目的 探讨急性冠脉综合征(acute coronary syndrome,ACS)患者血清钙浓度的变化,探讨血清钙浓度与急性心肌梗死(acute myocardial infarction,AMI)的相关性.方法 选择2019年6-7月首都医科大学附属北京天坛医院心内科病房收治的ACS患者247例.收集患者的临床资料,采集血标本行血清钙等生化指标检测.采用二元logistic回归分析AMI的相关危险因素.结果 247例ACS患者分为两组,不稳定性心绞痛组149例,年龄(62.88±9.91)岁;AMI组98例,年龄(60.21±10.86)岁.AMI组患者的血清钙(2.21±0.11)mmol/L,明显低于不稳定性心绞痛组(2.25±0.09)mmol/L(P<0.001).Logistic回归分析显示,校正性别、心率、血白蛋白、总胆固醇、血磷等混杂因素后,血清钙四分位数(OR 0.591,95％CI 0.399～0.874,P=0.008)、年龄(OR 0.834,95％CI 0.791～0.898,P<0.001)、血红蛋白(OR 1.048,95％CI 1.017～1.079,P=0.002)、低密度脂蛋白胆固醇(OR 2.532,95％CI 1.544～4.151,P<0.001)、GRACE评分(OR 1.129,95％CI 1.092～1.167,P<0.001)是AMI的独立危险因素.结论 与不稳定性心绞痛患者相比,AMI患者表现出较低的血清钙浓度,血清钙水平降低是AMI的独立危险因素.

We attempted to answer two central questions about epigenetic silencing of the tumor suppressor gene p16INK4a in this study: (1) whether the maintenance of associated histone modifications is dependent on DNA methylation and (2) whether such histone modifications can occur prior to DNA methylation. By coupling chromatin immunoprecipitation with gene targeting and the analysis of specific alleles, we found that elimination of DNA methylation from a p16INK4a allele resulted in profound changes in surrounding histones. After continued passage of such cells, methylation of histone H3 lysine-9 occurred in conjunction with re-silencing in the absence of DNA methylation. These results have important implications for understanding the biochemical events underlying the silencing of tumor suppressor genes and the resultant growth suppression.

目的 探讨急性冠脉综合征(acute coronary syndrome,ACS)患者血清钙水平与全球急性冠状动脉事件注册(global registry of acute coronary events,GRACE)评分的相关性.方法 选取2019年6—7月首都医科大学附属北京天坛医院心内科病房收治的ACS确诊患者247例,收集患者的临床资料和GRACE评分,采集血标本测定血清钙等生化指标,所有患者均行冠状动脉造影.分析血清钙与GRACE评分的相关性.结果 根据临床资料和冠状动脉造影结果,将247例患者分为急性心肌梗死组98例及不稳定型心绞痛组149例.与不稳定型心绞痛组比较,急性心肌梗死组血清钙显著降低(P<0.001).根据血清钙的四分位数将患者分为4组:Q1组(≤2.15mmol/L)54例、Q2组(>2.15～2.23mmol/L)59例、Q3组(>2.23～2.30mmol/L)77例和Q4组(>2.30mmol/L)57例.Q3组与Q4组患者的GRACE评分均低于Q1组(P<0.01).根据GRAC评分分为高危组(≤108分)34例,中危组(109～140分)87例,低危组(>140分)126例,发现高危组患者血清钙低于中危组和低危组(P<0.01).Pearson直线相关分析显示,ACS患者的血清钙水平与GRACE评分呈显著负相关(r=-0.246,P<0.001).结论 ACS患者血清钙水平与GRACE评分呈明显负相关,血清钙水平降低对识别高危ACS患者具有重要参考价值.

