老年血液透析患者颈动脉内中膜厚度影响因素分析

摘要

目的：探讨老年维持性血液透析（MHD）患者颈动脉内中膜厚度（IMT）的影响因素。方法老年MHD患者45例，高频超声检测IMT＜1．0 mm者24例（A组）、≥1．0 mm者21例（B组）。比较两组成纤维细胞生长因子23（FGF23）、1，25-二羟维生素D3[1，25-（OH）2D3]、低密度脂蛋白（LDL-c）、磷、钙磷乘积、血清全段甲状旁腺激素（iPTH）、血压、年龄、脉压。采用Logisitic回归分析法分析老年MHD患者IMT影响因素。结果 A组年龄（68．08±4．90）岁、收缩压（145．00±14．19）mmHg、脉压（66．33±16．31）mmHg、LDL-c（2．07±0．18）mmol／L、磷（1．94±0．40） mmol／L、钙磷乘积（4．06±0．83）mmol2／L2、iPTH（168．29±104．89）pg／mL、1，25-（OH）2D3（1415．8±320．28）fmol／L、FGF23（206．4±42．4）pg／mL，B组分别为（73．90±5．66）岁、（163．19±12．43）mmHg、（86．48±15．91）mmHg、（2．99±0．31）mmol／L、（2．25±0．46）mmol／L、（4．82±1．23）mmol2／L2、（321．23±218．14）pg／mL、（925．55±293．72）fmol／L、（363．6±58．93）pg／mL，两组比较，P均＜0．05。将年龄、收缩压、脉压、LDL-c、FGF23、1，25-（OH）2D3、iPTH作为自变量，将IMT作为因变量，进行多元回归Logistic分析，显示年龄、FGF23、1，25-（ OH）2 D3水平是影响IMT的主要危险因素。结论年龄、FGF23、1，25-（OH）2D3水平是IMT的主要影响因素。%Objective To discuss the influence factors of carotid artery intima-media thickness ( IMT) in the elderly maintenance hemodialysis ( MHD) patients.Methods Forty-five elderly MHD patients were involved.The high-frequency ultrasound showed that IMT<1.0 mm was found in 24 cases (group A), IMT ≥1.0 mm was found in 21 cases (group B).Fibroblast growth factor-23(FGF23), 1,25-(OH)2 vitamin D3[1,25-(OH)2D3], low density lipoprotein cholesterin (LDL-c), phosphorus(P), intact parathyroid hormone (iPTH ) and blood pressure were compared between these two groups.The influence factors of carotid artery IMT in elderly MHD patients were analyzed by Logisitic regression analysis. Results In the group A, the average age was 68.08 ±4.9, systolic blood pressure was (145.00 ±14.19) mmHg, pulse pressure was (66.33 ±16.31) mmHg, LDL-c was (2.07 ±0.18) mmol/L, P was(1.94 ±0.4) mmol/L, calcium-phos-phorus product was (4.06 ±0.83) mmol2/L2, iPTH was (168.29 ±104.89) pg/mL, 1,25-(OH)2D3 was (1415.8 ± 320.28) fmol/L and FGF23 was (206.4 ±42.4) pg/mL.They were 73.9 ±5.66, (163.19 ±12.43) mmHg,(86.48 ± 15.91) mmHg, (2.99 ±0.31) mmol/L,(2.25 ±0.46) mmol/L,(4.82 ±1.23) mmol2/L2,(321.23 ±218.14) pg/mL, (925.55 ±293.72) fmol/L and (363.6 ±58.93) pg/mL in the group B.Significant differences were found between these two groups (all P<0.05).Statistical analysis found that if we took the age, dialysis ages,systolic blood pressure, pulse pressure, LDL-c, FGF23, iPTH, 1,25-( OH) 2 D3 as the independent variable, IMT as the dependent variable, to do the Logisitic regression analysis, it showed that ages, FGF23 and 1,25-(OH)2D3 were the main risk factors which effected the IMT.Conclusion Ages, FGF23 and 1,25-(OH)2D3 are the main risk factors for IMT.