【摘要】：背景:持續(xù)非臥床腹膜透析(Continuous ambulatory peritoneal dialysis,CAPD)是終末期腎病(End stage of renal disease,ESRD)患者腎臟替代治療方式之一。隨著腹膜透析(Peritoneal dialysis,PD)技術(shù)的不斷完善,CAPD患者生存率提高,但腹膜透析患者心血管病并發(fā)癥的發(fā)生率仍較高,以左心室肥厚(Left ventricular hypertrophy,LVH)及功能障礙最為常見,越來越多的研究證實(shí)LVH可獨(dú)立預(yù)測心血管疾病的死亡率。近幾年,胱抑素C(Cystatin C,Cys C)與心臟結(jié)構(gòu)及功能的相關(guān)性已成為國內(nèi)外的研究熱點(diǎn),文獻(xiàn)報(bào)道Cys C在鈣化瓣膜及伴有功能障礙的心肌表達(dá)增加,但對于CAPD患者,胱抑素C與左心室肥厚的相關(guān)研究較少,因此本研究探討胱抑素C與CAPD患者LVH的相關(guān)性,為今后干預(yù)腹膜透析患者的危險(xiǎn)因素、防治心血管病并發(fā)癥等方面提供理論依據(jù)。目的:研究胱抑素C與CAPD患者LVH的相關(guān)性,為早期防治CAPD患者左心室肥厚、降低心血管并發(fā)癥提供一定的理論依據(jù)。方法:選擇2016年1月-2016年12月在吉林大學(xué)第一醫(yī)院二部腎內(nèi)科腹膜透析中心,穩(wěn)定透析三個(gè)月以上的CAPD患者129例,根據(jù)左心室質(zhì)量指數(shù)分為LVH組和無LVH組。選取健康對照組63例,均為在本院體檢中心就診的健康體檢者,記錄體檢者的血清胱抑素C水平。收集CAPD患者一般資料、生化指標(biāo)、超聲心動(dòng)圖測量的左心房內(nèi)徑(Left atrial diameter,LAD)、左心室舒張末期內(nèi)徑((Left ventricular end-systolic diameter,LVDd)、室間隔厚度(Interventricular septal thickness,IVST)、左心室后壁厚度(Left ventricular posterior wall thickness,LVPWT)。根據(jù)Devereux校正公式計(jì)算左心室質(zhì)量指數(shù)(Left ventricular mass index,LVMI),LVH診斷標(biāo)準(zhǔn)為LVMI130g/m2(男性)、LVMI100g/m2(女性)[1]。分析血清Cys C與CAPD患者LVH的相關(guān)性。運(yùn)用社會(huì)科學(xué)統(tǒng)計(jì)軟件包(SPSS 20.0)軟件包對以上數(shù)據(jù)進(jìn)行統(tǒng)計(jì)描述和分析。結(jié)果:1、129例CAPD患者LVH組和無LVH組的一般資料比較:LVH者60例,發(fā)生率為46.5%;LVH組透析齡長于無LVH組,收縮壓、脈壓高于無LVH組,LVH組患者伴有高血壓者達(dá)23例,占LVH組總?cè)藬?shù)的38.3%,無LVH組患者伴有高血壓者達(dá)11例,占無LVH組總?cè)藬?shù)的15.9%,兩組組間比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2、129例CAPD患者LVH組和無LVH組的生化指標(biāo)比較:LVH組血清磷、胱抑素C、甲狀旁腺激素水平高于無LVH組,血清白蛋白水平低于無LVH組,兩組差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3、采用Logistic回歸分析示血清Cys C、甲狀旁腺激素、血磷,高血壓、收縮壓是CAPD患者左心室肥厚的危險(xiǎn)因素(P0.01)。4、129例CAPD患者的血清Cys C水平為(6.42±1.29mg/L),健康對照組血清Cys C水平為(0.92±0.23 mg/L),兩組組間差異顯著、有統(tǒng)計(jì)學(xué)意義(P0.01);129例CAPD患者血清Cys C與血清SCr、收縮壓、脈壓正相關(guān),與GFR、Kt/V負(fù)相關(guān)(P0.05),與其他指標(biāo)無相關(guān)性。5、129例CAPD患者LVH組和無LVH組心臟彩超結(jié)果比較:LVH組的LAD、LVDd、LVPWT、IVST、LVMI高于無LVH組,LVH組的LVEF低于無LVH組,兩組比較有統(tǒng)計(jì)學(xué)意義(P0.05)。6、60例CAPD左心室肥厚患者血清Cys C水平與心臟參數(shù)的相關(guān)性:血清Cys C與LVMI、LVPWT、LVDd正相關(guān),血清Cys C與LVEF負(fù)相關(guān)(P0.05)。結(jié)論:1、CAPD患者血清Cys C水平高于健康人群,CAPD并發(fā)左心室肥厚患者血清Cys C水平明顯高于無左心室肥厚者。2、CAPD患者血清Cys C與左心室質(zhì)量指數(shù)、收縮壓、脈壓正相關(guān),Cys C可以作為預(yù)測CAPD患者左心室肥厚的生化學(xué)指標(biāo)。
[Abstract]:Background: continuous ambulatory peritoneal dialysis (Continuous ambulatory peritoneal dialysis, CAPD) is one of the renal replacement therapies for patients with end-stage renal disease (End stage of renal disease, ESRD). With the continuous improvement of peritoneal dialysis (Peritoneal) technology, the survival rate of patients is improved, but the patients with peritoneal dialysis are complicated with cardiovascular disease. The incidence of the disease is still high, Left ventricular hypertrophy (LVH) and dysfunction are the most common. More and more studies have shown that LVH can predict the mortality of cardiovascular disease independently. In recent years, the correlation of cystatin C (Cystatin C, Cys C) with cardiac structure and energy has become a hot topic at home and abroad. Literature reports C The expression of YS C increased in calcified valvular and dysfunctional myocardium, but for CAPD patients, the correlation between cystatin C and left ventricular hypertrophy was less. Therefore, this study explored the correlation between cystatin C and LVH in CAPD patients, providing a theoretical basis for the future intervention in the risk factors of peritoneal dialysis patients and the prevention and treatment of cardiovascular complications. To