本文選題：主動脈 + 腹　； 參考：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:終末期腎臟病(end stage renal disease,ESRD)患者死亡的主要原因是心血管疾病(cardiovascular disease,CVD),而血管鈣化是發(fā)生心血管疾病的重要病因之一。最近研究表明血清可溶性Klotho(soluble Klotho,s KL)蛋白與慢性腎臟病(cronic kidney disease,CKD)患者礦物質(zhì)代謝紊亂及血管鈣化有關(guān)。本研究旨在了解腹膜透析(peritoneal dialysis,PD)患者腹主動脈鈣化情況,并分析該人群血清s KL與腹主動脈鈣化的關(guān)聯(lián)性,為早期發(fā)現(xiàn)和評估PD患者的心血管病變提供理論依據(jù)。方法:選取持續(xù)不臥床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)3個月以上的PD患者80例,收集其臨床資料,應(yīng)用側(cè)位腹平片評價腹主動脈鈣化情況,并計算腹主動脈鈣化積分(abdominal aortic calcification score,AACs)。按血清s KL水平分布范圍的四分位數(shù)分組,正常成人體檢健康者55例為對照組。血清s KL及成纖維細胞生長因子23(fibroblast growth factor 23,FGF23)濃度通過ELISA法檢測。Logistic回歸分析法分析PD患者發(fā)生腹主動脈中、重度鈣化的危險因素,受試者工作特征曲線評價s KL預(yù)測腹主動脈中、重度鈣化的準確性與特異性。結(jié)果:1 PD組與健康對照組比較:PD患者共80例,女性42例,男性38例,平均年齡(46.90±13.60)歲;健康對照組共55例,女性26例,男性29例,平均年齡(40.13±8.20)歲。性別、年齡二組間無統(tǒng)計學(xué)差異。PD組患者血清s KL較低,與健康對照組相比,差異有統(tǒng)計學(xué)意義[分別為(381.39±48.99)pg/ml比(478.85±58.13)pg/ml,P0.01]。2腹主動脈鈣化情況:80例PD患者中,發(fā)生腹主動脈鈣化患者41例(51.3%),輕度鈣化(0AACs≤4)20例,中度鈣化(5≤AACs≤15)15例,重度鈣化(AACs≥16)6例。其中12例(29.3%)患者L1水平存在鈣化,14例(34.2%)患者L2水平存在鈣化,22例(53.7%)患者L3水平存在鈣化,24例(58.5%)患者L4水平存在鈣化。鈣化主要發(fā)生在第四腰椎節(jié)段,并隨著節(jié)段的上升逐漸減少。3按血清s KL水平分布范圍的四分位數(shù)分組后四組的比較:I組:s KL≤351pg/m L;II組:s KL352~376pg/m L;III組:s KL377~415pg/m L;Ⅳ組:s KL≥416pg/m L。四組患者臨床資料,生化指標,透析指標,并發(fā)癥,用藥史及FGF23均無統(tǒng)計學(xué)差異,P0.05。I組、II組患者的AAC積分高于Ⅳ組,不同s KL濃度組間AAC積分有統(tǒng)計學(xué)差異,P0.05。4血清s KL與AAC的關(guān)系:比較不同程度腹主動脈鈣化組間的血清s KL水平發(fā)現(xiàn),中度或重度鈣化患者與輕度鈣化患者相比,血清s KL更低,差異有統(tǒng)計學(xué)意義[(357.20±46.25)pg/ml、(319.33±48.64)pg/ml比(382.85±44.12)pg/ml,P0.05]。單因素直線相關(guān)分析顯示s KL與AAC積分(r=-0.48,P0.01)、空腹血糖(r=-0.22,P0.05)、hs-CRP(r=-0.30,P0.01)負相關(guān),與尿量正相關(guān)(r=0.23,P0.05),與其他因素?zé)o相關(guān)性。隨著s KL水平的逐漸降低,高AAC評分患者的比例也顯著增高,Ⅳ組腹主動脈中度及重度鈣化患者的比例顯著降低,而無鈣化或輕度鈣化患者的比例顯著增加(P0.05)。5 PD患者發(fā)生腹主動脈中重度鈣化危險因素分析:選擇腹主動脈中、重度鈣化(AACs≥5賦值為1)為應(yīng)變量。Logistic回歸分析結(jié)果顯示,較低的血清s KL濃度(OR=0.966,95%CI0.945~0.988,P0.01)和較高年齡(OR=1.097,95%CI1.033~1.165,P0.01)是PD患者腹主動脈中、重度鈣化的獨立危險因素。與s KLP75的患者相比,s KLP25的患者發(fā)生腹主動脈中、重度鈣化的危險度大。調(diào)整一般狀況及相關(guān)臨床生化指標后仍有統(tǒng)計學(xué)差異。6血清s KL預(yù)測腹主動脈中、重度鈣化的準確性:血清s KL預(yù)測腹主動脈中、重度鈣化的AUC為0.800(95%CI0.678~0.922,P0.01)。取s KL濃度361.50pg/m L作為截點時,其預(yù)測腹主動脈中、重度鈣化的敏感性和特異性分別為71.4%和84.6%。結(jié)論:PD患者血清s KL濃度降低與發(fā)生腹主動脈鈣化顯著相關(guān),其在腹主動脈鈣化機制中起重要作用,血清s KL濃度測定可能有助于預(yù)測腹主動脈鈣化。
[Abstract]:Objective: the main cause of death of patients with end-stage renal disease (end stage renal disease, ESRD) is cardiovascular disease (cardiovascular disease, CVD), and vascular calcification is one of the important causes of cardiovascular disease. Recent studies have shown that serum soluble Klotho (soluble Klotho, s) protein and chronic kidney disease (chronic renal disease) are the main causes of the disease. D) patients with mineral metabolism disorder and vascular calcification. The purpose of this study was to understand the calcification of abdominal aorta in patients with peritoneal dialysis (PD) and to analyze the association between serum s KL and abdominal aortic calcification in order to provide a theoretical basis for early detection and assessment of cardiovascular disease in PD patients. The clinical data were collected from 80 patients with continuous ambulatory peritoneal dialysis (CAPD) for more than 3 months. The clinical data were collected. Abdominal aortic calcification was used to evaluate the calcification of the abdominal aorta, and the abdominal aorta calcification score (abdominal aortic calcification score, AACs) was calculated. According to the four digits of the level of the level of the level of the serum s, it was positive. S KL and fibroblast growth factor 23 (fibroblast growth factor 23, FGF23) were detected by ELISA method to analyze the risk factors of severe calcification in the abdominal aorta by ELISA method, and the risk factors of severe calcification in the patients with PD were analyzed by ELISA method, and the predictive s KL was used to predict the abdominal aorta in the aorta and the severity of the abdominal aorta in