressure monitoring, carotid artery ultrasound and two-dimensional echocardiography. Results: (1) A series of ambulatory blood pressure parameters were significantly correlated with atherosclerosis (P≤0.05). The dynamic atherosclerosis index (AASI) was the most representative and correlated index (Logistic regression analysis, P = 0.005). (2) AASI is a comprehensive index (P <0.001) reflecting ESRD atherosclerosis (P <0.001), left ventricular end diastolic dimension (P = 0.028) and risk of death (P <0.001) ), Increased fibrinogen (P = 0.009) and serum albumin (P = 0.022). CONCLUSIONS: A series of ambulatory blood pressure parameters, such as AASI, correlate well with atherosclerosis and predict cardiac structural changes and prognosis. It is recommended that ambulatory blood pressure monitoring be widely performed in ESRD patients.