發(fā)布時間：2018-01-21 09:20

  本文關(guān)鍵詞： 維持性血液透析 心臟瓣膜鈣化 影響因素 Meta分析　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:近20年來對慢性腎臟病(Chronic Kidney Disease,CKD)的深入研究,發(fā)現(xiàn)隨著腎功能下降其心腦血管疾病的發(fā)生風(fēng)險顯著增加,包括冠狀動脈疾病、心力衰竭、嚴(yán)重心律失常和猝死等。而心腦血管疾病是終末期腎病(End-Stage Renal Disease,ESRD)的首要死亡原因,占所有死因的50%以上。CKD患者的動脈鈣化及由此所致的血管硬化也是導(dǎo)致心血管疾病發(fā)生和發(fā)展的重要因素之一,其中包括心臟瓣膜鈣化(Cardiac Valve Calcification,CVC)。心臟瓣膜鈣化是瓣膜狹窄的重要原因,常常發(fā)生在主動脈瓣和二尖瓣,可以導(dǎo)致心臟瓣膜功能性失調(diào),引起瓣膜狹窄或者關(guān)閉不全,進(jìn)而導(dǎo)致血流動力學(xué)改變。雖然心臟瓣膜鈣化的發(fā)生率較動脈鈣化發(fā)生率低,但與腎功能正常人群相比,CKD患者心臟瓣膜鈣化發(fā)生率高出5-10倍。而且透析也是CKD患者心臟瓣膜鈣化的危險因素之一,無論是血液透析還是腹膜透析。CKD患者中透析者心臟瓣膜鈣化的發(fā)生率是非透析者的4-5倍,維持性血液透析(Maintenance Hemodialysis,MHD)患者發(fā)生心臟瓣膜鈣化更加普遍,且病變進(jìn)展更快。有關(guān)維持性血液透析患者心臟瓣膜鈣化的研究較多,但對于其發(fā)病機(jī)制及治療等問題仍有較大爭議。目前越來越多的證據(jù)表明,除了傳統(tǒng)的心血管危險因素之外,礦物質(zhì)代謝異常、炎癥反應(yīng)等也參與CVC的發(fā)生和發(fā)展。為了更全面地了解并掌握MHD患者心臟瓣膜鈣化發(fā)生的影響因素、發(fā)病機(jī)制等問題,據(jù)此本文檢索了近15年有關(guān)維持性血液透析患者心臟瓣膜鈣化的病例對照研究的相關(guān)文獻(xiàn)進(jìn)行Meta分析,為進(jìn)一步探討其治療及預(yù)防措施,最終降低MHD患者的死亡率并提高患者的生活質(zhì)量做基礎(chǔ)。目的:通過Meta分析探討維持性血液透析患者心臟瓣膜鈣化的影響因素。方法:基于觀察性研究的Meta分析規(guī)范(Meta-analysis Of Observational Studies in Epidemiology,MOOSE)聲明進(jìn)行研究及撰寫。計(jì)算機(jī)檢索Embas、Pubmed、Web of Sciences、中國知網(wǎng)、萬方、維普、CBMdisc等數(shù)據(jù)庫,收集2000年1月-2015年10月公開發(fā)表的有關(guān)維持性血液透析患者心臟瓣膜鈣化的影響因素的文獻(xiàn),并應(yīng)用Rev Man5.3軟件進(jìn)行Meta分析,Stata 13.0軟件進(jìn)行偏倚分析。結(jié)果:共納入16篇文獻(xiàn),共納入研究對象3061例,其中存在心臟瓣膜鈣化1541例,無心臟瓣膜鈣化1520例。Meta分析結(jié)果顯示:1)維持性血液透析患者心臟瓣膜鈣化與年齡增加[WMD=9.64,95%CI(7.75,11.52),P0.001]、血液透析時間增加[WMD=25.87,95%CI(15.90,35.83),P0.001]、血磷濃度更高[WMD=0.57,95%CI(0.22,0.92),P=0.001]、炎癥反應(yīng)中的C-反應(yīng)蛋白水平更高[WMD=3.13,95%CI(1.29,4.95),P0.001]、成纖維細(xì)胞生長因子-23水平更高[WMD=0.5,95%CI(0.21,0.79),P0.001]相關(guān),差異存在統(tǒng)計(jì)學(xué)意義(P0.01)。2)維持性血液透析患者心臟瓣膜鈣化與血清白蛋白水平降低[WMD=-0.88,95%CI(-1.41,-0.36),P=0.001]、胎球蛋白A水平降低[SMD=-1.24,95%CI(-1.83,-0.65),P0.001]具有相關(guān)性,差異存在統(tǒng)計(jì)學(xué)意義(P0.01)。結(jié)論:初步確定年齡、血液透析時間、血磷濃度、成纖維細(xì)胞生長因子-23、炎癥反應(yīng)中的C-反應(yīng)蛋白是影響維持性血液透析患者心臟瓣膜鈣化發(fā)生的重要危險因素,胎球蛋白A、血清白蛋白是維持性血液透析患者心臟瓣膜鈣化的保護(hù)性因素。
[Abstract]:Background: in the past 20 years of chronic kidney disease (Chronic Kidney, Disease, CKD) of the study, found that the risk of cardiovascular and cerebrovascular diseases with the decline in renal function increased significantly, including coronary artery disease, heart failure, arrhythmia and sudden death. The cardiovascular disease is the end-stage renal disease (End-Stage Renal Disease. ESRD) the primary cause of death, accounting for more than 50% of all deaths of arterial calcification in.CKD patients and thus induced vascular sclerosis is one of the important factors leading to the occurrence and development of cardiovascular disease, including heart valve calcification (Cardiac Valve, Calcification, CVC). Cardiac valve calcification is an important cause of valvular stenosis, often occurs in the aortic valve and the mitral valve, which can lead to cardiac valvular function disorder, caused by valvular stenosis or insufficiency, leading to hemodynamic changes. Although cardiac valve calcium The incidence of arterial calcification rate is low, but compared with the normal renal function group, CKD patients with heart valve calcification rate is 5-10 times higher. And is also one of the risk factors of dialysis