study the correlation between cystatin C and LVH in patients with CAPD, to provide a certain theoretical basis for early prevention and treatment of left ventricular hypertrophy and cardiovascular complications in CAPD patients. Methods: in December -2016 January 2016, two nephrology peritoneal dialysis centers in No.1 Hospital of Jilin University were selected, and 129 cases of CAPD patients who were stable dialysis for more than three months, according to the left heart. The ventricular mass index was divided into LVH group and no LVH group. 63 healthy controls were selected from the health control group. The serum cystatin C levels were recorded in the physical examination center of the hospital. The general data of the CAPD patients, biochemical indexes, the left atrial diameter (Left atrial diameter, LAD) measured by echocardiography, and the left ventricular end diastolic diameter (Le (Le) were measured (Le). FT ventricular end-systolic diameter, LVDd), interventricular septum thickness (Interventricular septal thickness, IVST), and left ventricular posterior wall thickness (Left ventricular posterior). I100g/m2 (female) [1]. analysis of the correlation between serum Cys C and LVH in CAPD patients. The above data were statistically described and analyzed using the software package (SPSS 20) software package (SPSS 20). Results: the general data of the LVH group and the non LVH group in 1129 CAPD patients were compared with the LVH 60 cases and the incidence rate of 46.5%; the length of the dialysis age of the LVH group was longer than that of no group, systolic pressure, Pulse pressure is higher than no LVH group, group LVH patients with hypertension, 23 cases, accounting for 38.3% of the total number of LVH group, no LVH patients with 11 cases of hypertension, accounting for 15.9% of the total number of LVH group, the two groups were statistically significant (P0.05).2129 cases CAPD patients LVH group and no LVH group biochemical indexes: LVH group serum phosphorus, Cystatin C, a, a, a C, a, a cystatin C, a, a The level of parathyroid hormone was higher than that in no LVH group. The serum albumin level was lower than that without LVH group. The two groups were statistically significant (P0.05).3. The Logistic regression analysis showed that serum Cys C, parathyroid hormone, blood phosphorus, hypertension, and systolic pressure were the risk factors of left ventricular hypertrophy in CAPD patients (P0.01).4129 CAPD patients' serum Cys levels were (6.42 +) 1.29mg/L), the level of serum Cys C in the healthy control group was (0.92 + 0.23 mg/L), and the difference between the two groups was significant (P0.01). The serum Cys C in 129 cases of CAPD patients was positively correlated with the serum SCr, systolic pressure and pulse pressure, and was negatively correlated with GFR, Kt/V (P0.05). The LAD, LVDd, LVPWT, IVST, LVMI in the group H were higher than the non LVH group, and the LVEF in the LVH group was lower than that in the non LVH group. The two groups were statistically significant (P0.05). The level of serum Cys C in patients with CAPD complicated with left ventricular hypertrophy was significantly higher than that of.2 without left ventricular hypertrophy. The serum Cys C in patients with CAPD was positively correlated with left ventricular mass index, systolic pressure and pulse pressure. Cys C could be used as a biochemical indicator for predicting left ventricular hypertrophy in CAPD patients.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R692.5;R542.2

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