the aorta, and the severity of the abdominal aorta in the abdominal aorta. Results: the accuracy and specificity of calcification. Results: 1 PD group and healthy control group: PD patients, 80 cases, 42 women, 38 men, average age (46.90 + 13.60) years, 55 cases of healthy control, 26 women, 29 men, average age (40.13 + 8.20) years. There is no statistical difference between groups in group.PD with low S KL. The difference was statistically significant [381.39 + 48.99) pg/ml ratio (478.85 + 58.13) pg/ml, P0.01].2 abdominal aorta calcification: 80 cases of PD patients, 41 cases of abdominal aortic calcification (51.3%), mild calcification (0AACs < 4) 20 cases, moderate calcification (5 < < AACs < 15) 15 cases, severe calcification (AACs > 16) 6 cases. There was calcification at the 1 level, calcification in L2 level in 14 cases (34.2%), calcification in L3 level in 22 cases (53.7%) and calcification in 24 cases (58.5%). Calcification mainly occurred in the fourth lumbar segment, and as the segment increased, the comparison of four groups after.3 was grouped by the four digits of serum s KL level: I group: s KL < 3. 51pg/m L; group II: s KL352~376pg/m L; III group: s KL377~415pg/m L; group IV: s KL > four groups of patients with clinical data, biochemical indicators, dialysis indexes, complications, medication history and no statistical difference. AAC relationship: a comparison of serum s KL levels between groups of abdominal aortic calcification found that the serum s KL was lower in patients with moderate or severe calcification compared with those with mild calcification, and the difference was statistically significant [(357.20 + 46.25) pg/ml, (319.33 + 48.64) pg/ml ratio (382.85 + 44.12) pg/ml, and P0.05]. single factor linear correlation analysis showed s KL and AAC integral (r=-0.48, P0.01), r=-0.22 (P0.05), hs-CRP (r=-0.30, P0.01) negative correlation, positive correlation with urine volume (r=0.23, P0.05), and no correlation with other factors. With the gradual decrease of s KL, the proportion of patients with high AAC score increased significantly, and the proportion of moderate and severe calcified abdominal aorta decreased significantly in group IV, without calcification or mild. The proportion of patients with calcification increased significantly (P0.05) in.5 PD patients with severe calcification in the abdominal aorta. In the selection of abdominal aorta, severe calcification (AACs > 5 is 1) was the result of.Logistic regression analysis, and the lower serum s KL concentration (OR= 0.966,95%CI0.945~0.988, P0.01) and higher age (OR=1.097,95%CI1.033~1.) 165, P0.01) is an independent risk factor for severe calcification in the abdominal aorta of PD patients. Compared with the s KLP75 patients, the risk of severe calcification in the abdominal aorta of the patients with s KLP25 is greater. The general condition and the related clinical biochemical parameters are still statistically different..6 serum s KL predicts the accuracy of severe calcification in the abdominal aorta, the accuracy of the severe calcification in the abdominal aorta: Serum s. KL predicted that severe calcification was 0.800 (95%CI0.678~0.922, P0.01) in the abdominal aorta. When s KL concentration 361.50pg/m L was taken as a cut point, the sensitivity and specificity of severe calcification in the abdominal aorta were 71.4% and 84.6%., respectively. The decrease of s KL concentration in the serum of PD patients was significantly related to the occurrence of abdominal aortic calcification, and it was calcium in the abdominal aorta. The serum s KL concentration may help predict the calcification of abdominal aorta.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R459.5

【參考文獻】

相關(guān)期刊論文 前5條

1 蔡宏;嚴玉澄;陸任華;張敏芳;龐慧華;朱銘力;張偉明;倪兆慧;錢家麒;;血清可溶性Klotho水平與維持性血液透析患者腹主動脈鈣化相關(guān)[J];中華腎臟病雜志;2013年02期

2 劉力生;;中國高血壓防治指南2010[J];中華高血壓雜志;2011年08期

3 甘良英;王梅;;慢性腎臟病患者血管鈣化的檢測方法[J];中國血液凈化;2010年05期

4 甘良英;王梅;于小勇;蔡美順;;X線平片在診斷血液透析患者血管鈣化中的應(yīng)用[J];中華腎臟病雜志;2009年02期

5 錢榮立;關(guān)于糖尿病的新診斷標準與分型[J];中國糖尿病雜志;2000年01期

，

本文編號：1994111