腹膜透析患者心血管钙化的发生率及影响因素  

The morbidity and related factors of cardiovascular calcification in peritoneal dialysis patients

作　　者：尹飞挺 周婷婷[1] 周岩[1] 周玉超[1] 刘志红[1] 俞雨生[1] 

机构地区：[1]南京大学医学院附属金陵医院(南京军区总医院)肾脏科,国家肾脏疾病临床医学研究中心,全军肾脏病研究所,南京210016

出　　处：《肾脏病与透析肾移植杂志》2015年第5期435-440,454,共7页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家科技支撑计划课题(2013BAI09B04,2015BAI12B05);江苏省临床医学中心项目(BL2012007)

摘　　要：目的:调查腹膜透析(PD)患者心血管钙化的发生率并分析影响因素。方法:选取2013年12月至2014年8月的PD患者,测定其血清钙、磷、全段甲状旁腺激素(i PTH),评估患者透析状态;应用多层螺旋CT计算冠状动脉钙化积分(CACS,Agatston方法),腹部侧位平片计算腹主动脉钙化积分(AACS,Kauppila方法),超声心动图检测心脏瓣膜钙化(CVC)。采用Logistic回归分析心血管钙化的相关危险因素。结果:150例入选PD患者血清校正总钙、血磷、血i PTH的达标率分别为58.0%、46.0%、23.3%(参照中华医学会肾脏病学分会发布的指导)。共计57.3%患者发生钙化,其中CAC、AAC、CVC的发生率分别为40.7%、32.7%、27.3%。任意部位钙化的发生率(除个别组别外)均随着年龄、透析龄增长而增加。Logistic回归分析显示高龄(OR=1.10)、透析龄长(OR=1.03)是CAC的独立危险因素,尿素清除指数(Kt/V)(OR=0.27)是其保护性因素;高龄(OR=1.07)、高磷(OR=1.94)是CVC的独立危险因素。结论:尽管本组PD患者有较低的心血管钙化发生率(CAC 40.7%,AAC32.7%,CVC 27.3%),但高磷血症、i PTH异常仍很突出。高龄、透析龄长、高磷仍是钙化的传统危险因素。Objective： To explore the incidence of cardiovascular calcification and related factors in patients with peritoneal dialysis（ PD）. Methodology： From December 2013 to August 2014,one hundred fifty PD patients were enrolled in this study. Laboratory measurements included serum calcium（ Ca）,phosphorus（ P）,intact parathyroid hormone（ i PTH）,and dialysis status was evaluated. Coronary Artery Calcification Score（ CACS） was assessed with multislice spiral computed tomography（ MSCT,Agatston method）. Abdominal Aortic Calcification Score（ AACS） was assessed with lateral plain radiograph of the abdomen（ Kauppila method）. Echocardiography was used to detect the cardiac valve calcification（ CVC）. The related factors of cardiovascular calcification were analyzed by binary logistic regression.Results： Only 58. 0%,46. 0% and 23. 3% of 150 patients reached the target for serum Ca,P and i PTH defined by Chinese Society of Nephrology（ CSN）. The total 57. 3% patients had calcification. The incidence of CAC,AAC and CVC was found in 40. 7%,32. 7% and 27. 3% patients respectively. In addition to the individual groups,the incidence of calcification of any part increased with age and dialysis vintage. Using binary logistic regression,age（ OR = 1. 10）,dialysis vintage（ OR =1. 03） were independent risk factors for CAC,but Kt / V as a protect factor（ OR = 0. 27）,the independent risk factors for CVC included age（ OR = 1. 07） and serum P（ OR = 1. 94）. Conclusion： Although our PD patients had low incidence of cardiovascular calcification（ CAC： 40. 7%,AAC： 32. 7%,CVC： 27. 3%）,hyperphosphate and abnormal i PTH were still prominent. Age,dialysis vintage and serum P were traditional risk factors for calcification in patients with PD.

关 键 词：腹膜透析 心血管钙化 发生率 影响因素 

分 类 号：R459.5[医药卫生—治疗学]