Objectives To establish a new ambulatory blood pressure (ABP) parameter (24-hour ABP profile) and evaluated its performance on stroke outcome in ischaemic stroke (IS) or transient ischaemic attack (TIA) patients. Methods The prospective cohort consisted of 1996 IS/TIA patients enrolled for ABP monitoring and a 3-month follow-up for stroke recurrence as outcome. Profile groups of systolic blood pressure (SBP) were identified via an advanced functional clustering method, and the associations of the profile groups and conventional ABP parameters with stroke recurrence were examined in a Cox proportional hazards model. Results Three discrete profile groups (n=604, 781 and 611 in profiles 1, 2 and 3, respectively) in 24-hour ambulatory SBP were identified. Profile 1 resembled most to the normal diurnal blood pressure pattern; profile 2 also dropped at night, but climbed earlier and with higher morning surge; while profile 3 had sustained higher nocturnal SBP without significant nocturnal SBP decline. The incidence of stroke recurrence was 2.9%, 3.9% and 5.5% in profiles 1, 2 and 3, respectively. After adjustment for covariates, profile 3 was significantly associated with higher risk of stroke recurrence with profile 1 as reference (HR 1.76, 95% CI: 1.00 to 3.09), while no significant difference was observed between profiles 2 and 1 (HR 1.22, 95% CI: 0.66 to 2.25). None of conventional ABP parameters showed significant associations with the outcome. Conclusions Ambulatory 24-hour SBP profile is associated with short-term stroke recurrence. Profiles of ABP may help improve identification of stroke recurrence by capturing the additive effects of individual ABP parameters.

目的 评估贴式可穿戴动态心电记录分析系统检测心律失常的有效性和安全性.方法 研究纳入2018年10月至2019年12月于首都医科大学附属北京安贞医院、北京天坛医院、北京同仁医院就诊的可疑心律失常患者115例.使用传统的24 h动态心电记录分析仪(对照组)和贴式可穿戴动态心电记录分析系统(试验组)同时记录动态心电图.主要终点是在监测期间内检测到的心律失常,定义为室上性心动过速(连续≥3跳)、室性心动过速(连续≥4跳)、心房颤动/心房扑动(持续≥1 min)、心脏停搏(≥3 s)、室上性早搏(累计≥10000跳)、室性早搏(累计≥10000跳).以对照组检测结果为金标准,计算试验组的敏感性作为主要有效性评价指标.安全性评价指标为试验期间发生的不良事件.结果 试验组检测心律失常的敏感性在全分析集为99.09％(95％CI:95.03％～99.84％),在符合方案集为99.07％(95％CI:94.94％～99.84％),95％CI下限均高于标准值85％.试验组患者的佩戴舒适度及应用偏好均优于对照组(P<0.0001),两组记录心电图波形一致率为92.7％.在试验期间,两组均未出现不良事件.结论 贴式可穿戴动态心电记录分析系统可以安全有效地检测心律失常,可作为传统动态心电记录分析仪的替代方案.

Background: There have been no studies investigating the relationship between serum calcium level at admission and long-term cardiovascular outcome in patients with the acute coronary syndrome (ACS).  \r\nObjectives: This study aimed to explore the correlation of admission serum calcium with cardiovascular outcome in ACS patients.\r\nMethods: This longitudinal study included 105 ACS or suspected ACS patients who were referred to the Coronary Care Unit between June 1st, 2015, and August 31st, 2016. Serum calcium was measured upon admission, and the patients were followed up till November 30th, 2016. Cardiovascular death or cardiovascular re-hospitalization was the study\u0027s end.\r\n \r\nResults: According to the median of serum calcium, the patients were divided into two groups of lower (n=47) and higher serum calcium (n=58). Kaplan-Meier analysis found that patients with lower serum calcium had an obviously reduced cardiovascular event-free survival (log-rank χ2=5.594, P=0.018), compared to those with higher serum calcium. Furthermore, lower serum calcium level (HR=0.265, 95% CI=0.072-0.981, P=0.047) independently correlated with poor cardiovascular outcome in ACS or suspected ACS patients after adjustment for potential confounders in the multivariable Cox model.\r\nConclusion: Lower serum calcium upon admission independently correlated with poor long-term cardiovascular outcomes in patients with severe coronary artery disease.

