腹主动脉钙化与维持性血液透析患者预后的关系  

Relationship between abdominal aortic calcification and outcomes in maintenance hemodialysis patients

作　　者：王喆[1] 魏芳[1] 孟甲[1] 李博[1] 王博[1] 卢志[1] 贾兰[1] 杨洁[1] 姜埃利[1] 

机构地区：[1]天津医科大学第二医院肾脏病血液净化科,300211

出　　处：《中华肾脏病杂志》2016年第12期899-904,共6页Chinese Journal of Nephrology

基　　金：天津医科大学科研基金（2015KYZQ15）

摘　　要：目的探讨腹主动脉钙化与维持性血液透析（maintenance hemodialysis，MHD）患者预后的关系。方法纳入2014年6月至2014年10月于本院血液净化科进行MHD的患者170例。采用腹部侧位x线片评估腹主动脉钙化积分（abdominal aortic calcification score,AACS）。根据AACS分为轻度钙化（AACS〈5）组和重度钙化（AACS≥5）组进行比较，并采用Kaplan．Meier生存曲线分析两组的生存率。多因素COX回归分析影响MHD患者全因死亡和心血管疾病死亡的危险因素。结果重度腹主动脉钙化（AACS≥5）的患病率为28．2％（48／170），中位随访25．6（22．0，26．0）个月，AACS〈5组死亡6例（4．9％），AACS≥5组死亡14例（29．2％）。Kaplan-Meier生存分析显示AACS〈5组患者全因死亡、心血管死亡累积生存率均高于AACS≥5组（χ^2=9．746，P=0．002；χ^2=9．697，P=0．002）。多因素COX回归分析显示，AACS≥5（HR=4．373，95％CI：1．562—7．246，P=0.005）、低白蛋白（HR=0.886，95％CI：0．797～0．985，P=0．025）是MHD患者全因死亡的独立危险因素；低白蛋白（HR=0.829，95％CI：0．718—0．956，P=0．010）、低1，25羟维生素D3（HR=0．769，95％CI：0．627～0．944，P=0．012）是MHD患者心血管疾病死亡的独立危险因素。结论腹主动脉钙化增加MHD患者死亡风险。但仍需要多中心大样本长期随访的临床研究进一步评价腹主动脉钙化对MHD患者预后的影响。Objective To investigate the relationship between abdominal aortic calcification （AAC） and outcomes in maintenance hemodialysis （MHD） patients. Methods One hundred and seventy MHD patients in the dialysis center of the Second Hospital of Tianjin Medical University from June 2014 and October 2014 were enrolled prospectively. Abdominal aortic calcification （AAC） was measured using AAC score （AACS） by abdominal lateral plain radiography. According to the AACS, the patients were divided into mild AAC （AACS 〈 5） group and severe AAC （AACS≥5） group for comparison, and Kaplan-Meier analysis was used to compare their survival rates. Multivariable COX regression models were used to determine the risk factors of all- cause mortality and cardiovascular disease mortality in MHD patients. Results Severe AAC （AACS≥5） was present in 28.2% （48/170） patients. The median follow-up duration was 25.6 （22.0, 26.0） months. During the follow-up, 6 patients （4.9%） in AACS 〈 5 group and 14 patients （29.2%） in AACS≥5 group died. Kaplan-Meier analysis showed that patients in AACS≥5 group had higher all-cause mortality rate and cardiovascular disease mortality rate as compared with patients in AACS 〈 5 group （χ^2=9.746, P=0.002; χ^2=9.697, P=0.002）. Multivariate COX regression analysis demonstrated that high AACS （HR=4.373, 95%CI 1.562-7.246, P=0.005） and hypoproteinemia （HR=0.886, 95% CI 0.797- 0.955, P=0.025） were independent risk factors for all-cause mortality, while hypoproteinemia （HR=0.829, 95%CI 0.718-0.956, P=0.010） and low 1,25（OH）D3 （HR=0.769, 95% CI 0.627- 0.944, P=0.012） were independent risk factors for cardiovascular disease mortality. Conclusions AAC is significantly associated with overall survival in MHD patients. To further evaluate the relationship between AAC and outcomes in MHD patients, multi-center and long term follow up studies of large sample size are necessary.

关 键 词：主动脉 腹 钙质沉着症 肾功能不全 慢性 肾透析 死亡率 

分 类 号：R543.1[医药卫生—心血管疾病] R692[医药卫生—内科学]