慢性腎臟病患者心血管疾病的發(fā)生規(guī)律及相關(guān)性研究
發(fā)布時間：2018-07-28 20:10
【摘要】：本論文主要包括文獻(xiàn)綜述和臨床研究兩個部分。 文獻(xiàn)綜述的題目為慢性腎臟病患者心血管疾病的發(fā)生規(guī)律及相關(guān)性研究,總結(jié)了近年來國內(nèi)外慢性腎臟病對心血管疾病的影響,并分析二者之間的關(guān)系。本文從腎臟和心臟的病理、生理機(jī)制方面進(jìn)行系統(tǒng)分析,在臨床上從CKD患者的年齡、性別、CKD的分期、高血壓病、糖尿病史、蛋白尿及血脂等方面闡述了慢性腎臟病發(fā)生心血管疾病的規(guī)律,發(fā)現(xiàn)早期腎功能異常即對心血管系統(tǒng)造成影響。慢性腎臟病患者可出現(xiàn)冠狀動脈硬化性心臟病(CAD)、心肌梗死(MI)、充血性心力衰竭(CHF)、周圍血管病變(PVD)等心血管事件。同時闡述了慢性腎臟病和心血管疾病共同的危險因素(高血壓病、糖尿病、脂代謝紊亂、蛋白尿、尿毒素、高尿酸、鈣磷代謝異常等)對心血管疾病的影響,可見慢性腎臟病與心血管疾病關(guān)系十分密切,臨床上加強(qiáng)早期防治各種危險因素,可以減少心血管事件的發(fā)生。 慢性腎臟病在全球范圍的發(fā)病率呈逐步增加的趨勢(10.1%～15.1%),已成為繼心腦血管疾病、腫瘤、糖尿病之后又一個威脅健康的重要疾病。慢性腎臟病持續(xù)進(jìn)展,最終將導(dǎo)致終末期腎病(ESRD)及其相關(guān)并發(fā)癥的發(fā)生,CKD患者有很高的動脈硬化和心血管事件風(fēng)險,常合并心血管疾病,而CVD是慢性腎臟病患者最主要的并發(fā)癥,其死亡率約占慢性腎臟病患者總死亡率的44%～51%,是導(dǎo)致這類患者死亡的首位原因。有文獻(xiàn)報道,輕度腎衰竭患者的CVD患病率高于普通人群,且CVD的發(fā)生率隨著腎功能的進(jìn)展而逐步升高,至ESRD時達(dá)到高峰。我國有關(guān)CKD患者CVD患病率的調(diào)查多集中在ESRD和透析患者,而對CKD早期患者的調(diào)查甚少。 本課題臨床研究部分回顧分析了2001年7月至2014年6月在北京大學(xué)第一醫(yī)院和山東大學(xué)齊魯醫(yī)院慢性腎臟病一體化門診隨訪1年以上的491例慢性腎臟病患者,結(jié)合患者的病歷記錄、隨診1年以上的新發(fā)事件調(diào)查問卷以及患者在門診的實驗室檢查結(jié)果、心電圖、彩超等相關(guān)輔助檢查,得出患者慢性腎臟病的分期、原發(fā)病的診斷以及CVD的發(fā)生情況,采用SPSS20.0軟件進(jìn)行統(tǒng)計學(xué)分析,利用單因素方差分析進(jìn)行組間均值的比較,采用t檢驗,對分類變量進(jìn)行組間的比較,采用X2檢驗,統(tǒng)計不同年齡、性別、原發(fā)病及不同腎臟病分期的患者CVD的患病率情況,并進(jìn)行多因素的Logistic回歸分析,對CKD患者的年齡、血壓、血脂、尿蛋白、白蛋白、尿酸、血磷、腎功能、eGFR等危險因素對CKD患者心血管疾病的影響進(jìn)行分析。結(jié)果發(fā)現(xiàn)隨著CKD的進(jìn)展,CVD的發(fā)生率呈逐步上升趨勢,并在CKD3期明顯升高,CKD患者發(fā)病年齡越大,發(fā)生心血管事件的風(fēng)險越大,且男性患者較女性患者更容易發(fā)生CVD。在原發(fā)病調(diào)查中以糖尿病腎病、高血壓腎病為最多,這類患者更易發(fā)生CVD。臨床調(diào)查結(jié)果說明慢性腎臟病患者發(fā)生心血管疾病的比率較高,年齡、高血壓、高血脂、蛋白尿、低蛋白血癥、高磷血癥是心血管事件的發(fā)生的獨(dú)立危險因素,且高血壓、高血磷對CKD患者發(fā)生心血管事件影響最大。通過此項研究,提示我們充分認(rèn)識心血管的相關(guān)危險因素,為早期防治CKD患者發(fā)生心血管事件,提高患者的生存質(zhì)量提供理論依據(jù)。本研究屬于臨床調(diào)查研究初級階段,由于病例數(shù)偏少,尚待進(jìn)一步深入研究。
[Abstract]:This paper mainly includes two parts: literature review and clinical research.
