维持性血液透析患者血管钙化的危险因素分析  

Risk factors for vascular calcification in maintenance hemodialysis patients

作　　者：魏萌[1] 魏丽敏 王萌[1] 何荃[1] 严森辉 党喜龙 蒋红利[1] WEI Meng;WEI Li-min;WANG Meng;HE Quan;YAN Sen-hui;DANG Xi-long;JIANG Hong-li(Department of Blood Purification,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院血液净化科,西安710061

出　　处：《中国血液净化》2020年第11期742-746,共5页Chinese Journal of Blood Purification

基　　金：国家自然科学基金(No.81900674);陕西省重点研发计划项目(No.2019SF-074)。

摘　　要：目的研究单中心维持性血液透析(maintenance hemodialysis,MHD)患者血管钙化(vascular calcification,VC)的发生率及其危险因素。方法选择西安交通大学第一附属医院规律血液透析慢性肾脏病(chronic kidney diseases,CKD)5期患者154例,收集基线资料、完成营养不良微炎症评分(nutrition inflammatory score,MIS)问卷以评估其营养不良-微炎症状态(malnutrition-inflammation complex syndrome,MICS);透析前空腹采血检测血红蛋白,超敏C反应蛋白、血清白蛋白、碱性磷酸酶、血钙、血磷、甲状旁腺激素、25-(OH)D3等生化指标,ELISA测定血清维生素K2(vitamin K2,VK2)水平;腹部侧位片评估腹主动脉血管钙化情况,比较2组间指标的差异。结果①血管钙化的阳性率48.7%;均合并不同程度的MICS,钙化组MIS评分显著高于非钙化组(t=-5.095,P<0.001),且随着MICS程度加重,血管钙化阳性率显著增加(χ^2=21.673,P<0.001);②患者血清VK2均值为(1.88±0.38)nmol/L,钙化阳性组VK2水平显著低于钙化阴性组[(1.77±0.39)nmol/L比(1.97±0.35)nmol/L,t=2.473,P=0.016];③多因素Logistic回归分析校正透析龄、钙磷乘积、25-(OH)D3、冠状动脉粥样硬化性心脏病史后发现:年龄(OR 1.165,95%CI:1.055~1.286;P<0.001)及MICS(OR1.440,95%CI:1.009~1.910,P=0.045)是VC的主要危险因素,而VK2(OR 0.062,95%CI0.007~0.559,P=0.013)为保护性因素。结论MHD患者VC发生率高于普通人群;年龄较大、营养不良-微炎症状态是MHD患者VC的独立危险因素,而提高血清VK2水平有利于预防血管钙化。Objective To investigate the prevalence and the influencing factors involved in vascular calcification(VC)in maintenance hemodialysis(MHD)patients.Method A total of 154 patients treated with MHD at the Department of Blood Purification,the First Affiliated Hospital of Xi'an Jiaotong University were enrolled in this study.Demographics data at baseline were collected.Malnutrition-inflammation complex syndrome(MICS)was evaluated using the nutrition inflammatory score(MIS).Laboratory examinations including hypersensitive C-reactive protein(hs-CRP),calcium(Ca2+),phosphorus(P),albumin(ALB),parathyroid hormone(PTH)and serum vitamin K2 were conducted.Patients were divided into two groups based on the presence or absence of abdominal aortic calcification assessed by lateral lumbar radiography.Results①The rate of VC was 48.7%.All of the patients with VC had different degrees of MICS;MIS score was significantly higher in VC group than in non-VC group(8.27±3.52 vs.5.56±3.07,t=-5.095,P<0.001),and MIS score increased along with the increase of VC rate(χ^2=21.673,P<0.001).②The mean value of serum vitamin K2 in this cohort of MHD patients was 1.88±0.38nmol/L,and the level was significantly lower in VC group than in non-VC group(1.77±0.39 vs.1.97±0.35nmol/L,t=2.473,P=0.016).③Multivariate regression analysis indicated that age(OR=1.165,95%CI 1.055~1.286,P<0.001)and MICS(OR=1.440,95%CI 1.009~1.910,P=0.045)were the risk factors for VC,and serum vitamin K2 was the protective factor for VC(OR=0.062,95%CI 0.007~0.559,P=0.013)after corrections of dialysis age,Ca2+xP product,25-(OH)D3 and the history of coronary arteriosclerosis heart disease.Conclusion The incidence of VC in MHD patients is higher than that in the general population.Older age and malnutrition-microinflammatory state are the independent risk factors for VC in MHD patients,and increase of serum vitamin K2 is a favorable factor for the prevention of VC.

关 键 词：血液透析 血管钙化 营养不良-微炎症 维生素K2 

分 类 号：R318.16[医药卫生—生物医学工程]