摘要目的 研究持续不卧床腹膜透析(CAPD)患者24 h腹透液总蛋白量与临床心血管疾病(CVD)的关系.方法 选择我中心随访的CAPD患者178例,完成24 h腹透液总蛋白量检测及有关病史采集,完成颈动脉彩超和心脏彩超检测,并进行前瞻性随访≥12个月,观察新发临床CVD的发生.结果 CAPD患者24 h腹透液总蛋白量平均为(5.0±1.8)g.CAPD患者有既往心血管疾病史或糖尿病史者或有颈动脉硬化者24 h腹透液总蛋白量均较无相应病史者多(分别是t=2.082,P=0.039;t=2.601,P=0.010;t-2.217,P=0.029).CAPD患者24 h腹透液总蛋白量与舒张末期左室内径(LVDd,单位:mm)、舒张末期室间隔厚度(ⅣSd,单位:mm)、舒张末期左室后壁厚度(LVPWd,单位:mm)、左室心肌重量指数(LVMI,单位:g/m2)均呈正的直线相关关系(分别是r=0.222,P=0.040;r=0.217,P=0.043;r=0.339,P=0.002;r=0.305,P=0.007),与左室射血分数(LVEF)呈负的直线相关关系(r=-0.221,P=0.040).其中114例CAPD患者完成了前瞻性随访,平均随访(15.3±1.5)个月.以24 h腹透液总蛋白量的第50位数(P50)为界分为高腹透液蛋白组和低腹透液蛋白组,卡方检验显示,高腹透液蛋白组新发CVD发生率显著高于低腹透液蛋白组(40.4%比19.3%,x2=6.035,P=0.014).多因素logistic回归分析显示,24 h腹透液总蛋白量与年龄、血清白蛋白、LVDd均为CAPD患者新发CVD的独立危险因素.结论 CAPD患者24 h腹透液总蛋白量与既往心血管疾病史、糖尿病史、颈动脉硬化有关,且与左心室结构和功能障碍相关,是CAPD患者新发CVD的独立危险因素.

abstractsObjective To study the relationship between cardiovascular diseases (CVD)and 24-h peritoneal protein losses (PPL) in continuous ambulatory peritoneal dialysis (CAPD)patients. Methods One hundred and seventy-eight CAPD patients in our department were enrolled in this study. Their 24-h PPL was measured and other clinical data were recorded at the beginning. Meanwhile, Doppler ultrasound examination was performed. They were then followed-up prospectively for the development of CVD. Results The average of 24-h PPL was (5.0±1.8) g.Patients with diabetic status or preexisting CVD or carotid arteries arteriosclerosis had higher 24-h PPL than those without (t=2.082, P=0.039; t=2.601, P=0.010; t=2.217, P=0.029). 24-h PPL was positively correlated with left ventricular end-diastolic diameter (LVDd), interventricular septal thickness (IVSTd), posterior wall diameter of left ventricle at end-diastolic (LVPWd) and left ventricular mass index (LVMI) (r=0.222, P=0.040; r=0.217, P=0.043; r=0.339, P=0.002; r=0.305, P=0.007). It was negatively correlated with ejection fraction of left ventricle (r=0.221, P=0.040). One hundred and fourteen CAPD patients were prospectively followed-up for at least twelve months. Patients developing CVD were 40.4% and 19.3% for high and low PPL groups respectively (x2=6.035, P=0.014). In the multivariable logistic regression analysis, the 24-h PPL was one of the independent factors for developing CVD. Conclusions There is a significant and independent relationship between 24-h PPL and new cardiovascular events. 24-h PPL may be an important predictor of cardiovascular disease.