腹膜透析患者AAC与钙磷代谢相关性及预测CVD价值研究  

Correlation between abdominal aortic calcification with calcium and phosphorus metabolism in patients with peritoneal dialysis and its value in predicting cardiovascular disease

作　　者：陈珊珊[1] 刘东海[1] 岳英丽[1] CHEN Shanshan;LIU Donghai;YUE Yingli(Department of Nephrology,Langfang Municipal People′s Hospital,Langfang,Hebei 065000,China)

机构地区：[1]河北省廊坊市人民医院肾内科,065000

出　　处：《重庆医学》2021年第23期4003-4007,共5页Chongqing medicine

基　　金：河北省医学科学研究指导课题计划项目(20190473);河北省廊坊市科学技术研究与发展指导计划项目(2018013138)。

摘　　要：目的探讨腹膜透析患者腹主动脉钙化(AAC)与钙磷代谢的关系及其判断预测心血管疾病(CVD)的价值。方法选择该院肾内科2018年8月至2020年3月收治的腹膜透析患者80例,采用AAC评分(AACS)记录AAC程度。比较不同钙化程度患者钙磷代谢水平,分析AACS与钙磷代谢指标的关系;治疗结束后对患者均行12个月随访,采用受试者工作特征曲线(ROC)分析AACS预测CVD的价值。结果80例患者中无AAC 36例,轻度钙化18例,中度钙化12例,重度钙化14例。不同钙化程度患者血磷、全段甲状旁腺激素(iPTH)及钙磷乘积(CPP)比较,差异均有统计学意义(P<0.001)。Pearson线性相关分析显示,AACS与血磷、iPTH、CPP呈正相关(r=0.318、0.387、0.506,P<0.001)。中位随访时间为(10.24±1.77)个月,失访3例,77例患者发生CVD 14例(18.18%)。Cox风险回归分析显示,AACS(HR=1.822,95%CI:1.308~2.538,P<0.001)、高血压肾损害(HR=1.690,95%CI:1.325~2.156,P<0.001)、CPP(HR=1.752,95%CI:1.332~2.304,P<0.001)及iPTH(HR=1.449,95%CI:1.023~2.052,P=0.037)是腹膜透析患者发生CVD的独立影响因素。ROC分析显示,AACS[曲线下面积(AUC)=0.806,95%CI=0.694~0.918]、高血压肾损害(AUC=0.685,95%CI:0.526~0.844)、CPP(AUC=0.671,95%CI=0.506~0.836)及iPTH(AUC=0.703,95%CI=0.548~0.859)对判断CVD风险具有一定价值。AACS判断CVD的AUC明显高于高血压肾损害、CPP及iPTH(P<0.05)。结论腹膜透析患者AAC与钙磷代谢相关,监测AACS有助于判断CVD风险。Objective To study the correlation between abdominal aortic calcification(AAC)with calcium and phosphorus metabolism in the patients with peritoneal dialysis and its value in predicting cardiovascular disease(CVD).Methods Eighty patients with peritoneal dialysis in this hospital from August 2018 to March 2020 were selected and the degree of AAC was recorded by AAC score(AACS).The levels of calcium and phosphorus metabolism were compared among the patients with different degrees of calcification,the relationship between the AACS with calcium and phosphorus metabolism was analyzed.After treatment,the 12-month follow up lasted in the patients.The receiver operating characteristic(ROC)curve was used to analyze the value of AACS in predicting CVD.Results Among 80 cases,there were 36 cases without AAC,18 cases had mild calcification,12 cases had moderate calcification and 14 cases had severe calcification.There were statistically significant differences in the levels of serum phosphorus,iPTH and calcium phosphorus product(CPP)among the patients with different degrees of calcification(P<0.001).The Pearson linear correlation showed that the AACS had significant correlation with serum phosphorus,iPTH and CPP(r=0.318,0.387,0.506,P<0.001).The median follow up time was(10.24±1.77)months.Three cases lost to follow-up.Among77 cases,CVD occurred in 14 cases(18.18%).The Cox risk regression analysis showed that the AACS(HR=1.822,95%CI:1.308-2.538,P<0.001),hypertensive renal damage(HR=1.690,95%CI:1.325-2.156,P<0.001),CPP(HR=1.752,95%CI:1.332-2.304,P<0.001)and iPTH(HR=1.449,95%CI:1.023-2.052,P=0.037)were the independent influencing factors of CVD occurrence in the patients with peritoneal dialysis.The ROC analysis showed that the AACS(AUC=0.806,95%CI:0.694-0.918),hypertensive renal damage(AUC=0.685,95%CI:0.526-0.844),CPP(AUC=0.671,95%CI:0.506-0.836)and iPTH(AUC=0.703,95%CI:0.548-0.859)had a certain value in judging the CVD occurrence.AUC of the AACS for judging CVD was significantly higher than that of hypertensive renal damage,CP

关 键 词：腹膜透析 腹主动脉钙化 钙磷代谢 心血管事件 

分 类 号：R692.5[医药卫生—泌尿科学]