摘要
目的应用Framingham风险评估预测慢性肾脏病(CKD)患者未来10年心血管疾病的患病风险,并对CKD相关危险因素与患者未来10年心血管疾病的患病风险进行相关性分析。方法选择于2014―2017年在上海长海医院CKD随访门诊长期随访且未进行透析治疗的患者122例,其中男85例、女37例,平均年龄为(61.93±11.65)岁。根据估测的肾小球滤过率(eGFR)进行肾功能不全分期,CKD 2期4例、CKD 3期61例、CKD 4期46例、CKD 5期11例。应用Framingham风险评估预测CKD患者未来10年心血管疾病的患病风险,并根据结果将患者分为低风险组(患病风险<5%)、中风险组(患病风险为5%～<10%)和高风险组(患病风险≥10%)。比较各组的一般资料和尿蛋白水平,并对CKD相关指标与患者未来10年心血管疾病的患病风险进行相关性分析。结果随着患者未来10年心血管疾病患病风险的增大,男性患者所占比例逐渐升高(F=24.62,P=0.000)、年龄逐渐增大(F=43.98,P=0.000)、病程逐渐延长(F=12.70,P=0.000),且3组间的差异均有统计学意义(P值均<0.05)。3组间的BMI、收缩压(SBP)的差异均无统计学意义(P值均>0.05)。随着患者未来10年心血管疾病患病风险的增大,尿蛋白/尿肌酐(H=7.024,P=0.030)和尿蛋白定量(H=9.148,P=0.010)显著上升,但两组间比较仅低风险组与高风险组间的差异有统计学意义(P值均<0.05)。CKD伴有高血压(r=―0.156)、糖尿病(r=―0.170),以及尿蛋白/尿肌酐(r=0.160)和尿蛋白定量水平(r=0.166)与患者未来10年心血管疾病患病风险相关(P值均<0.05);而CKD分期,以及血肌酐、尿素氮、尿酸、血白蛋白、血红蛋白、血钙、血磷、甲状旁腺激素(PTH)水平与CKD患者未来10年心血管疾病患病风险均不相关(P值均>0.05)。结论 CKD患者心血管疾病患病风险普遍偏高,CKD患者未来10年心血管疾病患病风险与其是否伴有高血压、糖尿病和尿蛋白水平相关。在临床工作中应积极治疗蛋白尿,密切关注和随访心血管事件并积极干预。
Objective To explore risk factors of cardiovascular disease in patients with chronic kidney disease(CKD) by applying Framingham risk assessment to predict the risk of cardiovascular disease over the next 10 years. Methods A total of 122 CKD patients without dialysis who were followed up in our hospital between 2014 and 2017 were enrolled in this study. There were 85 males and 37 females with an average age of(61.93±11.65) years. According to the estimated glomerular filtration rate(eGFR), there were 4 cases at CKD 2 stage, 61 cases at CKD 3 stage, 46 cases at CKD 4 stage group and 11 cases at CKD 5 stage group. Framingham risk assessment was used to predict the risk of cardiovascular disease in CKD patients over next 10 years. According to the outcome of Framinham risk assessment, the patients were divided into low-risk group(risk<5%), medium-risk group(risk 5%-<10%), and high-risk group(risk≥10%). The general data and urinary protein were compared between groups. The correlation between CKD and cardiovascular disease risk in the next 10 years was analyzed. Results Higher proportion of male patients(F=24.62, P=0.000), older patients(F=43.98, P=0.000) and the patients with longer course of disease(F=12.70, P=0.000) had higher risk of cardiovascular diseases in the next 10 years(all P<0.05). There were no significant differences in BMI or systolic blood pressure(SBP) among the three groups(both P>0.05). As the risk of cardiovascular diseases increased in the next 10 years, urinary protein/creatinine(H=7.024, P=0.030) and 24-hour urinary protein(H=9.148, P=0.010) increased gradually, but there was only significant difference between low-risk group and high-risk group(all P<0.05). Hypertension(r=―0.156), diabetes mellitus(r=―0.170), urinary protein/creatinine(r=0.160) and 24-hour urinary protein(r=0.166 were closely related to the risk of cardiovascular diseases in CKD patients in the next 10 years(all P<0.05), while CKD stage, as well as serum creatinine, urea nitrogen, uric acid, uric acid, albumin, hemoglobin, calcium, phosphorus and parathyroid hormone(PTH) were not correlated with the risk(all P>0.05). Conclusion CKD patients have a high risk of cardiovascular disease in the next 10 years. The prevalence of cardiovascular disease in CKD patients is associated with hypertension, diabetes, and urinary protein. Proteinuria should be actively treated in clinic, and cardiovascular events should be closely followed up and actively intervened.
作者
李双喜
李娟
赵丽芳
LI Shuangxi;LI Juan;ZHAO Li fang(Department of Nephrology, Changhai Hospital, Shanghai 200433, China)
出处
《上海医学》
CAS
北大核心
2019年第1期8-10,共3页
Shanghai Medical Journal
基金
国家自然科学基金青年科学基金(81600596)
关键词
慢性肾脏病
分析评估
危险因素
心血管
Chronic kidney disease
Analysis and assessment
Risk factors
Cardiovascular
