维持性血液透析患者腹主动脉钙化与左心室舒张功能的相关性分析  

Association between left ventricular diastolic dysfunction and abdominal aortic calcification in maintenance hemodialysis

作　　者：甘言刚 滕洁 赵明明 夏文亚 张颖 冯锦红 Gan Yangang;Teng Jie;Zhao Mingming;Xia Wenya;Zhang Ying;Feng Jinhong(Department of Nephrology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China;Department of Radiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]徐州医科大学附属医院肾内科,徐州221000 [2]徐州医科大学附属医院影像科,徐州221000

出　　处：《国际泌尿系统杂志》2021年第6期1063-1067,共5页International Journal of Urology and Nephrology

摘　　要：目的探讨分析维持性血液透析(MHD)患者腹主动脉钙化与左心室舒张功能的关系。方法选取2019年2月至2020年1月在徐州医科大学附属医院血液净化中心治疗的MHD患者。收集患者的人口学资料及临床资料,采用腹部侧位X线平片评估患者腹主动脉钙化情况,采用超声心动图测量心脏各参数。根据是否发生腹主动脉钙化将患者分为钙化组和非钙化组,比较两组之间各指标的差异,用Spearman相关分析评估左心室舒张功能指标二尖瓣舒张早期峰流速(E)/二尖瓣环室间隔部舒张早期运动速度峰值(e')与其他指标的相关性,多元线性回归法分析影响E/e的相关因素。二元logistic回归法分析影响MHD患者发生腹主动脉钙化的危险因素。结果共75例患者入选本研究,其中钙化组41例(54.67%),非钙化组34例(45.33%)。钙化组冠心病、糖尿病的患病率更高,年龄、收缩压、全段甲状旁腺水平更高,血白蛋白水平更低,差异均有统计学意义(P<0.05);在超声心动图测量参数方面,腹主动脉钙化组的LAD、E/e比值更高,e值更低,差异均有统计学意义(P<0.05)。MHD患者舒张功能指标E/e'与年龄、冠心病、收缩压、全段甲状旁腺激素、腹主动脉钙化评分(AACs)、收缩末期左房前后径(LAD)、左室质量指数(LVMI)呈正相关,与血肌酐、e及左室射血分数(LVEF)呈负相关(P<0.05)。多元线性回归分析发现,年龄、收缩压、AACs、LVMI是影响MHD患者E/e水平的相关因素。多因素二元logistic回归分析结果显示,年龄、冠心病、血白蛋白减低是腹主动脉钙化的独立危险因素。结论年龄、收缩压、AACs、LVMI是影响MHD患者舒张功能指标E/e的危险因素。AACs对MHD患者左室舒张功能诊治有一定价值。Objective To investigate the relationship between abdominal aortic calcification and left ventricular diastolic function in patients with maintenance hemodialysis(MHD).Methods Patients with MHD who were treated in our hospital from February 2019 to January 2020 were selected.The demographic and clinical data of the patients were collected.Abdominal lateral X-ray plain film was used to evaluate the calcification of abdominal aorta and echocardiography was used to measure cardiac parameters.According to the occurrence of abdominal aortic calcification,the patients were divided into calcified group and non-calcified group.The differences of each index between the two groups were compared.The correlation between diastolic function index E/e'and other indexes was evaluated by Spearman correlation analysis.Multiple linear regression was used to analyze the related factors affecting E/e'in patients with MHD.Binary logistic regression was used to analyze the risk factors of abdominal aortic calcification in patients with MHD.Results A total of 75 patients were enrolled in this study,including 41 cases(54.67%)in calcification group and 34 cases(45.33%)in non-calcification group.There were significant differences in age,coronary heart disease,diabetes,systolic blood pressure,parathyroid hormone,serum albumin,left atrial diameter(LAD),E/e'and e'between the two groups.The index of diastolic function in patients with MHD was positively correlated with age,coronary heart disease,systolic blood pressure,parathyroid hormone,abdominal aortic calcification score(AACs),LAD,left ventricular mass index(LVMI),and negatively correlated with serum creatinine,e'and left ventricular ejection fraction(LVEF).Multiple linear regression analysis showed that E/e'in patients with MHD was correlated with age,systolic blood pressure,AACs and LVMI.Multivariate logistic regression analysis showed that age,coronary heart disease and decreased serum albumin were independent risk factors for abdominal aortic calcification.Conclusions Age,systolic bloo

关 键 词：肾透析 腹主动脉钙化 心室功能 左 

分 类 号：R692.5[医药卫生—泌尿科学] R543.1[医药卫生—外科学]