Background: There have been no studies investigating the association of serum calcium level upon admission with long-term cardiovascular outcome among patients suffering from acute coronary syndrome (ACS). Objectives: This study aimed to explore the correlation of serum calcium level upon admission with cardiovascular outcomes among ACS patients. Methods: This longitudinal study included 105 ACS or suspected ACS patients who were referred to the Coronary Care Unit from June 1st, 2015, to August 31st, 2016. Serum calcium was measured upon admission, and the patients were followed up until November 30th, 2016. Cardiovascular death or cardiovascular re-hospitalization was the study's end. Results: According to the median of serum calcium, the patients were divided into two groups of lower (n=47) and higher serum calcium level (n=58). The results of the Kaplan-Meier analysis revealed that patients with lower serum calcium obtained a significant decrease in cardiovascular event-free survival (log-rank χ2=5.594, P=0.018), compared to those with higher serum calcium level. Furthermore, lower serum calcium level (HR=0.265, 95% CI=0.072-0.981, P=0.047) independently correlated with poor cardiovascular outcome in ACS or suspected ACS patients after adjusting the potential confounders in the multivariable Cox model. Conclusion: Lower serum calcium level upon admission independently correlated with poor long-term cardiovascular outcomes in patients with severe coronary artery disease.

目的:探讨心腔内三维超声辅助下经导管射频消融治疗心房颤动伴造影剂不相容患者的安全性及临床疗效.方法:选择2015年1月至2017年1月期间中国医学科学院阜外医院收治的16例心房颤动伴造影剂不相容的患者.患者均未行左心房、肺静脉CT和造影,在心腔内三维超声辅助下建立左心房及肺静脉三维模型,并指导穿刺房间隔和消融导管在心脏内的操作.结果:15例患者顺利完成心房颤动射频消融,平均手术时间(96.0±14.3)min,透视时间(6.1±1.2)min,X线透视剂量(115.8±49.3)mGy,未发生心脏压塞、脑栓塞、左心房-食道瘘、肺静脉狭窄及动脉瘤等并发症及死亡.1年随访结果显示,9例患者维持窦性心律,其中阵发性心房颤动7例,持续性心房颤动2例.结论:对于心房颤动伴造影剂不相容的患者,心腔内三维超声可以替代经食道超声心动图,避免左心房造影及增强CT检查;心腔内三维超声不延长手术时间,显著减少X线曝光时间及剂量,可避免穿刺房间隔的并发症,提高穿刺准确性.

目的 调查急性冠脉综合征经皮冠状动脉介入(PCI)治疗后患者低密度脂蛋白胆固醇(LDL-C)的水平及达标状况.方法 采用回顾性调查方法 ,纳入121例经PCI治疗的急性冠脉综合征患者,出院后常规服用他汀类药物,2019年7月于天坛医院心内科冠心病介入门诊复诊,记录患者出院后1～3个月、3～6个月、6～12个月及1年以上的肝肾功能、甘油三酯(TG)、总胆固醇(TC)、LDL-C和高密度脂蛋白胆固醇(HDL-C)水平,并计算LDL-C的达标率.结果 患者出院后1～3月、3～6个月、6～12个月及一年以上肝肾功能均无明显变化.出院后1～3个月、3～6个月、6～12个月、1年以上TG、TC水平无显著差异(P>0.05);HDL-C水平略有差异(P=0.047),分别为(1.04±0.18)mmol/L、(1.15±0.25)mmol/L、(1.11±0.21)mmol/L、(1.11±0.23)mmol/L;LDL-C的水平分别为(1.97±0.83)mmol/L、(1.94±0.69)mmol/L、(1.88±0.76)mmol/L、(2.05±0.55)mmol/L,差异具有统计学意义(P=0.014);LDL-C的达标率分别为46.3％、47.8％、57.2％、37.6％,达标率在出院后6～12个月最高,1年后的达标率有下降趋势.结论 急性冠脉综合征经PCI治疗后患者的LDL-C的达标率还有待提高,长期的血脂管理需要加强.

