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中华危重症医学杂志(电子版) ›› 2021, Vol. 14 ›› Issue (03) : 206 -212. doi: 10.3877/cma.j.issn.1674-6880.2021.03.006

论著

维持性血液透析患者并发脑梗死的危险因素分析
应金萍1, 蔡根莲1, 项雪佳1, 刘申1, 邵碧云1, 郎夏冰1, 张萍1, 陈江华1, 袁静1,()   
  1. 1. 310003 杭州,浙江大学医学院附属第一医院肾脏病中心
  • 收稿日期:2021-01-15 出版日期:2021-06-30
  • 通信作者: 袁静
  • 基金资助:
    浙江省医药卫生科技计划项目(2021KY660); 浙江省教育厅科研项目(Y201839407); 浙江省自然科学青年基金项目(LQ19H050008)

Risk factors of cerebral infarction in patients undergoing maintenance hemodialysis

Jinping Ying1, Genlian Cai1, Xuejia Xiang1, Shen Liu1, Biyun Shao1, Xiabing Lang1, Ping Zhang1, Jianghua Chen1, Jing Yuan1,()   

  1. 1. Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
  • Received:2021-01-15 Published:2021-06-30
  • Corresponding author: Jing Yuan
引用本文:

应金萍, 蔡根莲, 项雪佳, 刘申, 邵碧云, 郎夏冰, 张萍, 陈江华, 袁静. 维持性血液透析患者并发脑梗死的危险因素分析[J/OL]. 中华危重症医学杂志(电子版), 2021, 14(03): 206-212.

Jinping Ying, Genlian Cai, Xuejia Xiang, Shen Liu, Biyun Shao, Xiabing Lang, Ping Zhang, Jianghua Chen, Jing Yuan. Risk factors of cerebral infarction in patients undergoing maintenance hemodialysis[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2021, 14(03): 206-212.

目的

探讨维持性血液透析(MHD)患者并发脑梗死的相关危险因素。

方法

选择2015年2月至2020年2月在浙江大学医学院附属第一医院治疗的624例MHD患者作为研究对象,根据是否发生脑梗死分为脑梗死组(42例)和非脑梗死组(582例)。比较两组患者的一般资料及实验室各指标,采用多元Logistic回归分析MHD并发脑梗死患者的危险因素。

结果

脑梗死组和非脑梗死组患者年龄[(73 ± 10)岁vs.(58 ± 15)岁,t = 14.112,P < 0.001]、体质量指数[20.9(19.6,23.3)kg / m2 vs. 17.8(15.6,20.0)kg / m2H = 5.377,P < 0.001]、透析龄[33.00(13.50,84.25)个月vs. 55.00(21.00,102.25)个月,H = 2.240,P = 0.025]、吸烟[13 / 42 vs. 93 / 582,χ2 = 6.228,P = 0.013]、合并高血压[37 / 42 vs. 382 / 582,χ2 = 8.958,P = 0.003]、合并糖尿病[16 / 42 vs. 141 / 582,χ2 = 4.001,P = 0.045]、合并冠状动脉粥样硬化性心脏病[14 / 42 vs. 50 / 582,χ2 = 26.054,P < 0.001]、合并心房颤动[4 / 42 vs. 18 / 582,χ2 = 4.763,P = 0.029]、血清白蛋白[37.9(34.3,40.0)g / L vs. 40.3(38.3,42.6)g / L,H = 5.541,P < 0.001]、甘油三酯[(2.1 ± 1.5)mmol / L vs.(1.6 ± 0.9)mmol / L,t = 6.865,P = 0.009]、C反应蛋白[8.85(3.00,45.05)mg / L vs. 2.65(0.76,6.32)mg / L,H = 5.298,P < 0.001]、甲状旁腺激素[323.50(170.03,487.50)ng / L vs. 217.00(91.03,382.25)ng / L,H = 2.759,P = 0.006]、纤维蛋白原[3.6(3.2,4.5)g / L vs. 3.1(2.6,3.7)g / L,H = 2.992,P = 0.003]和凝血酶时间[17.6(16.7,19.1)s vs. 18.9(18.2,19.8)s,H = 3.624,P < 0.001]比较,差异均有统计学意义。将上述指标纳入Logistic回归分析,结果显示年龄[比值比(OR)=1.088,95%置信区间(CI)(1.043,1.133),P < 0.001]、体质量指数[OR = 1.352,95%CI(1.195,1.529),P < 0.001]、合并高血压[OR = 4.036,95%CI(1.187,13.719),P = 0.025]和C反应蛋白[OR = 1.029,95%CI(1.010,1.048),P = 0.003]为MHD患者脑梗死的危险因素,而血清白蛋白[OR = 0.836,95%CI(0.745,0.939),P = 0.002]是其保护因素。

