腹膜透析患者心血管钙化的演变及临床意义  

Evolution of cardiovascular calcification and clinical significance in peritoneal dialysis patients

作　　者：余乐 程慧栋 周婷婷 周岩 娄丽璇 刘志红 俞雨生 

机构地区：[1]南京大学医学院附属金陵医院(南京总医院)肾脏科 [2]南京大学医学院附属金陵医院(南京总医院)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》2017年第4期328-332,365,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家重点研发计划课题(2016YFC0904103);国家科技支撑计划课题(2015BAI12B09;2015BAI12B02)

摘　　要：目的:动态观察腹膜透析(PD)患者心血管钙化的患病率和演变情况,分析影响钙化的因素及临床意义。方法:前瞻性观察150例PD患者,评估基线临床特征及心血管钙化的患病率,随访30个月,分别于第0、12和24个月评估钙化的影像学演变。Logistic回归分析影响心血管钙化及进展的相关因素;计算患者的全因或心血管疾病(CVD)死亡率和非致死性心血管事件(CVE)的发生率,分析相关危险因素。结果:基线时57.3%的患者存在钙化,至随访结束,心血管钙化率升至63.2%,53.5%(61/114)的患者观察到钙化进展。随访中5.3%(8/150)患者死亡,最常见的死因是CVD(75%),CVE的发生率为19.3%。有临床意义钙化患者的全因死亡(P=0.004)和CVD死亡显著高于其他患者(P=0.002)。低蛋白血症及二尖瓣钙化是全因死亡和CVD死亡的独立危险因素;年龄>46岁、低密度脂蛋白胆固醇及冠状动脉钙化+心瓣膜钙化是CVE的独立危险因素。结论:PD患者合并心血管钙化的患病率较高,病变进展较快,与CVD的发生有着密切的联系,心血管钙化对整体预后产生不良影响。Objective： To dynamically observe the morbidity and evolution of cardiovascular calcification in peritoneal dialysis（ PD） patients,and to analyze the factors influencing calcification and its clinical significance.Methodology： One hundred fifty PD patients were enrolled in a prospectively study. Their baseline clinical features and the morbidity of cardiovascular calcification were assessed. The durations of follow-up were 30 months. The calcification was assessed at 0,12 and 24 months,respectively. The Logistic regression was used to analysis factors affecting cardiovascular calcification and progression. The Kaplan-Meier method was used to calculate the all-cause mortality,cardiovascular disease（ CVD） mortality and nonfatal cardiovascular events（ CVE）,and COX regression analysis was associated with the risk factors. Results： 57. 3% of patients had calcification at baseline,and at the end of follow-up,the cardiovascular calcification rate increased to 63. 2%,and calcification progression was observed in 53. 5% of patients. 5. 3% of patients died during follow-up,the most common cause of death was CVD（ 75%）,and the incidence of CVE was 19. 3%. The allcause mortality（ P = 0. 004） and CVD mortality（ P = 0. 002） were significantly higher in patients with clinically significant calcification than in other patients. Hypoalbuminemia and mitral calcification are independent risk factors for all-cause mortality and CVD mortality. Age more than 46 years,low-density lipoprotein cholesterol and coronary artery calcification ＋heart valve calcification were independent risk factors for CVE. Conclusion： PD patients with high morbidity of cardiovascular calcification and the progression of calcification was rapid. Cardiovascular calcification may be closely related to the occurrence of CVD events,and it could be negative effects on prognosis.

关 键 词：腹膜透析 心血管钙化 演变 预后 

分 类 号：R692.5[医药卫生—泌尿科学]