The title of the literature review is the study of the regularity and correlation of cardiovascular disease in patients with chronic kidney disease. The effect of chronic kidney disease on cardiovascular disease at home and abroad in recent years is summarized, and the relationship between the two is analyzed. The paper systematically analyzes the pathological and physiological mechanisms of the kidney and heart and the age of the CKD patients. Sex, CKD staging, hypertension, diabetes history, albuminuria, and blood lipid and other aspects of the rules of CVD cardiovascular disease, the early renal dysfunction was found to affect the cardiovascular system. Patients with chronic kidney disease may have coronary atherosclerotic heart disease (CAD), myocardial infarction (MI), congestive heart failure (CHF). Cardiovascular events such as peripheral vascular disease (PVD). The effects of common risk factors (hypertension, diabetes, lipid metabolism disorder, proteinuria, urinary toxin, hyperuricemia, high uric acid, calcium and phosphorus metabolism) on cardiovascular disease in chronic kidney disease and cardiovascular disease are also described. It can be seen that chronic kidney disease is closely related to cardiovascular disease. Strengthening early prevention and treatment of various risk factors can reduce the incidence of cardiovascular events.
The global incidence of chronic kidney disease is gradually increasing (10.1% ~ 15.1%). It has become an important health threat after cardio cerebrovascular disease, tumor and diabetes. The continuous progression of chronic kidney disease will eventually lead to the occurrence of end-stage renal disease (ESRD) and its associated complications, and CKD patients have high arterial stiffness. The risk of cardiovascular events and cardiovascular events often combined with cardiovascular disease, and CVD is the most important complication of chronic kidney disease. The mortality rate is about 44% to 51% of the total mortality of chronic kidney disease. It is the leading cause of death in these patients. It is reported that the incidence of CVD in patients with mild renal failure is higher than that of the general population, and the incidence of CVD is higher. As the rate of renal function progresses, the rate reaches the peak at ESRD. The prevalence rate of CVD in CKD patients is mostly concentrated in ESRD and dialysis patients, and the investigation of early CKD patients is very small.
In this study, we reviewed and analyzed 491 cases of chronic kidney disease (CKD) in No.1 Hospital of Peking University and Shandong University from July 2001 to June 2014, who were followed up for more than 1 years in the clinic of chronic kidney disease (CKD) of Shandong University. The results of room examination, electrocardiogram, color Doppler ultrasound and other related auxiliary examinations, the staging of the patients with chronic kidney disease, the diagnosis of the primary disease and the occurrence of CVD were obtained. The SPSS20.0 software was used for statistical analysis. The comparison of the mean values between the groups was carried out by the single factor analysis of variance, and the t test was used to compare the classification variables, and the X2 test was used. The prevalence of CVD in patients with different age, sex, primary disease and different stages of kidney disease was analyzed, and multiple factor Logistic regression analysis was carried out. The effects of risk factors such as age, blood pressure, blood lipid, urine protein, albumin, uric acid, uric acid, blood phosphorus, renal function, eGFR on the cardiovascular disease of the patients with CKD were analyzed. The results were found with C. The results were found with C In the progress of KD, the incidence of CVD is rising gradually, and the higher the age of CKD3, the greater the age of the patients with CKD, the greater the risk of cardiovascular events, and the male patients are more likely to have CVD. in the primary investigation than the female patients with diabetic nephropathy, and the hypertension nephrosis is the most. These patients are more likely to have the CVD. clinical survey. The results indicate that the rate of cardiovascular disease in patients with chronic kidney disease is higher, age, hypertension, hyperlipidemia, proteinuria, hypoproteinemia, hyperphosphoremia, and hyperphosphoremia are independent risk factors for the occurrence of cardiovascular events, and high blood pressure, high blood phosphorus has the greatest impact on the cardiovascular events in CKD patients. The related risk factors of the tube provide a theoretical basis for the early prevention and treatment of cardiovascular events in CKD patients and the improvement of the quality of life of the patients. This study belongs to the primary stage of clinical investigation, and the number of cases is less, and further research has yet to be studied.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692.5
本文編號：2151442
[Abstract]:This paper mainly includes two parts: literature review and clinical research.