结论

年龄、体质量指数、合并高血压、C反应蛋白和血清白蛋白为MHD患者并发脑梗塞的影响因素,临床中应该针对以上因素采取有效的干预措施。

Objective

To investigate risk factors of cerebral infarction in patients receiving maintenance hemodialysis (MHD).

Methods

A total of 624 MHD patients treated in the First Affiliated Hospital, College of Medicine, Zhejiang University from February 2015 to February 2020 were selected as study subjects and divided into a cerebral infarction group (n = 42) and a non-cerebral infarction group (n = 582) according to whether cerebral infarction occurred. Their general data and laboratory indicators were compared between these two groups. Multivariate Logistic regression analysis was used for the risk factors of cerebral infarction in patients receiving MHD.

Results

The age [(73 ± 10) years vs. (58 ± 15) years, t = 14.112, P < 0.001], body mass index [20.9 (19.6, 23.3) kg / m2 vs. 17.8 (15.6, 20.0) kg / m2, H = 5.377, P < 0.001], dialysis age [33.00 (13.50, 84.25) months vs. 55.00 (21.00, 102.25) months, H = 2.240, P = 0.025], smoking [13 / 42 vs. 93 / 582, χ2 = 6.228, P = 0.013], hypertension [37 / 42 vs. 382 / 582, χ2 = 8.958, P = 0.003], diabetes [16 / 42 vs. 141 / 582, χ2 = 4.001, P = 0.045], coronary heart disease [14 / 42 vs. 50 / 582, χ2 = 26.054, P < 0.001], atrial fibrillation [4 / 42 vs. 18 / 582, χ2 = 4.763, P = 0.029], serum albumin [37.9 (34.3, 40.0) g / L vs. 40.3 (38.3, 42.6) g / L, H = 5.541, P < 0.001], triglyceride [(2.1 ± 1.5) mmol / L vs. (1.6 ± 0.9) mmol / L, t = 6.865, P = 0.009], C-reactive protein [8.85 (3.00, 45.05) mg / L vs. 2.65 (0.76, 6.32) mg / L, H = 5.298, P < 0.001], parathyroid hormone [323.50 (170.03, 487.50) ng / L vs. 217.00 (91.03, 382.25) ng / L, H = 2.759, P = 0.006], fibrinogen [3.6 (3.2, 4.5) g / L vs. 3.1 (2.6, 3.7) g / L, H = 2.992, P = 0.003] and thrombin time [17.6 (16.7, 19.1) s vs. 18.9 (18.2, 19.8) s, H = 3.624, P < 0.001] were statistically significantly different between the cerebral infarction group and the non-cerebral infarction group. These above indicators were included in the Logistic regression analysis, and the results showed that the age [odds ratio (OR) = 1.088, 95% confidence interval (CI) (1.043, 1.133), P < 0.001], body mass index [OR = 1.352, 95%CI (1.195, 1.529), P < 0.001], hypertension [OR = 4.036, 95%CI (1.187, 13.719), P = 0.025] and C-reactive protein [OR = 1.029, 95%CI (1.010, 1.048), P = 0.003] were risk factors for cerebral infarction in MHD patients, while serum albumin [OR = 0.836, 95%CI (0.745, 0.939), P = 0.002] was a protective factor.

