心脏瓣膜钙化在慢性肾脏病患者中的流行病学研究  

Epidemiology of heart valvular calcification in different stages of chronic kidney disease

作　　者：李志莲[1] 陈源汉[1] 梁馨苓[1] 冯仲林[1] 叶智明[1] 史伟[1] 

机构地区：[1]广东省人民医院肾内科广东省医学科学院,广东广州510080

出　　处：《国际泌尿系统杂志》2014年第4期471-476,共6页International Journal of Urology and Nephrology

基　　金：国家自然科学基金青年基金（81200544）;国家十二五科技支撑计划项目课题（2011BAI10B06）

摘　　要：目的 调查慢性肾脏病（CKD）不同分期患者瓣膜钙化的患病率及特点,了解影响CKD患者瓣膜钙化的可能因素.方法 回顾性分析2008年1月至2010年12月广东省人民医院肾内科CKD患者的心脏彩色B超和临床资料.患者分成CKD1 ～5期、5D期6个组.采用Logistic回归分析与瓣膜钙化相关的因素.结果 1550例CKD患者中,瓣膜钙化者有180例（占11.6％）,瓣环钙化（60％）多于瓣叶钙化（40％）.CKD1～5D期瓣膜钙化患病率依次为：0.6％、3.1％、8.9％、6.8％、4.4％和28.8％.CKD-5D期瓣膜钙化现象随透析龄的延长而增多.Logistic回归分析结果显示,与CKD心脏瓣膜钙化相关的危险因素包括年龄、血钙、iPTH、中重度瓣膜关闭不全、左室肥厚、进入维持性血液透析及伴有心血管合并症.结论 并非所有CKD都易合并瓣膜钙化,其在CKD1～2期非常少见,一旦进入维持性血液透析阶段,合并瓣膜钙化者明显增加.因此,瓣膜钙化的风险需要在CKD人群里分层评估,应重视筛查CKD-5D期患者的瓣膜钙化情况及可调控因素的综合干预.Objectives Heart valvular calcification （VC） is an important predictor of cardiovascular and all-cause mortality in patients with chronic kidney disease（CKD）.However,epidemiologic data about VC in CKD is scarce.Our study was to investigate the prevalence of VC in different stages of CKD and its associated factors.Methods Clinical and echocardiographic data was retrospectively collected from CKD patients in Guangdong General Hospital between January 2008 and December 2010.Results Among 1550 patients,180 cases （11.6％）were detected with VC by echocardiography.Prevalence of VC in CKD stage 1 ～ 5D was 0.6％,3.1％,8.9％,6.8％,4.4％ and 28.8％,respectively.VC was highest in CKD-5D and increased with dialysis vintage.Logistic regression analysis showed the associated factors included age,serum calcium,iPTH,moderate-to-severe heart valvular regurgitation,left ventricular hypertrophy,CKD-5 D stage and cardiovascular morbidity.Conclusions Prevalence of VC differs according CKD stages.Not all CKD patients were liable to VC.It was uncommon in CKD stage 1,but markedly increased in MHD patients.We suggest screening for heart VC in CKD-5D stage in order to stratify risk.

关 键 词：肾疾病 慢性病 心脏瓣膜 钙质沉着症 

分 类 号：R692.5[医药卫生—泌尿科学]