INTRODUCTION This study aimed to investigate the influence of peritoneal transport characteristics on clinical outcome in nondiabetic and diabetic nephropathy peritoneal dialysis (PD) patients. MATERIALS AND METHODS All 112 patients were from the PD Center. Peritoneal transport characteristic was assessed by peritoneal equilibration test. The patients were divided into 2 groups of high-transport group (HT) and non-high-transport group (non-HT) and followed-up till December 31st, 2010. The primary outcomes were all-cause death and technique failure. RESULTS The patients were followed-up for 65.9 ± 23.9 months. Diabetic nephropathy patients with HT had a higher all-cause mortality (P = .04) and technique failure (P = .04) than those with non-HT. There were no differences in outcomes between HT and non-HT subgroups without diabetic nephropathy. Cox regression demonrtrated that high peritoneal transport (HR, 2.369; 95% CI, 1.056 to 5.311), diabetic nephropathy (HR, 2.499; 95% CI, 1.134 to 5.508), age (HR, 1.081; 95% CI, 1.032 to 1.133), and peritoneal creatinine clearance (HR, 0.962; 95% CI, 0.929 to 0.997) independently predicted all-cause mortality in continuous ambulatory PD patients. Moreover, high peritoneal transport (HR, 2.299; 95% CI, 1.079 to 4.899) and age (HR, 1.070; 95% CI, 1.026 to 1.116) predicted technique failure in continuous ambulatory PD patients. CONCLUSIONS Diabetic nephropathy PD patients with HT had a higher all-cause mortality and technique failure than those with non-HT, but we did not find the correlation between peritoneal transport and outcome in nondiabetic patients. The peritoneal transport was an independent predictor for outcomes in continuous ambulatory PD patients.

目的 探讨糖尿病肾病(diabetic nephropathy,DN)患者血清半乳糖凝集素-3(galectin-3)和摄食抑制因子-1(nesfatin-1)表达及临床意义.方法 126例2型糖尿病患者依据尿微量白蛋白排泄率(urinary albumin excretion rate,UACR)分为单纯糖尿病组56例(UACR＜30 mg/24 h)、早期DN组39例(UACR 30～300 mg/24 h)、临床DN组31例(UACR＞300 mg/24 h),同期体检健康者63例为对照组.检测4组血清galectin-3和nesfatin-1及血肌酐等指标水平,Spearman法分析血清galectin-3和nesfatin-1与病程及各生化指标的相关性.结果 早期DN组、临床DN组血清galectin 3[(8.55±2.96)、(10.62±3.63)μg/L]、nesfatin-1[1.64(1.17,2.01)、1.89(1.61,2.32) ng/L]均高于对照组[(5.92±1.29)μg/L、0.92(0.53,1.36)ng/L]、单纯糖尿病组[(6.43±1.69)μg/L、1.21(0.89,1.46)ng/L](P＜0.05),且临床DN组高于早期DN组(P＜0.05),对照组与单纯糖尿病组比较差异无统计学意义(P＞0.05);血清galectin-3与血肌酐呈正相关(r=0.562,P＜0.001),与估算肾小球滤过率呈负相关(r=-0.526,P＜0.001);血清nesfatin-1与病程、血肌酐呈正相关(r=0.238,P＜0.001;r=0.597,P＜0.001),与估算肾小球滤过率呈负相关(r=-0.573,P＜0.001).结论 DN患者血清galectin-3和nesfatin-1水平升高,且其升高水平可反映肾功能损伤程度.

目的 探讨急性冠脉综合征(acute coronary syndrome,ACS)患者血清钙与全球急性冠状动脉事件注册(global registry of acute coronary events,GRACE)评分之间的关系.方法 回顾分析2015年6月至2016年8月,首都医科大学附属北京天坛医院心脏重症监护病房103例ACS患者,根据GRACE评分,将ACS患者分为GRACE低危组(≤108分)、中危组(109～140分)和高危组(＞140分),分别检测各组ACS患者的血清钙.分析血清钙与GRACE评分的相关性.结果 与非冠心病组对比,ACS组血清钙显著降低(P＜0.01).与非ST抬高ACS组对比,ST抬高ACS组血清钙显著降低(P＜0.01).在ACS患者三个亚组中,与GRACE低危组比较,GRACE中危组及高危组患者血清钙水平均显著降低(P＜ 0.05,P＜0.01).相关性分析显示,ACS患者血清钙与GRACE评分呈负相关(r=-0.389,P=0.000).结论 ACS患者血清钙与GRACE评分具有负相关,血清钙的降低对ACS的高危识别有重要参考意义.

