老年慢性肾脏病3~5期非透析患者心脏瓣膜钙化特点及其与血清骨代谢标志物的相关性  

Cardiac valve calcification and its relationship with serum bone turnover markers in elderly patients with stage 3-5 non-dialysis chronic kidney disease

作　　者：洪维 肖婧 傅辰生 张晓丽 叶志斌 HONG Wei;XIAO Jing;FU Chen-sheng;ZHANG Xiao-li;YE Zhi-bin(Department of Osteoporosis and Bone Disease, Huadong Hospital, Fudan University, Shanghai 200040, China;Department of Nephrology, Huadong Hospital, Fudan University, Shanghai 200040, China)

机构地区：[1]复旦大学附属华东医院骨质疏松科,上海200040 [2]复旦大学附属华东医院肾内科,上海200040

出　　处：《中国临床医学》2020年第4期639-644,共6页Chinese Journal of Clinical Medicine

基　　金：上海市卫生和计划生育委员会科研课题(201740028)。

摘　　要：目的:探讨老年慢性肾脏病(CKD)3~5期非透析患者心脏瓣膜钙化发生率及其特点,分析其与血清骨代谢标志物(BTM)的相关性。方法:入选复旦大学附属华东医院肾内科病房老年CKD 3~5期非透析住院患者168例,其中男性80例,女性88例,年龄60~93岁。记录相关临床资料、血生化和骨代谢标志物指标,行心脏彩超检查,根据有无瓣膜钙化分为心脏瓣膜钙化(VC)组与非钙化(NVC)组。结果:VC组的年龄、全段甲状旁腺素(iPTH)和Ⅰ型胶原羧基末端肽(β-CTX)显著高于NVC组(P<0.05或P<0.01),VC组的估算肾小球滤过率(eGFR)略低于NVC组(P<0.05),碱性磷酸酶略高于NVC组(P<0.05)。老年患者CKD 3~5期均以主动脉瓣钙化为最常见,二尖瓣钙化其次,三尖瓣最少见。CKD 4期和5期患者主动脉瓣钙化发生率(53.06%和39.75%)显著高于CKD 3期(25.00%,P<0.05),而二尖瓣钙化发生率在各期间无明显差异(11.11%vs 8.16%vs 18.07%,P>0.05)。单因素Logistic回归分析发现,年龄、eGFR、β-CTX和iPTH与心脏瓣膜钙化显著相关(P<0.05)。多因素Logistic逐步回归分析显示,年龄越大和iPTH越高是主动脉瓣钙化的独立危险因素(OR=1.102,95%CI 1.058~1.148,P<0.01;OR=1.004,95%CI 1.001~1.007,P<0.01)。年龄越大和β-CTX越高是二尖瓣钙化的独立危险因素(OR=1.104,95%CI 1.010~1.206,P<0.05;OR=1.001,95%CI 1.000~1.002,P<0.05)。结论:老年CKD 4~5期非透析患者VC发生率高,其中主动脉瓣钙化最常见,增龄是老年CKD 3~5期非透析患者VC的独立危险因素,常见的血清BTM与老年CKD患者中VC的相关性不大。Objective:The aim of this study is to determine the prevalence of cardiac valve calcification and its relationship with serum bone turnover markers in elderly patients with stage 3-5 non-dialysis chronic kidney disease(CKD).Methods:Totally,168 elderly inpatients aged 60-93 years with stage 3-5 non-dialysis CKD(80 male,88 female)were enrolled.Clinical data,serum blood biochemical and bone turnover marker examination results were collected and analyzed.Patients were divided into cardiac valve calcification(VC)group and non-cardiac valve calcification(NVC)group according to the echocardiography results.Results:Age,serum intact parathyroid hormone(iPTH),beta carboxyl-terminal cross-linking telopeptide of type I collagen(β-CTX),and ALP levels in the VC group were significantly higher than those in the NVC group(P<0.05 or P<0.01),whereas the eGFR level was lower than that in the NVC group(P<0.05).Aortic valve calcification was the most common,followed by the mitral valve and tricuspid valve calcification in stage 3-5 CKD elderly patients.The prevalence of aortic calcification in stage 4 and 5 CKD patients(53.06%and 39.75%)was significantly higher than that in stage 3 CKD patients(25.00%,P<0.05),while there was no significant difference in the prevalence of mitral valve calcification(11.11%vs 8.16%vs 18.07%,P>0.05).Binary logistic regression analysis showed that age,eGFR,β-CTX,and iPTH were significantly correlated with cardiac valve calcification(P<0.05).Multivariate logistic regression analysis showed that older age and higher iPTH were independent risk factors for aortic valve calcification(OR=1.102,95%CI 1.058-1.148,P<0.01;OR=1.004,95%CI 1.001-1.007,P<0.01).Older age and higherβ-CTX were independent risk factors for mitral valve calcification(OR=1.104,95%CI 1.010-1.206,P<0.05;OR=1.001,95%CI 1.000-1.002,P<0.05).However,the OR values of iPTH andβ-CTX are close to 1,so there were no clinical significance.Conclusions:The prevalence of VC in stage 4-5 non-dialysis CKD elderly patients was high,among which aortic valu

关 键 词：慢性肾脏病 心脏瓣膜钙化 血骨代谢标志物 老年 

分 类 号：R542.5[医药卫生—心血管疾病]