心脏瓣膜钙化对终末期肾病患者冠状动脉钙化积分进展的预测价值  

Predictive value of cardiac valve calcification for progression of coronary artery calcium in end stage renal disease patients

作　　者：李明霞[1] 杨斌[1] 李娟[1] 戴云[1] 王泓[1] 

机构地区：[1]南京大学医学院附属金陵医院超声诊断科,南京市210002

出　　处：《临床超声医学杂志》2015年第10期666-669,共4页Journal of Clinical Ultrasound in Medicine

摘　　要：目的应用超声心动图评价终末期肾病患者心脏瓣膜钙化情况,探讨心脏瓣膜钙化对冠状动脉钙化积分（CACS）进展的预测价值。方法选取127例终末期肾病患者,多层螺旋CT评价13个月后患者CACS进展情况;超声心动图评价心脏瓣膜钙化情况。相对风险回归模型计算瓣膜钙化患者CACS进展的相对危险比。结果多层螺旋CT随访结果显示,78例患者CACS进展,49例患者CACS无进展。CACS进展患者年龄、肌酐、低密度脂蛋白及总胆固醇水平明显高于无进展患者（P〈0.05）。血糖、低密度脂蛋白及心脏瓣膜钙化均为CACS进展的独立危险因子。与无瓣膜钙化患者比较,主动脉瓣或二尖瓣钙化患者CACS进展的危险性增加1.30倍,95%可信区间为1.10~1.43（P=0.003）;主动脉瓣和二尖瓣同时钙化患者CACS进展的危险性增加1.37倍,95%可信区间为1.11~1.68（P=0.004）。结论终末期肾病患者存在心脏瓣膜钙化时,冠状动脉的钙化进程加快,超声心动图评价心脏瓣膜钙化情况可以评估CACS进展的危险性。Objective To evaluate whether cardiac valve calcification detected by echocardiography can predict progression of coronary artery calcium scores（CACS） in end stage renal disease patients. Methods A total of 127 patients with end stage renal disease were enrolled.The progression of CACS during a mean interval of 13 months was acquired with multidetector CT,the presence of cardiac valve calcification was assessed by echocardiography.Relative regression model was used to calculate the relative ratio（RR） in presence of valve calcification.Results The CT results showed progression of CACS in 78 patients,while no progression of CACS in 49 patients.The age,the level of creatinine,low density lipoprotein and total cholesterol in CACS progression patients were higher than those in patients without CACS progression（P〈0.05）.Blood glucose,low density lipoprotein and cardiac valve calcification were independent risk factor for progression of CACS. In comparison with participants without cardiac valve calcification,the adjusted risk of a CACS increasing was increased by a RR of 1.30 among participants with aortic valve calcification or mitral valve calcification（95% CI was 1.10~1.43,P=0.003） and by a RR of 1.37 among participants with both valve calcification（95% CI was 1.11~1.68,P=0.004）.Conclusion The CACS progressed quickly in end stage renal disease patients with cardiac valve calcification. Echocardiography is a useful tool to predict the progression of CACS in end stage renal disease patients by detecting cardiac valve calcification.

关 键 词：超声心动描记术 心脏瓣膜钙化 冠状动脉钙化积分 终末期肾病 

分 类 号：R543.3[医药卫生—心血管疾病] R540.45[医药卫生—内科学]