目的 探讨维拉帕米联合氯沙坦钾治疗高血压的临床疗效.方法 选取2018年2月—2019年2月在首都医科大学附属北京天坛医院治疗的高血压患者96例,根据用药的差别分为对照组(48例)和治疗组(48例).对照组口服氯沙坦钾片,起始剂量50 mg/次,1次/d,必要时可增至100 mg/次,1次/d;治疗组在对照组的基础上口服盐酸维拉帕米片,起始剂量80 mg/次,3次/d,最大剂量360～480 mg/d,对于低剂量即有反应的老年人或体型瘦小者,起始40 mg/次,3次/d.两组患者治疗4周.观察两组患者临床疗效,同时比较治疗前后两组患者血压、C反应蛋白(CRP)、可溶性凝集素样氧化低密度脂蛋白受体1(sLOX-1)、可溶性细胞间粘附分子-1(sICAM-1)、基质金属蛋白酶-9(MMP-9)、转化生长因子 β1(TGF-β1)、单核细胞趋化蛋白1(MCP-1)和血管内皮功能.结果 治疗后,对照组临床有效率为81.25％,显著低于治疗组的97.92％,两组比较差异有统计学意义(P<0.05).治疗后,两组患者收缩压(SBP)、舒张压(DBP)均显著下降(P<0.05),且治疗组患者血压水平明显低于对照组(P<0.05).治疗后,两组患者血清CRP、sLOX-1、sICAM-1、MMP-9、TGF-β1、MCP-1水平均明显降低(P<0.05),且治疗组患者这些血清细胞因子水平明显低于对照组患者(P<0.05).治疗后,两组肱动脉内皮依赖性舒张功能(EDD)、肱动脉非内皮依赖的舒张功能(NMD)均明显升高(P<0.05),且治疗组患者血管内皮功能明显高于对照组(P<0.05).结论 维拉帕米联合氯沙坦钾治疗高血压可显著降低患者血压,改善患者临床症状和血管内皮功能.

Background/aim: Blood pressure (BP) variability is more closely associated with adverse outcomes than ‘usual’ BP in the general population. Residual renal function (RRF) and left ventricular hypertrophy (LVH) are thought to be predictors of poor outcome in dialysis patients. However, only a few studies have focused on BP variation and its link to RRF, LVH, and outcome in peritoneal dialysis (PD) patients. Therefore, we aimed to explore the effect of visit-to-visit BP variability on RRF and LVH in continuous ambulatory PD (CAPD) patients.Materials and methods: We performed an observational study that included all prevalent PD patients between 1 February 2006 and 31 January 2007. All patients underwent BP measurements, pulse wave velocity (PWV), cardiac ultrasound, and biochemical examination during the 1-year observation. Patients were divided into the HBPV group (higher BP variability) and LBPV group (lower BP variability) based on the standard deviation of systolic BP (SBP).Results: There were 70 patients recruited for the final analysis. Patients with HBPV had a higher SBP as compared to patients with LBPV at baseline. Renal Kt/V decreased significantly from 0.50 ± 0.49 to 0.32 ± 0.35 (P < 0.01) in HBPV group (but not in the LBPV group) during follow-up. Patients with HBPV also showed a higher left ventricular mass index (LVMI) and PWV than those with LBPV at the end of follow-up. Conclusion: Our study suggests that BP variability may affect RRF in PD patients. PD patients with HBPV had a faster decline in RRF and higher PWV and LVH.

