不同透析模式患者心脑血管事件死亡的前瞻性队列研究

Cardio-cerebral vascular disease (CVD) is the main cause of death and disability in dialysis patients. In 2005, our epidemiological investigation results in patients with chronic kidney diseases hinted: the CVD risk was significantly increased in dialysis patients and CVD occurrence regularity in dialysis patients was different from those in the general population. It also existed differences in Chinese patients from that in foreign patients. In 2010, We proceeded a multi-centers cross-sectional cohort study on CVD events in dialysis patients (China Collaborative Study on Dialysis, CCSD). In this cohort, CVD morbidity affected 57% patients, of which the incidence of ischemic heart disease was 22.7%, the incidence of stroke was 9.6%. Even though the overall cardiovascular morbidity was comparable between hemodialysis (HD) and peritoneal dialysis (PD) patients (56.3% vs. 58.9%), the proportion of patients with ischemic heart disease and stroke was significantly more prevalent in patients on PD than those on HD. Glucose exposure dose was the strongest risk factor for cardiovascular morbidity in PD patients, PD itself may increase the CVD risk in PD patients. Based on the results of CCSD, the prospective cohort study is proposed to observe the incidence of CVD events and mortality in dialysis patients, by using data of the established large sample and long-term follow-up of dialysis patients. The project would compare the incidence of CVD events and mortality in HD patients with those in PD patients. The project aims to explore the risk factors for CVD events and mortality in the dialysis patients and explicit the effect of dialysis modality on CVD events and mortality. The results of this project would provide evidence base for the mechanism research and preventive measures in CVD events of Chinese dialysis patients.

心脑血管疾病是透析病人死亡和致残的主要原因。2005年我们对慢性肾脏病患者进行的流行病学调查结果提示：透析患者是心脑血管疾病的高发人群，其发病规律与一般人群有别，与国外报告存在差异；2010年我们对透析病人心脑血管事件进行的大样本横断面队列研究（CCSD），结果表明：我国透析病人心脑血管疾病的新发率为57%，其中缺血性心脏病的发病率为22.7%，脑卒中发生率为9.6%；虽血透、腹透病人心脑血管疾病的总发病率无差异，但腹透病人缺血性心脏病及脑卒中的发病率比血透病人高；腹透本身可能增加病人心脑血管事件的风险。本项目拟以CCSD为基础，利用已建立的大样本、长程随访的透析病人群，进行前瞻性队列研究，观察透析病人心脑血管事件发生率、死亡率，对两种透析模式下的患者进行比较，探讨我国透析病人心脑血管事件、死亡的危险因素，明确两种透析模式对心脑血管事件、死亡事件的影响，为我国透析病人心脑血管事件发生的机制。

心脑血管疾病是透析病人死亡和致残的主要原因。我们既往对慢性肾脏病患者进行的流行病学调查结果提示：透析患者是心脑血管疾病的高发人群，其发病规律与一般人群有别，与国外报告存在差异；我国透析病人心脑血管疾病的新发率为57%；血透、腹透病人心脑血管疾病的总发病率无差异，但腹透病人缺血性心脏病及脑卒中的发病率比血透高。本研究以CCSD为基础，进行5年的前瞻性队列研究。5年期间透析患者新发心脑血管事件率为42.20%，其中腹透46.15%，血透41.55%；两组间无差异，但缺血性心脏病的新发率，腹透病人明显高于血透。5年研究终点时，总心脑血管事件发生率为67.76%，其中腹透68.86%，血透67.56%；缺血性心脏病、心衰发病率，腹透病人与血透之间无差异；脑卒中及周围血管事件发生率，腹透病人高于血透。5年期间，透析病人总死亡率为29.42%，其中腹透27.25%，血透29.81%；血透、腹透病人死亡率之间无差异。心脑血管事件是患者死亡的首位原因，感染并发症是腹透病人死亡的主要原因之一。组织晚期糖基化终产物水平是透析患者心脑血管事件发生、死亡的独立风险因素，并可作为预测透析患者死亡的生物学指标。