慢性肾脏病住院患者白蛋白尿与心血管疾病相关性研究

摘要

目的:研究慢性肾脏病(CKD)住院患者白蛋白尿与心血管疾病(CVD)的相关性,探讨白蛋白尿对非糖尿病CKD患者CVD的预测价值.方法:回顾性分析1 245例非糖尿病CKD患者的一般情况、生化指标、心电图、胸部X线、心超及CVD的危险因素.结果:(1)1 245例患者中CKD1、2、3、4、5期分别为304例(24.4%)、281例(22.6%)、372例(29.9%)、157例(12.6%)、131例(10.5%);CKD1～5各期有蛋白尿者分别为208例(68.8%)、194例 (69%)、269例(72.3%)、117例 (74.5%)、106例 (80.9%).(2)与CKD1期患者相比,CKD2～5期患者年龄、SBP、DBP、Scr、UA明显升高,eGFR、Hb、Alb明显降低(P＜0.05);CKD3期患者TG、LDL升高,HDL降低(P＜0.05);CKD4、5期患者TC、LDL、HDL降低;TG升高(P＜0.05).(3)与CKD同期非白蛋白尿组相比,白蛋白尿组CKD1～5期患者Scr、UA明显升高,Alb明显降低(P＜0.05);CKD2～5期患者SBP、DBP明显升高,eGFR、Hb明显降低(P＜0.05);CKD4、5期患者TC、HDL降低,TG、LDL升高(P＜0.05).(4)CKD患者CVD发病率从CKD1～CKD5期逐步升高(P＜0.05),白蛋白尿患者CVD发病率以及胸部X片、心电图、心超异常阳性率升高更加明显(P＜0.05).(5)Logistic回归分析显示CVD与年龄、SBP、UA、TG、白蛋白尿呈现正相关,与GFR、Hb呈现负相关(P＜0.05).结论:非糖尿病CKD患者CVD发病率随CKD进展而增高,与白蛋白尿密切相关,白蛋白尿是CVD患者心血管疾病危险标志.%Objective:To study the correlation of albuminuria and cardiovascular disease ( CVD ) in the hospitalized patients with chronic kidney disease ( CKD ) . To evaluate the predictive value of albuminuria on CVD in non - diabetic CKD patients. Methods:1 245 adult CKD patients hospitalized in our renal center without diabetes and renal replacement therapy were retrospectively studied. Clinical characters and risk factors of cardiovascular disease in CKD patients were analyzed. Results :( 1 ) Patients at CKD stage 1,2,3,4,and 5 were 24.4％, 22.6％, 29.9％ , 12.6％ ％ , 10.5％ , respectively. Patients with proteinuria at CKD stage 1,2, 3,4,and 5 were 68.8％ , 69％, 72.3％ , 74.5％ and 80.9％ respectively. ( 2 )Compared with the CKD1 patients, the ages, SBP, DBP, Scr and UA was increasingly higher in CKD2 ～ 5 patients, and eGFR, Hb, Alb was significantly lower ( P ＜ 0.05 ); TG, LDL were increased and HDL decreased in CKD3, ( P ＜ 0.05 ); TC, LDL, HDL decreased and TG increased in CKD4, 5( P ＜ 0.05 ). ( 3 )In the same stage of CKD, compared with non -albuminuria patients, Scr, UA was significantly higher in patients with albuminuria in CKD1 ～ 5, and Alb was significantly lower ( P ＜ 0.05 ); SBP, DBP significantly increased in patients with albuminuria in CKD2 ～5, and eGFR, Hb was significantly lower ( P ＜0.05 );TC, HDL decreased in patients with CKD4, 5, and TG, LDL increased( P ＜ 0.05 ). ( 4 )The prevalence of CVD and abnormalities of chest X - ray, ECG, UCG in CKD was increased from stage 1 to 5 progressively ( P ＜ 0.05 ). In the same stage of CKD, compared with non - albuminuria patients, incidence of CVD in patients, abnormalities of chest X ray, ECG, echocardiography were significantly higher ( P ＜ 0.05 ) in CKD2 ～ 5 patients with albuminuria. ( 4 ) Logistic Regression analysis showed that CVD is positively correlated with age, SBP, UA, TG, negatively correlated with GFR, Hb ( P ＜ 0.05 ). Conclusion:In non - diabetic CKD patients, the incidence of CVD is increased with the progress of CKD. Incidence of CVD is closely related with albuminuria, and albuminuria is the risk marker of cardiovascular disease in CKD patients.