腹主动脉钙化评分预测腹膜透析患者心脑血管预后的价值  

Abdominal aortic calcification score predicts cardiovascular outcome in peritoneal dialysis patients

作　　者：马大骅 严豪[1] 杨晓晓[1] 俞赞喆[1] 倪兆慧[1] 方炜[1] Ma Dahua;Yan Hao;Yang Xiaoxiao;Yu Zanzhe;Ni Zhaohui;Fang Wei(Department of Nephrology,Renji Hospital,School of Medicine,Shanghai Jiao Tong University/Shanghai Research Center for Peritoneal Dialysis,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院肾脏内科上海市腹膜透析研究中心,上海200127

出　　处：《中华肾脏病杂志》2020年第3期189-196,共8页Chinese Journal of Nephrology

基　　金：国家自然科学基金(81370864、81670691);上海市教育委员会高峰高原学科建设计划(20152211)。

摘　　要：【目的】 探讨腹主动脉钙化评分(abdominal aortic calcification score,AACS)与腹膜透析患者心脑血管预后的关系。方法 研究对象来自2011年7月至2014年7月期间在上海交通大学医学院附属仁济医院接受规律腹透治疗的患者。采用腹部侧位X线摄片评估所有入选者腹主动脉钙化程度,并根据Kauppila评分系统行AACS评分。根据AACS三分位数将患者分为无钙化组(AACS=0)、轻中度钙化组(0<AACS≤4)和重度钙化组(4<AACS≤24)。随访终点时间为研究终止日期(2018年8月31日),或退出腹膜透析,或患者死亡。采用竞争风险模型分析AACS与腹膜透析患者心脑血管预后的关系。结果 共292例腹膜透析患者入选本研究,男性160例(54.8%),年龄(57.1±15.2)岁,中位腹膜透析龄28.4(12.0,57.8)月,中位AACS 2.0(0.0,6.0)分。无钙化组125例,轻中度钙化组72例,重度钙化组95例。有序Logistic回归分析结果显示,年龄(OR=1.081,95%CI 1.057~1.106,P<0.001)、腹膜透析龄(OR=1.012,95%CI 1.004~1.019,P=0.003)、合并糖尿病(OR=2.554,95%CI 1.415~4.609,P=0.002)和有心脑血管疾病(CVD)(OR=1.919,95%CI 1.108~3.325,P=0.020)是AACS的独立相关因素。随访期间共有65例患者发生CVD事件,50例CVD相关死亡。与无钙化组相比,轻中度及重度钙化组患者中CVD事件累积发生率和累积病死率显著升高(分别Gray=27.81,P<0.001;Gray=20.91,P<0.001)。AACS是腹膜透析患者发生CVD事件(轻中度钙化组比无钙化组:SHR=2.823,95%CI 1.333~5.970,P=0.007;重度钙化组比无钙化组:SHR=3.063,95%CI 1.460~6.430,P=0.003)和CVD相关死亡(SHR=2.590,95%CI 1.132~5.920,P=0.024)的独立预测因子。结论 年龄、腹膜透析龄、合并糖尿病及有心脑血管疾病是腹膜透析患者AACS升高的独立相关因素,AACS可预测腹膜透析患者心脑血管事件和心脑血管死亡的风险。Objective To explore the association of abdominal aortic calcification score(AACS)with cardiovascular disease(CVD)outcomes in peritoneal dialysis(PD)patients.Methods The patients who underwent regular PD at Renji Hospital between July 2011 and July 2014 were recruited and prospectively followed up until the end of the study(August 31,2018),death,or dropout PD.Abdomen lateral X-ray was used to determine AACS for each patient at enrollment.Patients were divided into three groups based on the tertiles of AACS:non-calcified group,AACS group(AACS=0),mild-moderate calcification group AACS group(0<AACS≤4)and severe calcification group(4<AACS≤24).Cumulative incidences of cardiovascular outcomes among three groups were estimated using competing risk model and compared through Gray test.Competing risk regression model was used to evaluate the association of AACS and cardiovascular events as well as CVD mortality.Results Two hundred and ninety-two PD patients were enrolled in this study.The cohort consisted of 160 males(54.8%)with the age(57.1±15.2)years and median PD vintage 28.4(IQR 12.0,57.8)months,and their average AACS was 2.0(0.0,6.0).Order logistic regression analysis showed that older age(OR=1.081,95%CI 1.057-1.106,P<0.001)and longer PD vintage(OR=1.012,95%CI 1.004-1.019,P=0.003),CVD history(OR=1.919,95%CI 1.108-3.325,P=0.020)and diabetes(OR=2.554,95%CI 1.415-4.609,P=0.002)were independent risk factors of escalating AACS in PD patients.During the follow-up,65 cases CVD events and 50 cases CVD-related deaths developed.Patients in the upper AACS tertile had significantly higher estimated cumulative incidences of CVD occurrence(Gray=27.81,P<0.001)and CVD mortality(Gray=20.91,P<0.001).AACS was an independent predictor of both CVD occurrence(medium AACS group vs low AACS group:SHR=2.823,95%CI 1.333-5.970,P=0.007;high AACS group vs medium AACS group:SHR=3.063,95%CI 1.460-6.430,P=0.003)and CVD mortality(SHR=2.590,95%CI 1.132-5.920,P=0.024)in competing risk regression models.Conclusions Age,PD vintage,diabetes and pree

关 键 词：血管钙化 主动脉 腹 腹膜透析 心血管疾病 死亡 

分 类 号：R692[医药卫生—泌尿科学] R45[医药卫生—外科学]