慢性肾脏病患者心脏瓣膜钙化新危险因素分析  

New Risk Factors of Cardiac Valve Calcification in Patients with Chronic Kidney Disease

作　　者：汤日宁[1,2,3] 汪晓晨 王立婷 陈思洁 张玉霞 张朔凡 TANG Rining;WANG Xiaochen;WANG Liting;CHEN Sijie;ZHANG Yuxia;ZHANG Shuofan(Department of Nephrology,Zhongda Hospital,Southeast University,Nanjing 210009,China;School of Clinical Medicine,Southeast University,Nanjing 210009,China;Institute of Nephrology,Zhongda Hospital,Southeast University School of Medicine,Nanjing 210009,China)

机构地区：[1]东南大学附属中大医院肾内科,江苏省南京市210009 [2]东南大学临床医学院,江苏省南京市210009 [3]东南大学肾脏病研究所,江苏省南京市210009

出　　处：《中国全科医学》2021年第11期1365-1371,共7页Chinese General Practice

基　　金：国家自然科学基金资助项目(81770735)。

摘　　要：背景心脏瓣膜钙化(CVC)是慢性肾脏病(CKD)患者发生心血管疾病最高危险因素。伴随人们对CKD骨矿物质代谢认识深入和新型非钙磷结合剂、拟钙剂等使用,有必要重新分析此类人群临床特征,且国内外关于CKD患者CVC危险因素的研究较少。目的探讨CKD患者CVC的发生率,并分析CKD患者发生CVC的危险因素。方法选取东南大学附属中大医院肾内科2014年8月—2019年7月收治的CKD 3~5期透析和非透析患者为研究对象,采集其人口学资料、血清学指标及影像学资料。根据是否发生CVC分为钙化组与无钙化组,采用Logistic回归分析探讨CKD患者CVC的危险因素,并进行亚组分析。结果本研究共纳入1383例CKD 3~5期患者,其中CVC患者619例(44.8%);单纯主动脉瓣膜钙化(AVC)426例(30.8%)、单纯左房室瓣瓣膜钙化(MVC)37例(2.7%)、AVC+MVC 150例(10.9%),其他6例(0.4%)。钙化组女性占比、年龄、透析占比、合并症(糖尿病、高血压、冠心病、脑梗死)占比、他汀类药物使用史、左心室肥厚占比、血清钙水平、血清蛋白水平、碱性磷酸酶水平、C反应蛋白(CRP)>3 mg/L占比均高于无钙化组,碳酸钙使用史占比、肌酐水平、三酰甘油水平、总胆固醇水平、低密度脂蛋白水平均低于无钙化组(P<0.05)。多因素Logistic回归分析结果显示,高龄[OR=1.065,95%CI(1.053,1.077)]、透析[OR=1.917,95%CI(1.423,2.582)]、合并冠心病[OR=1.608,95%CI(1.134,2.281)]、低血红蛋白[OR=0.993,95%CI(0.987,0.999)]、高碱性磷酸酶[OR=1.002,95%CI(1.000,1.003)]、CRP>3 mg/L占比高[OR=1.478,95%CI(1.095,1.995)]是CKD患者CVC的危险因素(P<0.05);高龄[OR=1.078,95%CI(1.057,1.099)]、他汀类药物使用史[OR=1.853,95%CI(1.003,3.424)]是CKD 3~5期未透析患者CVC的危险因素(P<0.05);高龄[OR=1.081,95%CI(1.061,1.101)]、透析时间长[OR=1.123,95%CI(1.067,1.181)]、合并高血压[OR=3.071,95%CI(1.453,6.490)]、碳酸钙使用史[OR=0.515,95%CI(0.300,0.882)]是CKD 5D期且透�Background Cardiac valve calcification(CVC)may maximally increase the risk of developing cardiovascular disease in patients with chronic kidney disease(CKD).Increasing understanding of bone mineral metabolism and the use of new non-calcium phosphate binders and calcimimetic agents in CKD patients,requires a new analysis of clinical characteristics of this population.And there are few studies on CVC in CKD patients as a risk factor for cardiovascular disease.Objective To explore the prevalence and risk factors of CVC in patients with CKD stages 3-5.Methods Patients with CKD stages 3-5 with and without dialysis treated in Department of Nephrology,Zhongda Hospital,Southeast University from August 2014 to July 2019 were selected and their demographic,serological and imaging data were collected.According to the presence of CVC,they were divided into calcification group and non-calcification group.Logistic regression and subgroup analyses were used to explore the risk factors of CVC.Results Of the included 1383 cases,619(44.8%)were identified with CVC,of whom 426(30.8%)with aortic valve calcification(AVC),37(2.7%)with mitral valve calcification(MVC),150(10.9%)with both AVC and MVC,and 6(0.4%)with other diseases.Compared to non-calcification group,calcification group had higher proportions of women,dialysis recipients,previous or present users of statins,and cases with elevated C-reactive protein(more than 3 mg/L),greater mean age,higher prevalence of concomitant diabetes,concomitant hypertension,concomitant coronary heart disease,concomitant cerebral infarction and left ventricular hypertrophy,and higher mean levels of serum calcium,albumin and alkaline phosphatase(P<0.05).Calcification group also showed lower proportion of previous or present users of calcium carbonate,and lower mean levels of creatinine,triglyceride,total cholesterol and low-density lipoprotein(P<0.05).In multivariate logistic regression analysis,older age[OR=1.065,95%CI(1.053,1.077)],dialysis[OR=1.917,95%CI(1.423,2.582)],concomitant coronary heart d

关 键 词：心脏瓣膜疾病 慢性肾脏病 心脏瓣膜钙化 危险因素 影响因素分析 

分 类 号：R542.5[医药卫生—心血管疾病]