The title of the literature review is the study of the regularity and correlation of cardiovascular disease in patients with chronic kidney disease. The effect of chronic kidney disease on cardiovascular disease at home and abroad in recent years is summarized, and the relationship between the two is analyzed. The paper systematically analyzes the pathological and physiological mechanisms of the kidney and heart and the age of the CKD patients. Sex, CKD staging, hypertension, diabetes history, albuminuria, and blood lipid and other aspects of the rules of CVD cardiovascular disease, the early renal dysfunction was found to affect the cardiovascular system. Patients with chronic kidney disease may have coronary atherosclerotic heart disease (CAD), myocardial infarction (MI), congestive heart failure (CHF). Cardiovascular events such as peripheral vascular disease (PVD). The effects of common risk factors (hypertension, diabetes, lipid metabolism disorder, proteinuria, urinary toxin, hyperuricemia, high uric acid, calcium and phosphorus metabolism) on cardiovascular disease in chronic kidney disease and cardiovascular disease are also described. It can be seen that chronic kidney disease is closely related to cardiovascular disease. Strengthening early prevention and treatment of various risk factors can reduce the incidence of cardiovascular events.
The global incidence of chronic kidney disease is gradually increasing (10.1% ~ 15.1%). It has become an important health threat after cardio cerebrovascular disease, tumor and diabetes. The continuous progression of chronic kidney disease will eventually lead to the occurrence of end-stage renal disease (ESRD) and its associated complications, and CKD patients have high arterial stiffness. The risk of cardiovascular events and cardiovascular events often combined with cardiovascular disease, and CVD is the most important complication of chronic kidney disease. The mortality rate is about 44% to 51% of the total mortality of chronic kidney disease. It is the leading cause of death in these patients. It is reported that the incidence of CVD in patients with mild renal failure is higher than that of the general population, and the incidence of CVD is higher. As the rate of renal function progresses, the rate reaches the peak at ESRD. The prevalence rate of CVD in CKD patients is mostly concentrated in ESRD and dialysis patients, and the investigation of early CKD patients is very small.
In this study, we reviewed and analyzed 491 cases of chronic kidney disease (CKD) in No.1 Hospital of Peking University and Shandong University from July 2001 to June 2014, who were followed up for more than 1 years in the clinic of chronic kidney disease (CKD) of Shandong University. The results of room examination, electrocardiogram, color Doppler ultrasound and other related auxiliary examinations, the staging of the patients with chronic kidney disease, the diagnosis of the primary disease and the occurrence of CVD were obtained. The SPSS20.0 software was used for statistical analysis. The comparison of the mean values between the groups was carried out by the single factor analysis of variance, and the t test was used to compare the classification variables, and the X2 test was used. The prevalence of CVD in patients with different age, sex, primary disease and different stages of kidney disease was analyzed, and multiple factor Logistic regression analysis was carried out. The effects of risk factors such as age, blood pressure, blood lipid, urine protein, albumin, uric acid, uric acid, blood phosphorus, renal function, eGFR on the cardiovascular disease of the patients with CKD were analyzed. The results were found with C. The results were found with C In the progress of KD, the incidence of CVD is rising gradually, and the higher the age of CKD3, the greater the age of the patients with CKD, the greater the risk of cardiovascular events, and the male patients are more likely to have CVD. in the primary investigation than the female patients with diabetic nephropathy, and the hypertension nephrosis is the most. These patients are more likely to have the CVD. clinical survey. The results indicate that the rate of cardiovascular disease in patients with chronic kidney disease is higher, age, hypertension, hyperlipidemia, proteinuria, hypoproteinemia, hyperphosphoremia, and hyperphosphoremia are independent risk factors for the occurrence of cardiovascular events, and high blood pressure, high blood phosphorus has the greatest impact on the cardiovascular events in CKD patients. The related risk factors of the tube provide a theoretical basis for the early prevention and treatment of cardiovascular events in CKD patients and the improvement of the quality of life of the patients. This study belongs to the primary stage of clinical investigation, and the number of cases is less, and further research has yet to be studied.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692.5
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