老年慢性肾脏病患者心脏瓣膜钙化情况分析  

Study on the calcification of aortic valves in elderly patients with chronic renal diseases

作　　者：李玓嬗[1] 刘文虎[1] 代文迪[1] 刁宗礼[1] LI Di-shan;LIU Wen-hu;DAI Wen-di(Department of Nephrology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院肾内科

出　　处：《临床和实验医学杂志》2019年第21期2310-2313,共4页Journal of Clinical and Experimental Medicine

基　　金：北京市科学技术委员会科技计划重大项目(编号:D131100004713001);北京市医院管理局临床医学发展专项经费(编号:ZXLX201824)

摘　　要：目的观察老年慢性肾脏病(CKD)患者心脏瓣膜钙化(AVC)情况,并分析其危险因素。方法采用横断面研究方法,连续纳入2015年1月至2016年12月就诊于首都医科大学附属北京友谊医院CKD专病门诊年龄大于等于65岁的老年患者,记录一般资料、基础疾病、实验室检查(包括肾功能、血常规、尿液检查、血清钙、磷及骨代谢指标等)结果。应用Philips IE33型号彩色超声分析检测245位老年(年龄≥65岁)非透析CKD患者是否存在AVC情况,了解老年CKD患者心脏瓣膜钙化发生率,并根据老年CKD患者肾小球滤过率(e GFR)分为三组,即e GFR≤29.99 ml/(min·1.73 m^2),30.00~59.99 ml/(min·1.73 m^2)和≥60.00 ml/(min·1.73 m^2)三组,比较不同肾功能水平患者AVC发生率。根据是否存在心脏瓣膜钙化分为AVC组(96例)及非AVC组(149例),比较两组患者的年龄,性别构成比,合并症情况,血清钙、磷,全段甲状旁腺素(i PTH),白蛋白等指标。进一步应用Logistic回归分析筛选出影响老年CKD患者心脏瓣膜钙化的危险因素。结果老年CKD患者AVC的发生率为39.2%(96/245),不同e GFR水平分组间AVC发生率无统计学差异(χ^2=5.424,P=0.066)。ACV组患者年龄为79(74~84)岁,非AVC组患者年龄为74(69~81)岁,AVC组患者年龄高于非AVC组,两组比较有统计学差异(Z=-3.9978,P=0.000)。AVC组患者高血压患病率为84.4%(81/96),非AVC组患者高血压患病率为71.8%(107/149),AVC组患者高血压患病率高于非AVC组(χ^2=5.161,P=0.023)。结论老年CKD患者ACV的发生率高,年龄和患有高血压为AVC的危险因素。Objective To observe the condition of calcification in aortic valves of elderly patients with chronic renal diseases(CRD),and to analyze and identify their risk factors.Methods This cross-sectional study was based upon clinical records of 245 elderly patients over 65 years old and complicated with CRD,visiting in the CRD clinic during January 2015 to December 2016.The general information of these patients as basic diseases and laboratory test results(including serum levels of creatinine,urea nitrogen,results of urinalysis,serum levels of calcium,phosphorus and bone metabolism indices etc.)were collected and recorded.Evaluation of ACV conditions in 245 elderly CRD patients via Philips IE33 color Doppler ultrasonography device.Patients were divided into three groups by eGFR,there were eGFR≤29.99,30.00~59.99 and eGFR≥60.00 respectively,and to compare the incidence of AVC in different groups.These patients were divided into two groups,AVC group and non-AVC group.Analysis was performed to compare the general information,basic diseases,serum calcium,phosphorus,iPTH,serum albumin and other indices.The risk factors of AVC with Logistic regression were analyzed.Results The ACV incidence in elderly CRD patients is 39.2%(96/245),there was no significant difference in the incidence of AVC in different eGFR groups(χ^2=5.424,P=0.066).The age[79(74~84)years vs.74(69~81)years]and morbidity rate of high blood pressure(81/96 vs.107/149)in patients of ACV group are higher than those of non-ACV group(Z=-3.9978,P=0.000;χ^2=5.161,P=0.023).Conclusion High incidence of AVC was found in elderly patients with chronic renal disease.Complicated hypertension and age were risk factors for heart valve calcification.

关 键 词：老年患者 慢性肾脏病 心脏瓣膜钙化 

分 类 号：R692[医药卫生—泌尿科学] R542.5[医药卫生—外科学]