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目的通过分析持续非卧床式腹膜透析的围绝经期女性患者透析治疗前后血钙、CRP代谢水平及变化情况,了解其与心脏瓣膜钙化的关系。方法随访2014—2016年本院就诊的女性腹膜透析患者,包括住院及门诊腹膜透析女性患者共100例,其中围绝经期组45例,其他年龄组55例。透析方式为持续非卧床腹膜透析,测定血钙、CRP,讨论CRP表达水平与特殊雌激素水平状态的围绝经期女性腹膜透析患者心脏瓣膜钙化的关联,计量资料使用t检验、χ~2检验以及回归分析等进行检验和分析,P<0.05为差异有统计学意义。结果本研究中,围绝经期组患者中存在心脏瓣膜钙化33例,比例为73.33%,高于另一组的比例58.18%,全部受试患者透析前后比较,CRP水平显著升高,透析后围绝经期腹膜透析女性中,心脏瓣膜钙化组血钙水平低于无瓣膜钙化组,对照组女性以及合计分析全部100例受试者时也发现了同样的趋势,对比差异有统计学意义(P<0.05)。透析后心瓣膜钙化患者中,围绝经期受试与其他年龄受试比较,仅见CRP水平在围绝经期受试中水平较高[(24.09±5.32)、(20.77±4.39)mg/L],透析后非瓣膜钙化组也见到了类似趋势,围绝经期受试的CRP水平较高[(20.44±3.99)、(17.94±5.54)mg/L],对比差异有较统计学意义。回归模型分析结果提示,对于围绝经期患者来说,透析前CRP水平异常者发生心瓣膜钙化的危险性为CRP正常者的2.781倍,其OR及95%CI为2.781(1.975~3.917);对其他年龄患者进行分析提示透析前CRP水平异常的OR值没有围绝经期组高。结论 CRP水平异常者发生心瓣膜钙化的风险增高,且在围绝经期女性中非常显著。
Objective To investigate the relationship between calcium and CRP metabolism and heart valve calcification in perimenopausal women with continuous ambulatory peritoneal dialysis before and after dialysis treatment. METHODS: A total of 100 female peritoneal dialysis patients, including 100 inpatient and outpatient peritoneal dialysis patients, were followed up in 2014-2016, including 45 perimenopausal and 55 other age groups. Dialysis was continuous ambulatory peritoneal dialysis, determination of serum calcium and CRP. The association of CRP expression with heart valve calcification in perimenopausal women with peri-menopausal status at estrogen-specific status was discussed. T-test, χ ~ 2 test and Regression analysis and other tests and analysis, P <0.05 for the difference was statistically significant. Results In the present study, there were 33 patients with cardiac valve calcification in the perimenopausal group, the proportion of which was 73.33%, which was higher than that of the other group (58.18%). CRP levels were significantly increased in all the patients before and after dialysis In menopausal women with peritoneal dialysis, the same tendency was found for calcium values in the valvular heart calcification group compared with those in the non-valvular calcification group, in the control group, and in total analysis of 100 subjects (P < 0.05). In post-dialysis patients with heart valve calcification, peri-menopausal subjects had significantly higher levels of CRP during peri-menopausal period compared with those at other age groups [(24.09 ± 5.32) and (20.77 ± 4.39) mg / L, respectively] A similar tendency was observed in the non-valvular calcification group after dialysis, with a higher CRP level in the perimenopausal period (20.44 ± 3.99 vs. 17.94 ± 5.54 mg / L), respectively. The differences were statistically significant. The results of regression model analysis showed that the risk of heart valve calcification in premenopausal women with CRP was 2.781 times of that of normal CRP, and OR and 95% CI was 2.781 (1.975-3.917) Analysis of patients at other ages suggests that the OR of pre-dialysis CRP abnormalities was not high in the perimenopausal group. Conclusion There is an increased risk of heart valve calcification in patients with abnormal CRP levels and is very significant in perimenopausal women.