本文選題：脈搏波傳導(dǎo)速度　切入點(diǎn)：動(dòng)脈硬化　出處：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：通過觀察肱-踝脈搏波傳導(dǎo)速度（brachial-ankle pulse wave velocity，baPWV）在慢性腎臟病（chronic kidney disease，CKD）患者中的變化，分析其在評價(jià)CKD患者動(dòng)脈硬化中的意義及其影響因素。 方法：選取2013年6月至2014年1月在大連醫(yī)科大學(xué)附屬第二醫(yī)院腎內(nèi)科住院的CKD患者，共44例。排除標(biāo)準(zhǔn)：嚴(yán)重感染、肝膽疾病、惡性腫瘤、嚴(yán)重心律失常、急性心肌梗死、心力衰竭、腦血管意外、外周血管疾病患者。選取同期在本院體檢中心參加體檢人員作為對照組，共45例。根據(jù)簡化腎臟病膳食改良實(shí)驗(yàn)（Modification Of Diet InRenal Disease，MDRD）公式計(jì)算估計(jì)腎小球?yàn)V過率（estimated glomerular filtrationrate，eGRF），將CKD患者按照eGFR分為CKD2期6例、CKD3期10例、CKD4期6例、CKD5期22例。收集所有研究對象的年齡、性別、身高、體重等一般臨床資料；日立7600自動(dòng)生化分析儀檢測血紅蛋白、血清白蛋白、血膽固醇、甘油三酯、低密度脂蛋白膽固醇、血清肌酐、血尿酸、血鈣、血磷，計(jì)算校正鈣、鈣磷乘積；免疫化學(xué)熒光法檢測血全段甲狀旁腺激素（intact parathyroid hormone，iPTH）；免疫比濁法測定血C-反應(yīng)蛋白（C-reactive protein, CRP）；日本COLIN公司VP1000無創(chuàng)動(dòng)脈硬化檢測儀測定baPWV及血壓；美國GE LOGIQ7超聲診斷儀測量頸動(dòng)脈內(nèi)中膜厚度（carotid intima-mediathickness，cIMT）。所有資料的統(tǒng)計(jì)和分析采用SPSS17.0軟件，P0.05為差異具有統(tǒng)計(jì)學(xué)意義。 結(jié)果：1．CKD5期患者的血紅蛋白低于對照組及CKD2-4期（P＜0.05），血清白蛋白低于對照組及CKD2期（P＜0.05），血膽固醇和甘油三酯低于CKD3期及CKD4期（P＜0.05），血鈣低于對照組及CKD2-4期，血磷高于對照組及CKD2-3期（P＜0.05），血iPTH高于對照組及CKD2-4期（P＜0.05），鈣磷乘積低于CKD2期（P＜0.05），血CRP高于對照組及CKD2期（P＜0.05），血尿酸高于對照組及CKD2-4期（P＜0.05）。同時(shí)，CKD3-4期患者的血紅蛋白和血清白蛋白低于對照組及CKD2期（P＜0.05），CKD4期患者的血甘油三酯高于對照組及CKD2期（P＜0.05）。 2．CKD5期患者的cIMT高于對照組及CKD2期（P＜0.05），斑塊檢出率高于對照組及CKD2-4期（P＜0.05）。同時(shí)，CKD3-4期患者的斑塊檢出率高于對照組及CKD2期（P＜0.05），CKD2期患者的斑塊檢出率高于對照組（P＜0.05）。 3．CKD5期患者的baPWV高于對照組及CKD2期（P＜0.05），CKD3-4期患者的baPWV高于對照組（P＜0.05）。CKD3-5期患者的收縮壓高于對照組（P＜0.05），CKD3期患者的收縮壓高于CKD2期（P＜0.05）。CKD5期患者的舒張壓低于CKD3期（P＜0.05）。CKD5期患者的脈壓高于對照組及CKD2期（P＜0.05）。 4． baPWV與cIMT的相關(guān)分析顯示，baPWV與cIMT呈正相關(guān)（r=0.341，P=0.024）。將CKD患者分為有斑塊組及無斑塊組，比較兩組間baPWV，，結(jié)果有斑塊組CKD患者的baPWV為（1864.53±315.31）cm/s，無斑塊組的baPWV為（1590.59±243.50）cm/s，兩組間差異有統(tǒng)計(jì)學(xué)意義（P=0.002）。相關(guān)分析顯示，baPWV與年齡（r=0.313，P=0.039）、收縮壓（r=0.790，P=0.000）、脈壓（r=0.654，P=0.000）、血CRP（r=0.477，P=0.001）和血尿酸（r=0.543，P=0.000）均呈正相關(guān)，而與eGFR（r=-0.374，P=0.012）呈負(fù)相關(guān)。多元線性回歸顯示，在校正了年齡、eGFR、CRP影響后，血尿酸(P=0.001)、收縮壓(P=0.000)、脈壓(P=0.018)均是CKD患者baPWV的獨(dú)立影響因素。 結(jié)論：1．肱-踝脈搏波傳導(dǎo)速度可作為慢性腎臟病患者動(dòng)脈硬化的早期評價(jià)指標(biāo)。 2．血尿酸、收縮壓、脈壓是慢性腎臟病患者動(dòng)脈硬化的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective : To observe the changes of brachial - ankle pulse wave velocity ( baPWV ) in patients with chronic kidney disease ( CKD ) , and to analyze the significance of brachial - ankle pulse wave velocity ( baPWV ) in evaluating the arteriosclerosis of CKD patients and their influencing factors .

