目的:本研究旨在探讨尿毒症合并高血压患者维持性血液透析(MHD)期间主要不良心脑血管事件(MACCEs)的危险因素。
方法:回顾性分析2018年2月至2022年2月常州市第四人民医院(常州市肿瘤医院)收治的尿毒症合并难治性高血压患者的临床资料。所有患者均接受MHD治疗,并根据治疗周期中是否发生MACCE分为MACCE组和非MACCE组。应用单因素分析和多因素logistic回归分析确定患者在治疗期间发生MACCEs的危险因素。
结果:(1)本研究共纳入156例患者,其中MACCE组75例,非MACCE组81例,MACCE发生率为48.08%。(2)糖尿病,体重增长率,甘油三酯(TG),N末端脑钠肽前体(NT-proBNP),收缩压(SBP)和舒张压(DBP)的标准差(SD)和变异系数(CV)显示两组之间存在显着差异,P<0.05。(3)糖尿病,体重增长率≥5.54%,TG≥1.40mmol/L,NT-proBNP≥5.82ng/L,发现SBP-SD≥13.52,SBP-CV≥8.63,DBP-SD≥8.14和DBP-CV≥8.82是患者MACCEs的危险因素。
结论:MHD期间尿毒症和高血压患者MACCEs的发生率与糖尿病有关,体重增长率,TG,NT-proBNP,SBP-SD,SBP-CV,DBP-SD,和DBP-CV。应及早筛查高危患者,并采取积极干预措施,降低MACCE的风险,提高透析程序的安全性。
OBJECTIVE: This study aimed to investigate risk factors for major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with
uremia and hypertension during maintenance hemodialysis (MHD).
METHODS: Clinical data of patients with
uremia and refractory hypertension admitted to Changzhou Fourth People\'s Hospital (Changzhou Tumor Hospital) from February 2018 to February 2022 were retrospectively collected and analyzed. All patients were treated with MHD and categorized into an MACCE group and a non-MACCE group according to whether MACCEs occurred during the treatment cycle. Univariate analysis and multivariate logistic regression analysis were applied to identify the risk factors for MACCEs in the patients during the treatment period.
RESULTS: (1) A total of 156 patients were included in this study, among whom 75 patients were in the MACCE group and 81 in the non-MACCE group, with an MACCE incidence of 48.08%. (2) Diabetes, body mass growth rate, triglyceride (TG), N-terminal pro-brain natriuretic peptide (NT-proBNP), as well as the standard deviation (SD) and coefficient of variability (CV) for both systolic (SBP) and diastolic blood pressure (DBP) showed significant differences between the two groups, with P<0.05. (3) Diabetes, body mass growth rate ≥5.54%, TG≥1.40 mmol/L, NT-proBNP≥5.82 ng/L, SBP-SD≥13.52, SBP-CV≥8.63, DBP-SD≥8.14, and DBP-CV≥8.82 were found to be risk factors for MACCEs in the patients.
CONCLUSIONS: The incidence of MACCEs in patients with
uremia and hypertension during MHD was associated with diabetes, body mass growth rate, TG, NT-proBNP, SBP-SD, SBP-CV, DBP-SD, and DBP-CV.Early screening for high-risk patients and positive intervention measures should be given to reduce the risk of MACCEs to enhance the safety of dialysis procedures.