慢性肾脏病非透析患者心脏瓣膜钙化的影响因素及对预后的影响  

Influencing factors and prognostic value of cardiac valve calcification in non ⁃ dialysis patientswith chronic kidney disease

作　　者：李文[1] 贾林沛 董星彤[1] 付文静[1] 林娜[1] 张爱华 Li Wen;Jia Linpei;Dong Xingtong;Fu Wenjing;Lin Na;Zhang Aihua(Department of Nephrology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院肾内科,北京100053

出　　处：《中华肾脏病杂志》2022年第9期794-801,共8页Chinese Journal of Nephrology

摘　　要：目的探讨慢性肾脏病(chronic kidney disease,CKD)非透析患者心脏瓣膜钙化(cardiac valve calcification,CVC)的发生率、危险因素及对预后的影响。方法回顾性纳入2018年1月1日至2019年12月31日在首都医科大学宣武医院肾内科住院治疗且进行超声心动图检查的CKD 1~5期尚未进入透析的患者,将患者分为CVC组和非CVC组,比较两组患者的临床资料。随访时间截至2021年11月1日,随访终点事件为全因死亡。应用Logistic回归模型和Cox回归模型分别分析CKD患者CVC和全因死亡的风险因素。结果入选563例CKD患者中,年龄(59.49±13.97)岁,男性352例(62.52%),CKD 1~3期325例(57.73%),CKD 4~5期238例(42.27%)。CVC 182例(32.32%),主动脉瓣钙化173例(30.73%),二尖瓣钙化55例(9.77%),双瓣膜(二尖瓣和主动脉瓣)钙化47例(8.35%),三尖瓣钙化1例(0.18%)。CVC组年龄(t=12.223,P<0.001)、CKD 4~5期比例(χ^(2)=10.854,P=0.001)、合并高血压比例(χ^(2)=7.811,P=0.005)、糖尿病比例(χ^(2)=8.424,P=0.004)、高脂血症比例(χ^(2)=9.331,P=0.002)及服用他汀类药物比例(χ^(2)=4.868,P=0.027)明显高于非CVC组,总胆固醇(t=2.243,P=0.025)、低密度脂蛋白胆固醇(t=2.025,P=0.043)、血小板计数(t=2.230,P=0.026)及估算肾小球滤过率(t=8.630,P<0.001)低于非CVC组。多因素Logistic回归分析结果显示,年龄≥60岁(≥60岁/<60岁,OR=7.412,95%CI 4.514~12.170,P<0.001)、CKD 4~5期(4~5期/1~3期,OR=2.791,95%CI 1.730~4.505,P<0.001)及合并高脂血症(OR=5.241,95%CI 3.283~8.367,P<0.001)为CKD患者出现CVC的独立影响因素。对563例患者进行随访,平均随访时间为26个月,其中死亡68例(12.08%),生存436例(77.44%),失访59例(10.48%)。多因素Cox回归分析结果显示,年龄≥60岁(≥60岁/<60岁,HR=2.157,95%CI 1.127~4.127,P=0.020)、血白蛋白<30 g/L(<30 g/L/≥30 g/L,HR=1.923,95%CI 1.037~3.568,P=0.038)及双瓣膜钙化(双瓣膜钙化/无瓣膜钙化,HR=2.516,95%CI 1.279~4.950,P=0.008)是CKD患者全因死亡的独立影响因素。Objective To explore the incidence,influencing factors and prognostic value of cardiac valve calcification(CVC)in chronic kidney disease(CKD)non⁃dialysis patients.Methods The non⁃dialysis patients with CKD stage 1-5 who were hospitalized and underwent echocardiography in the Department of Nephrology,Xuanwu Hospital,Capital Medical University from January 1,2018 to December 31,2019 were retrospectively admitted.The patients were divided into CVC group and non⁃CVC group,and the clinical data were compared between the two groups.The deadline for follow⁃up was November 1,2021,and the follow⁃up end point event was all⁃cause mortality.Logistic regression model was used to analyze the risk factors of CVC in patients with CKD,and Cox proportional hazards regression model was used to analyze the risk factors of all⁃cause mortality in patients with CKD.Results A total of 563 patients with CKD were enrolled in the study,with age of(59.49±13.97)years old,and 352 males(62.52%).There were 325 patients(57.73%)with CKD stage 1-3 and 238 patients(42.27%)with CKD stage 4-5.The incidence of CVC in CKD stage 1-5 patients was 32.32%(182/563).Aortic valve calcification occurred in 30.73%(173/563),mitral valve calcification occurred in 9.77%(55/563),double valve(mitral and aortic valve)calcification occurred in 8.35%(47/563),and tricuspid valve calcification occurred in 0.18%(1/563).Age(t=12.223,P<0.001)and the proportions of CKD stage 4-5(χ^(2)=10.854,P=0.001),hypertension(χ^(2)=7.811,P=0.005),diabetes(χ^(2)=8.424,P=0.004),hyperlipidemia(χ^(2)=9.331,P=0.002),and taking statins(χ^(2)=4.868,P=0.027)in CVC group were significantly higher than those in non⁃CVC group.Total cholesterol(t=2.243,P=0.025),low density lipoprotein cholesterol(t=2.025,P=0.043),platelet count(t=2.230,P=0.026)and estimated glomerular filtration rate(t=8.630,P<0.001)in CVC group were lower than those in the non⁃CVC group.Logistic regression analysis results showed that age≥60 years old(≥60 years old/<60 years old,OR=7.412,95%CI 4.514-12.1

关 键 词：心脏瓣膜 肾功能不全 慢性 预后 危险因素 

分 类 号：R692[医药卫生—泌尿科学]