维持性血液透析患者心血管钙化进展的相关影响因素分析  

Progression of cardiovascular calcification in hemodialysis patients

作　　者：陈佩玲 龚德华[2] 徐斌[2] 何群鹏 周敏林 章海涛 刘志红[2] 

机构地区：[1]南京大学附属金陵医院(南京总医院),南京210016 [2]南京大学附属金陵医院(南京总医院)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5期403-407,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家科技支撑计划课题(2015BAI12B02、2015BAI12B05)

摘　　要：目的:探讨维持性血液透析(MHD)患者心血管钙化进展的影响因素。方法:选择MHD>6月的患者104例,完善相关实验室检查,胸部螺旋CT检测冠状动脉钙化评分(CACS,Agston法),腹部侧位平片检测腹主动脉钙化评分(AACS,Kauppila法),心脏超声检测心脏瓣膜钙化情况。随访观察3年,探讨心血管钙化进展情况及其影响因素。结果:随访基线时钙化总阳性率为69.23%,随访3年后钙化总阳性率升至81.18%,CACS、AACS、心脏瓣膜钙化均较基线明显加重。Logistic回归分析显示舒张早期和舒张晚期二尖瓣口最大血液速度之比(E/A值)、时间平均血磷、时间平均钙磷乘积、基线CACS、碳酸钙的使用均是CACS进展的独立危险因素(P<0.05)。研究期间17例(16.34%)患者死亡,因心脑血管疾病死亡患者基线钙化情况更为严重。结论:MHD患者心血管钙化发生率高,且随透析时间延长逐年加重,临床血磷、钙磷乘积等指标控制达标情况及基线CAC等均影响远期CAC进展。Objective： To investigate the influencing factors of the progression of cardiovascular calcification in hemodialysis patients. Methodology： 104 cases of patients with maintenance hemodialysis（ MHD） were enrolled in this respective study. Coronary artery calcification score（ CACS,Agstonscores） was detected by chest spiral CT,abdominal aortic calcification score（ AACS,Kauppila score） was determined by abdominal lateral radiographs,and the cardiac valve calcification was examined by cardiac ultrasound. Results： The baseline cardiovacular calcification rate was 69. 23%,and it the progressed to 81. 18% after 3 years of follow-up. The CACS,AACS and valve calcification were significantly worse than the baseline. Logistic regression analysis showed that the E peak/A peak ratio,time-average serum phosphorus（ TA-P）,time-average calcium phosphorus products（ TA-Ca×P）,Baseline CACS and calcium carbonate were independent risk factors of CACS progression,and there was statistical significance（ P 〈 0. 05）. During the study period,17 patients（ 16. 34%） died. Cardiovascular calcification was more significant noticed in patients died of cerebro-cadiovascular reasons.Conclusion： The incidence of vascular calcification in hemodialysis patients was high,and it increases gradually with the prolongation of dialysis time. The level of serum phosphorus、calcium phosphorus product index,baseline CACS were the factors affect the long-term CAC progression.

关 键 词：维持性血液透析 心血管钙化 影响因素 

分 类 号：R459.5[医药卫生—治疗学]