Methods : A total of 44 patients with CKD hospitalized in the Second Affiliated Hospital of Dalian Medical University from June 2013 to January 2014 were selected . The criteria were as follows : severe infection , liver and gallbladder diseases , malignant tumor , severe arrhythmia , acute myocardial infarction , heart failure , cerebrovascular accident and peripheral vascular disease .
detecting hemoglobin , serum albumin , blood cholesterol , triglyceride , low - density lipoprotein cholesterol , serum creatinine , blood uric acid , blood calcium , and blood phosphorus by using an automatic biochemical analyzer , and calculating and correcting the product of calcium and phosphorus ;
Whole - segment parathyroid hormone ( PTH ) was detected by immunofluorescence assay .
C - reactive protein ( CRP ) was determined by turbidimetric method .
baPWV and blood pressure were measured by the VP1000 non - invasive arteriosclerosis detector in COLIN Company , Japan ;
The thickness of carotid intima - media thickness ( cIMT ) was measured by GE LOGIQ7 ultrasonic diagnostic instrument . The statistics and analysis of all the data were statistically significant by SPSS 17.0 software , P0.05 .

Results : 1 . Serum albumin was lower than that of control group and CKD2 - 4 stage ( P < 0.05 ) , and serum albumin was higher than that in control group and CKD2 - 4 stage ( P < 0.05 ) . The serum level of serum albumin was higher than that in control group and CKD2 - 4 stage ( P < 0.05 ) . The serum levels of serum albumin were higher than those in control group and CKD2 - 4 period ( P < 0.05 ) .

2 . cIMT of CKD5 patients was higher than that in control group and CKD2 stage ( P < 0.05 ) . The detection rate of plaque in CKD3 - 4 patients was higher than that in control group and CKD2 stage ( P < 0.05 ) .

The systolic blood pressure in CKD3 - 4 patients was higher than that in the control group ( P < 0.05 ) . The systolic blood pressure in CKD3 - 4 patients was higher than that in the control group ( P < 0.05 ) . The systolic blood pressure in patients with CKD3 was higher than that in the control group ( P < 0.05 ) . The diastolic pressure in patients with CKD3 was lower than that in the control group and CKD2 stage ( P < 0.05 ) .

4 . Correlation analysis of baPWV and cIMT showed that baPWV was positively correlated with cIMT ( r = 0.341 , P = 0 . 024 ) . Correlation analysis showed that baPWV and age ( r = 0.313 , P = 0.039 ) , systolic blood pressure ( r = 0.790 , P = 0.000 ) , systolic blood pressure ( r = 0.654 , P = 0.000 ) , blood CRP ( r = 0.477 , P = 0.001 ) and uric acid ( r = 0.543 , P = 0.000 ) were positively correlated .

Conclusion : 1 . The brachial - ankle pulse wave conduction velocity can be used as an early evaluation index of arteriosclerosis in patients with chronic renal disease .

2 . Blood uric acid , systolic pressure and pulse pressure are independent risk factors of arteriosclerosis in patients with chronic kidney disease .

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692

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