patients with CKD cardiac valve calcification, whether hemodialysis or peritoneal dialysis in patients with.CKD. The analysis of heart valve calcification incidence 4-5 times of non dialysis, hemodialysis (Maintenance Hemodialysis, MHD) in patients with heart valve calcification is more prevalent, and the lesions progress faster. More research concerning the maintenance of cardiac valve calcification in hemodialysis patients, but for the pathogenesis and treatment of the problem is still controversial. At present more and more evidence that in addition to traditional cardiovascular risk factors, abnormal mineral metabolism, the occurrence and development of inflammatory reaction in CVC. In order to fully understand and master the MHD patients with heart Influence factors of valve calcification occurred, pathogenesis, so this paper retrieval literature comparative study of nearly 15 years concerning the maintenance of cardiac valve calcification in hemodialysis patients were analyzed by Meta, to further explore the treatment and preventive measures, and ultimately reduce the mortality of MHD patients and improve the patient's quality of life based. Through the Meta analysis to evaluate the effect of maintenance of cardiac valve calcification in hemodialysis patients. Methods: standard analysis of observational studies based on Meta (Meta-analysis Of Observational Studies in Epidemiology, MOOSE) to conduct research and write a statement. Retrieved from Embas, Pubmed, Web of Sciences, Chinese CNKI, Wanfang, VIP, CBMdisc and other databases. From January 2000 October -2015 published the effect of maintenance of cardiac valve calcification in hemodialysis patients and the factors of the literature. The application of Rev Man5.3 Meta analysis software, Stata 13 software for bias analysis. Results: a total of 16 articles were included, were included in the study of 3061 cases in which the presence of valvular calcification in 1541 cases, the results showed no cardiac valve calcification in 1520 cases of.Meta: 1) maintenance hemodialysis patients with heart valve calcification and age [WMD=9.64,95%CI (7.75,11.52, P0.001]), hemodialysis time increased by [WMD=25.87,95%CI (15.90,35.83), P0.001], serum phosphate concentration higher [WMD=0.57,95%CI (0.22,0.92), P=0.001], flat water C- reactive protein in inflammation, the higher [WMD=3.13,95%CI (1.29,4.95), P0.001], fibroblast growth factor -23 higher level of [WMD=0.5,95%CI (0.21,0.79), P0.001]. There were statistically significant differences (P0.01).2) in maintenance hemodialysis patients with heart valve calcification and serum albumin level decreased [WMD=-0.88,95%CI (-1.41, -0.36), P=0.001], Reduce the fetuin A level of [SMD=-1.24,95%CI (-1.83, -0.65), associated with P0.001], there were statistically significant differences (P0.01). Conclusion: to determine the initial age, dialysis time, blood phosphorus concentration, fibroblast growth factor -23, C- reaction protein in inflammation is to maintain an important risk of cardiac valve calcification in hemodialysis patients with blood factors, fetuin A, serum albumin is a protective factor of cardiac valve calcification in hemodialysis patients.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R692.5;R542.5

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