维持性腹膜透析患者血管钙化的发生情况及其相关因素研究  

Studies on the prevalence and influence factors of vascular calcification in maintenance peritoneal dialysis patients

作　　者：蔡士铭 赵慧萍[1] 武蓓[1] 吴舰[2] 张萌[2] 左力[1] 王梅[1] 

机构地区：[1]北京大学人民医院肾内科,北京100044 [2]北京大学人民医院放射科,北京100044

出　　处：《中国血液净化》2018年第1期19-24,共6页Chinese Journal of Blood Purification

基　　金：教育部留学回国启动基金(jwsl451)

摘　　要：目的探讨维持性腹膜透析(peritoneal dialysis,PD)患者血管钙化的发生情况、钙化的严重程度及其相关影响因素。方法选择北京大学人民医院病情稳定的PD≥6个月、规律随诊的PD患者,通过侧位腹平片、骨盆正位片、双手正位X线片检测大动脉(腹主动脉)、中动脉(髂动脉、股动脉)、小动脉(桡动脉、手指动脉)的血管钙化,2位放射科医师盲法阅片及评分。收集入选者一般资料、Charlson合并症评分(charlson comorbidity index,CCI),自PD开始后的基线和时间平均实验室指标,包括钙磷代谢指标、白蛋白、血脂、透析充分性等。应用logistic回归分析血管钙化的影响因素,多元线性回归分析血管钙化程度的影响因素。结果 (1)154例PD患者入选本研究,其中男性78例(50.64%),平均年龄(60.41±13.88)岁,平均透析龄(30.63±20.74)月。糖尿病肾病是主要的原发病,占38.96%。(2)111例患者存在不同程度、不同部位的血管钙化(72.07%)。111例血管钙化的患者中83.78%存在腹主动脉钙化,61.26%存在中动脉钙化,35.13%存在小动脉钙化。另外,中重度血管钙化者占45.04%。(3)Logistic回归分析显示年龄(OR 1.092,95%CI 1.047~1.139,P<0.001)、糖尿病(OR 12.982,95%CI3.258~51.722,P<0.001)、透析龄长(OR 1.049,95%CI 1.017~1.081,P=0.002)、基线全段甲状旁腺激素(intact parathyroid hormone,i PTH)水平低(OR 0.996,95%CI 0.992~0.999,P=0.010)是血管钙化的独立危险因素。(4)与轻度钙化的患者相比,中重度血管钙化的患者CCI更高(t=-4.575,P<0.001)、合并糖尿病的患者更多(χ~2=9.617,P=0.002)、基线碱性磷酸酶水平更高(t=-2.018,P=0.047)。多元线性回归结果显示CCI(Β=0.258,P=0.003)、性别(Β=1.136,P=0.042)、是否合并糖尿病(Β=0.242,P=0.008)是血管钙化严重程度的独立影响因素。结论维持性PD患者血管钙化的发生率高,血管钙化最常发生于腹主动脉,在合并糖尿病、高龄、男性、透析龄长、基线i PTH水平Objective To investigate the occurrence and severity of vascular calcification in patients with maintenance peritoneal dialysis （PD） patients,and its influencing factors. Methods This cross-section study enrolled PD patients with stable status who has received PD treatment for more than 6 months in Peking University People’s Hospital. We used plain X-ray films of abdomen, pelvis and hands to quantitatively evaluate vascular calcification of large artery （abdominal aorta）, medium artery （iliac artery, femoral artery）, and arteriola （radial artery, digital artery） Two radiologists blinded reading and scoring. Demographic data, clinical characteristics, Charlson comorbidity index （CCI）, baseline and time average laboratory indexes including parameters of calcium phosphorus metabolism, serum albumin, PD adequacy were collected. The related factors of vascular calcification were analyzed by logistic regression. The factors influencing the degree of vascular calcification were analyzed by multiple linear regression. Results （1） 154 PD patients were enrolled in this study. 78 males, mean age was 60.41±13.88 years, average PD duration was 30.63±20.74 months. The major primary disease was diabetic nephropathy （39%）. （2） Vascular calcification on X-ray films presented in 111 patients （72.07%）. among them, 83.78% had abdominal aorta calcification, 61.26% had medium artery calcification and 35.13% had small artery calcification. 45.04% patients were found to have moderate to severe degree of calcification. （3） Logistic regression showed that diabetes（OR 12.982, 95%CI 3.258-51.722, P 〈0.001）, older age（OR=1.092, 95%CI=1.047-1.139, P 〈0.001）, longer dialysis duration（OR 1.049, 95%CI 1.017-1.081, P =0.002）, and lower baseline intact parathyroid hormone （iPTH） （OR 0.996, 95%CI 0.992-0.999, P =0.010）were independent risk factors of vascular calcification. （4） Compared with mild calcification, patients with moderate to severe degree of calcification had higher

关 键 词：腹膜透析 血管钙化 X线平片 腹主动脉钙化 

分 类 号：R459.5[医药卫生—治疗学]