CKD_心血管疾病 疾病的防治—进展与问题.pptVIP

ADVANCE研究—治疗差异的中位数 Favors Cinacalcet Group Favors Control Group Agatston Score Volume Score Mitral Valve Aortic Valve Thoracic Valve Total Coronary Artery Stratum-adjusted Median Treatment Difference 95% CI （% Calcification Change） ADVANCE研究：结论 第一个评价西那卡塞对血管钙化进展作用的RCT研究 西那卡塞治疗有明显的减少血管钙化进展的趋势，尽管主要终点未达到统计学显著差异 两组的不良反应相仿 结果提示包括西那卡塞在内的治疗方案有利于减少心血管钙化的进展 针对维生素D的干预 是否使25羟-维生素D水平恢复正常能改善CV预后？ 给予活性维生素D或维生素D类似物能否改善CV预后？ 被忽视的CV危险因素 睡眠呼吸障碍 透析病人睡眠呼吸障碍的发生率（20~30%）明显高于一般人群（1~2%） 睡眠呼吸障碍与增高的死亡率相关，透析病人夜间PO2降低是死亡的预示指标 干预睡眠呼吸障碍改善生存率 每日夜间透析明显减少睡眠呼吸障碍 Pressman MR, et al. KI 1993;43:1134 Zoccali C, et al. JASN 2002;13:729 Bradley TD, et al. Lancet 2009;373:82 Hanly PJ, et al. NEJM 2001;344:102 抑 郁 透析病人20%~30%存在抑郁，死亡率随抑郁存在的时间延长而增加 无肾脏病的CVD患者抑郁患病率相仿，是死亡的独立危险因素 抑郁发生可能与微炎症、胰岛素抵抗、自主神经功能失衡、肾上腺皮质功能亢进有关 Lopes AA, et al. KI 2002;62:199 Glassman AH, et al. AmJ Psychiatry 1998;155:4 Everson-Rose SA, et al. Diabetes Care 2004;27:2856 今后需要研究的领域 深入认识心脏发育和功能的调控 影响心脏张力激素水平的因素 氧化应激和促氧化应激介质 交感过度活化的机制 CKD时CVD发病机制的研究：热点问题 今后需要研究的领域 β阻滞剂对CKD患者CV死亡率的影响 透析人群降压的靶目标值和CV死亡率的关系 进一步开展干预性研究：热点问题 为什么要闯进银行？ 因为那里有钱! 为什么关心我的心脏 ? 因为关系你的钱和最大利益! 谢 谢! * Postal questionnaire sent during 1997 to 1998 to all inhabitants in Groningen, the Netherlands, aged between 28 and 75 years (n=85,421). Information about risk factors for CV disease and CV morbidity, and urinary albumin concentration (UAC) collected. 40,856 (47.8%) responded; 40,548 included in the analysis. During median follow-up period of 961 days (maximum 1139 days), 516 deaths with known cause recorded; 178 classified as CV. PREVEND found a positive dose-response relationship between increasing UAC and mortality. A higher UAC increased the risk of both CV and non-CV death after adjustment for other well-recognized CV risk factors, with the increase being significantly higher for CV mortality than for non-CV mortality (p=0.014). A 2-fold increase in UAC was associated with a relative risk of 1.29 for CV mortality (95% CI 1.18 to 1.40) and 1.12 (95% CI 1.04 to