Lipoprotein-associated phospholipase A2 (Lp-PLA2) probably plays an important role in the development of acute coronary syndrome (ACS). However, alterations of Lp-PLA2 levels during ACS and its association with cardiovascular outcome are unclear. Our aim was to investigate the change in Lp-PLA2 and its association with cardiovascular outcome in patients with ACS.A total of 79 patients with ACS came from the coronary care unit (CCU) between June 1, 2015 and August 31, 2016 in this longitudinal study. Serum levels of Lp-PLA2, troponin I, and creatine kinase isoenzymes MB (CK-MB) were measured at admission, on the first morning (D1), on the second morning of hospitalization (D2), and on the last second morning before discharge (D4). The patients were followed up till November 30, 2016. The primary outcomes were cardiovascular death and cardiovascular rehospitalization. Kaplan-Meier analysis and Cox proportional hazard models were used to identify risk factors for poor outcome in patients with ACS.All patients were followed up for 10.6 ± 4.7 months. The patients were divided into 2 groups according to the median of Lp-PLA2: lower Lp-PLA2 group and higher Lp-PLA2 group. Elevated levels of Lp-PLA2 significantly decreased during the early phases of ACS in higher Lp-PLA2 group. And Lp-PLA2 level increased at first and then decreased in lower Lp-PLA2 group. Kaplan-Meier analysis showed that patients with elevated Lp-PLA2 had a lower cardiovascular event-free survival (log-rank χ = 4.736, P = .030) than those with lower Lp-PLA2. Cox regression analysis indicated that high Lp-PLA2 level (hazard ratio [HR] = 1.005, 95% confidence interval [CI] = 1.002-1.008, P = .003), time delay from symptom onset to admission (HR = 1.088, 95% CI = 1.038-1.139, P < .001) independently predicted cardiovascular event in patients with ACS after adjusting for potential confounders.Serum level of Lp-PLA2 altered considerably during the early phase of ACS and increased Lp-PLA2 independently predicted cardiovascular outcome in patients with ACS after adjustment for potential confounders.

Objective To build an animal model of unstable atherosclerotic plaque and investigate the relationship between lipoprotein-associated phospholipase A2(Lp-PLA2) and atherosclerosis in the New Zealand white rabbits. Method The 16 healthy male New Zealand rabbits were randomly divided into 2 groups: 8 rabbits in control group with normal diet; 8 rabbits in high-fat-diet and vascular endothelial injury group that underwent balloon induced arterial wall injury and high fat diet. Fasting serum samples were collected for tests of total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), Lp-PLA2, interleukin-6 (IL-6) and C-reactive protein (CRP) in the zero, 5thand 15thweek. Meanwhile, the arteries of rabbits were studied under optical microscope for pathological changes in 15thweek. Result In the model group, the body weight increased significantly in15thweek, and the blood lipid and Lp-PLA2increased significantly (P<0.01), but there were no significant changes in the control group. Compared with the control group, the serum levels of TC, LDL-C, Lp-PLA2, CRP in the model group were significantly increased in 5thand 15th week (P<0.05), and the serum TG and IL-6 levels were significantly increased in15thweek (P<0.05). Pathological analysis showed that atherosclerotic plaque model was successfully established in the model group. Conclusion An animal model of unstable atherosclerotic plaques can be built as based on high-fat-diet and balloon induced arterial wall injury. Lp-PLA2can be used as an early biological marker to determine the instability of atherosclerotic plaque.

临床教学中,传统的教学模式是教师讲授为主、学生被动接受,这种教学模式已不能很好地适应医学发展的需要.与传统教学模式相比,以问题为导向的教学方法(problem-based learning,PBL)强调以学生为中心,学生主动学习,充分发挥学生的主观能动性.笔者在心血管内科学见习学生中应用PBL教学,取得较好效果,现报告如下.

