尿毒症患者组合式血液净化治疗后的心血管疾病发生情况及影响因素

    Occurrence and influencing factors of cardiovascular diseases in uremic patients after combined blood purification therapy

    • 摘要: 目的 分析尿毒症患者组合式血液净化治疗后的心血管疾病(cardiovascular disease,CVD)发生情况及影响因素。方法 回顾性分析2021年1月1日至2023年1月31日上海同济大学附属普陀人民医院收治的尿毒症患者的临床资料,所有患者均接受组合式血液净化治疗(血液透析+血液灌流+血液透析滤过),依据治疗12个月后是否发生CVD分为发生组和未发生组,对比两组患者的一般人口学资料及临床资料,对差异有统计学意义的指标采取Logistic回归模型分析组合式血液净化后CVD发生的影响因素,采取Spearman相关性分析各因素和CVD发生的相关性。结果 共122例尿毒症患者纳入研究,其中20例发生CVD纳入发生组,占16.39%,余下102例未发生CVD纳入未发生组,占83.61%。Logistic回归分析结果显示年龄、治疗时间、CVD史、血清可溶性凋亡相关因子(soluble fas ligand,sFasL)表达、治疗前平均心肌肌钙蛋白T(cardiac troponin T,cTnT)、人晚期氧化蛋白产物(advanced oxidation protein products,AOPP)、血清铁蛋白(serum ferritin,SF)、血清血红蛋白(hemoglobin,Hb)、甲状旁腺素(parathyroid hormone,PTH)及钙磷乘积均为组合式血液净化后CVD发生的影响因素,OR值分别为1.270、1.938、13.800、46.984、1.270、8.522、2.145、1.495、1.733、1.528。年龄、治疗时间、CVD史、血清sFasL表达、治疗前平均cTnT、AOPP、PTH、钙磷乘积和CVD发生之间均呈正相关关系(r=0.471、0.643、0.589、0.485、0.647、0.499、0.528、0.492,P<0.05),SF、Hb和CVD发生之间均呈负相关关系(r=-0.505、-0.478,P<0.05)。结论 组合式血液净化治疗后有部分尿毒症患者发生CVD,其中年龄、治疗时间、CVD史、血清sFasL表达、治疗前平均cTnT、AOPP、SF、Hb、PTH及钙磷乘积是心血管预后的影响因素,和CVD发生有关,需要临床高度关注年龄大、治疗时间长、有CVD史的患者,并加强血清sFasL、cTnT、AOPP、SF、Hb、PTH及钙磷乘积等指标的检测,能为临床诊断和预防CVD提供理论依据,进而改善患者心血管预后。

       

      Abstract: Objective To analyze the incidence and influencing factors of cardiovascular disease (CVD) in uremia patients after combined blood purification therapy.Methods Clinical data of uremia patients admitted to Putuo People's Hospital, Tongji University from January 1, 2021 to January 31, 2023 were retrospectively analyzed. All patients received combined blood purification treatment (hemodialysis + hemoperfusion + hemodialysis filtration). They were divided into the CVD group and non-CVD group based on the presence or absence of CVD at 12 months of treatment. The general demographic data and clinical data of the two groups were compared. Logistic regression model was used to analyze the influencing factors of CVD occurrence after combined blood purification, and Spearman correlation analysis was used to analyze the correlation between each factor and CVD occurrence.Results A total of 122 uremia patients were included in the study, of which 20 had CVD, accounting for 16.39%, and the remaining 102 (83.61%) without CVD were included in the non-CVD group. Logistic regression analysis showed age, treatment time, CVD history, soluble Fas ligand (sFasL) expression in serum and soluble cardiac troponin T (cTnT) before treatment, human advanced oxidation protein products (AOPP), serum ferritin (SF), serum hemoglobin (Hb), parathyroid hormone (PTH) and calcium-phosphorus product were all factors affecting the development of CVD after combined blood purification. OR values were 1.270, 1.938, 13.800, 46.984, 1.270, 8.522, 2.145, 1.495, 1.733, and 1.528, respectively. Age, treatment time, CVD history, serum sFasL expression, average cTnT, AOPP, PTH, calcium and phosphorus product before treatment were positively correlated with CVD occurrence (r=0.471, 0.643, 0.589, 0.485, 0.647, 0.499, 0.528, and 0.492, respectively; all P<0.05). SF and Hb were negatively correlated with CVD (r=-0.505, and -0.478, respectively; both P<0.05).Conclusion CVD occurs in some uremia patients after combined blood purification treatment. Age, treatment time, CVD history, serum sFasL expression, average cTnT, AOPP, SF, Hb, PTH and calcium-phosphorus product before treatment are the influencing factors for cardiovascular prognosis, which are related to the occurrence of CVD. It is necessary to pay close attention to patients with old age, long treatment time and history of CVD, and strengthen the detection of serum sFasL, cTnT, AOPP, SF, Hb, PTH and calcium and phosphorus product, which can provide theoretical basis for clinical diagnosis and prevention of CVD, and thus improve the cardiovascular prognosis of patients.

       

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