维持性血液透析患者血管钙化情况横断面调查及其危险因素分析  

A cross-sectional study on the vascular calcification situation among maintenance hemodialysis patients and analysis of its risk factors

作　　者：吴雪平[1] 刘成[2] 陈卫东 WU Xue-ping(Nephrology department,the first affiliated hospital of Bengbu Medical college,Bengbu,Anhui,233000,China)

机构地区：[1]蚌埠医学院第一附属医院肾内科,安徽蚌埠233000 [2]蚌埠医学院第一附属医院ICU,安徽蚌埠233000

出　　处：《齐齐哈尔医学院学报》2020年第7期806-811,共6页Journal of Qiqihar Medical University

基　　金：蚌埠医学院自然科学类项目(BYKY1775)。

摘　　要：目的了解血透患者血管钙化(vascular calcification,VC)的发生率及严重程度;分析血透患者发生血管钙化的危险因素。方法1、对院血液净化中心规律行血液透析治疗(透析龄>3个月)的维持性血液透析(maintenance hemodialysis,MHD)患者共170例进行调查,了解其血管钙化的发生情况,记录所有患者的相关临床资料;留取血标本测定患者血钙、血磷、血清全段甲状旁腺素(iPTH)、超敏C反应蛋白(hs-CRP)、血脂、碱性磷酸酶(ALP)、血常规等实验室指标;行腹部侧位X线片检查,采用Kauppila半定量评分法,对患者腹主动脉钙化(Abdominal aortic calcification,AAC)情况进行评分。2、根据AAC积分值,将MHD患者分为非钙化组(AAC积分0分)、轻度钙化组(AAC积分≤4分)、中度钙化组(5分≤AAC积分≤15分)和重度钙化组(AAC积分≥16分)。3、将所有患者根据其是否有糖尿病,分为糖尿病组和非糖尿病组。4、计算MHD患者AAC的发生率;分析AAC与MHD患者各临床指标的相关性;通过Logistic多因素回归分析,归纳出影响MHD患者发生VC的危险因素。结果1、本次调查中170例MHD患者,X线片显示有AAC的共有109例(占64.12%)。其中轻度钙化组:28例,占16.47%;中度钙化组:60例,占35.29%;重度钙化组:21例,占12.35%。2、各钙化组和非钙化组比较,患者血脂(胆固醇、甘油三酯)、血红蛋白和血白蛋白,无明显差异(P>0.05);但各钙化组年龄、透析龄、血钙、血磷、血钙磷乘积、血iPTH、血ALP、hs-CRP水平均明显高于非钙化组(P<0.05);3、糖尿病组和非糖尿病组比较,腹主动脉钙化发生率明显高于非糖尿病组(P<0.05)。4、相关性分析结果显示:AAC与MHD患者年龄、透析龄、血钙、血磷、血钙磷乘积、iPTH、ALP以及hs-CRP呈正相关(P<0.01)。5、多因素logistic回归分析显示:MHD患者的透析龄、年龄、血钙磷乘积、血iPTH、血ALP以及合并糖尿病是发生VC的独立危险因素(P<0.01)。结论MHD患�Objective To assess the risk factors for vascular calcification in maintenance hemodialysis(MHD)patients in our hospital by analyzing the incidence and severity of vascular calcification(VC)in MHD patients.Methods A total of 170 cases of MHD patients who underwent stable hemodialysis treatment(dialysis age>3 months)in hemodialysis center of our hospital were investigated to understand the occurrence of VC.The general clinical data of the patients were collected.Blood samples were collected to measure serum calcium,serum phosphorus,serum total parathyroid hormone(iPTH),high-sensitivity C-reactive protein(hs-CRP),blood lipids,alkaline phosphatase(ALP),hemocytology,etc.Abdominal lateral position X-ray examination was performed,and the abdominal aortic calcification(AAC)score was calculated by the Kauppila semiquantitative scoring method.According to the presence or absence of AAC,MHD patients were divided into non-calcification group,mild calcification group(AAC score≤4 points),medium calcification group(5 points≤AAC score≤15 points),and severe calcification group(AAC score≥16 points).According to the primary disease,they were divided into the diabetic group and the non-diabetic group.The incidence of AAC in MHD patients was calculated,and to analyzed the correlation between AAC occurrence and clinical indicators of MHD patients.Risk factors affecting VC in MHD patients were analyzed by multivariate logistic regression analysis.Results The results of X-ray test revealed that AAC occurred in 109(64.12%)of the 170 MHD patients in the study.Among them,28 cases were mild calcification,accounting for 16.47%;60 cases were moderate calcification,accounting for 35.29%;and 21 cases were severe calcification,accounting for 12.35%.There were no significant differences in serum cholesterol,triglyceride,hemoglobin and albumin among the 4 groups group(P>0.05).Age of patients,age of dialysis,levels of serum calcium,serum phosphorus,product of serum calcium and phosphorus,serum iPTH,serum ALP,and hs-CRP in calcification gro

关 键 词：血液透析 血管钙化 Kauppila半定量评分 腹主动脉钙化 

分 类 号：R459.5[医药卫生—治疗学]