Conclusions

The age, body mass index, hypertension, C-reactive protein and serum albumin are influencing factors of cerebral infarction in patients receiving MHD. Effective intervention measures should be taken for the above factors in clinical practice.

表1 两组MHD患者一般资料比较( ± s
表2 两组MHD患者实验室指标比较( ± s
组别 例数 血红蛋白计数[g / L,MP25P75)] 血小板计数(× 109 / L) 红细胞分布宽度(%) 血小板分布宽度(%) 总蛋白[g / L,MP25P75)] 血清白蛋白[g / L,MP25P75)] 前白蛋白(mg / L)
脑梗死组 42 100(84,120) 187 ± 77 14.6 ± 1.8 12.7 ± 2.8 65.7(60.2,67.9) 37.9(34.3,40.0) 281 ± 78
非脑梗死组 582 107(98,115) 178 ± 61 14.1 ± 1.6 13.7 ± 2.8 65.8(62.8,69.2) 40.3(38.3,42.6) 320 ± 78
t / H   0.893 1.702 2.151 0.829 1.810 5.541 0.151
P   0.372 0.193 0.143 0.363 0.070 < 0.001 0.697
组别 例数 甘油三酯(mmol / L) 胆固醇(mmol / L) 高密度脂蛋白(mmol / L) 低密度脂蛋白(mmol / L) 极低密度脂蛋白[mmol / L,MP25P75)] 血糖(mmol / L) 尿素清除指数
脑梗死组 42 2.1 ± 1.5 3.7 ± 0.8 1.0 ± 0.4 2.0 ± 0.6 0.70(0.51,0.90) 8.1 ± 4.8 1.5 ± 0.4
非脑梗死组 582 1.6 ± 0.9 3.6 ± 0.9 1.0 ± 0.3 1.9 ± 0.7 0.69(0.46,1.01) 7.8 ± 4.0 1.6 ± 0.3
t / H   6.865 1.773 0.136 3.351 0.342 1.134 0.256
P   0.009 0.183 0.713 0.068 0.732 0.287 0.613
组别 例数 尿素下降率(%) 血清钾(mmol / L) 血清磷(mmol / L) 血清钙(mmol / L) CRP[mg / L,MP25P75)] 甲状旁腺激素[ng / L,MP25P75)] 纤维蛋白原[g / L,MP25P75)]
脑梗死组 42 69 ± 11 4.9 ± 0.6 1.7 ± 0.8 2.19 ± 0.25 8.85(3.00,45.05) 323.50(170.03,487.50) 3.6(3.2,4.5)
非脑梗死组 582 71 ± 12 5.1 ± 0.7 1.8 ± 0.6 2.22 ± 0.21 2.65(0.76,6.32) 217.00(91.03,382.25) 3.1(2.6,3.7)
t / H   0.642 1.662 2.747 2.477 5.298 2.759 2.992
P   0.423 0.198 0.098 0.116 < 0.001 0.006 0.003
组别 例数 活化部分凝血活酶时间(s) 凝血酶时间[s,MP25P75)] 凝血酶原时间(s) 血清铁[μmol / L,MP25P75)] 血清铁蛋白[μg / L,MP25P75)] 转铁蛋白(g / L) 转铁蛋白饱和度[%,MP25P75)]
脑梗死组 42 32 ± 13 17.6(16.7,19.1) 12.4 ± 1.9 9.5(8.2,12.1) 208.45(135.53,463.78) 1.6 ± 0.5 24.04(14.33,30.75)
非脑梗死组 582 29 ± 8 18.9(18.2,19.8) 12.0 ± 2.7 10.9(8.5,14.3) 179.65(65.48,374.88) 1.8 ± 0.4 24.21(18.38,31.70)
t / H   3.334 3.624 0.514 1.459 1.788 0.102 0.863
P   0.068 < 0.001 0.474 0.145 0.074 0.749 0.388
表3 MHD患者并发脑梗死的Logistic回归分析
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