Objective To explore the value of heart rate variability (HRV) in patients with coronary artery disease (CAD).Methods From october 2013 to february 2015,in hospital in Beijing Tiantan Hospital Affiliated Capital Medical University,85 patients with suspected CAD were selected.All patients received the routine laboratory tests,ambulatory electrocardiography and coronary angiography (CAG).The results of the CAG was as the gold standard for diagnose coronary artery disease.According to the results of CAG,patients were divided into CAD group (at least one major branch of coronary artery stenosis ≥ 50％ in CAG) and control group (vascular diameter stenosis ＜50％ in CAG).The differences in general data and heart rate variability between the groups were compared.Results The data of standard diviation of NN intervals (SDNN),triangle index (TRI) and standard diviation of NN during each 5-minute segment (SDANN) in CAD group were reduced compared with those in control group (P ＜ 0.05).In addition,the logistic regression analysis showed that the gender,diabetes and SDANN were risk factors for CAD,and the regression equation was Y =0.615+1.076X1+1.343X2-0.019X3 (X1 was man or wuman,X2 was diabetes mellitus or not,X3 was the number of SDANN).Conclusion Parts of HRV data are reduced in CAD pateints.And some parts of HRV,especially SDANN reducing predicts CAD risk increasing.

Objective To explore the associated factors for kidney damage in patients with type 2 diabetes mellitus (DM).Method The 802 type 2 DM inpatients were enrolled at Department of Endocrinology,Aerospace Center Hospital between January 1st 2012 and October 31st 2014.The general data,biochemistry parameters and urinary microalbumin were collected.The patients were divided into three groups according to the urinary microalbumin level:normal level group (NL group,615 patients),medium level group (ML group,140 patients) and high level group (HL group,47 patients).The risk factors for kidney damage were analyzed using the Logistic regression.Result The patients in HL group showed a higher incidence of hypertension,coronary artery disease and diabetic retinopathy,a longer duration of DM,higher systolic blood pressure (BP),triglycerides,total cholesterol,and serum uric acid than those in NL group (P＜0.01).The serum uric acid was also higher in patients with HL group than those in ML group (P＜0.01).The patients in ML group had a higher incidence of hypertension and diabetic retinopathy,a longer duration of DM,higher body mass index,systolic BP,diastolic BP,triglycerides,and hemoglobin Alc (HbA1c) than those in NL group (P＜0.01).Significantly lower high density lipoprotein cholesterol (HDL-C) was observed in patients with ML group than in NL group (P＜0.01).Logistic regression analysis found that the risk factors for kidney damage in DM were longer duration of DM,higher systolic BP,HbA1c and uric acid,and lower HDL-C (P＜0.05).Conclusion Our study suggested that duration ofDM,HbA1c,HDL-C,uric acid,and systolic BP were the risk factors for kidney damage in type 2 DM patients.

目的 探讨糖尿病肾病腹膜透析患者的预后.方法 选择腹膜透析患者160例,分为糖尿病肾病腹膜透析组(48例)和非糖尿病肾病腹膜透析组(112例),比较两组的预后.结果 糖尿病肾病腹膜透析组的患者在男性比例、收缩压、脉压、血红蛋白、残肾尿素清除指数(Kt/V)、总Kt/V、残肾肌酐清除率(Ccr)、总Ccr、残余肾功能、死亡率均显著高于非糖尿病肾病腹膜透析组(P<0.05),而透析龄、随访时间、血白蛋白、尿素氮、血肌酐均低于非糖尿病肾病腹膜透析组(P<0.05).Kaplan-Meier生存分析显示糖尿病肾病腹膜透析患者的生存率明显低于非糖尿病肾病腹膜透析患者(P=0.002).Cox回归分析显示校正性别、体质量指数、血白蛋白、血肌酐、收缩压、舒张压后,年龄(HR:1.059,95%CI:1.009~1.111,P=0.019)、糖尿病肾病(HR:2.301,95%CI:1.019~5.197,P=0.045)是腹膜透析患者死亡的预测因素.结论 糖尿病肾病腹膜透析患者的生存率低于非糖尿病肾病腹膜透析患者,糖尿病肾病是腹膜透析患者不良预后的危险因素.