慢性肾脏病3~5期非透析病人心血管钙化的病变特点  

The Pathological Characteristics of Cardiovascular Calcification in Chronic Kidney Disease Stages 3-5 Non-dialysis Patients

作　　者：林昌伟 袁心柱 袁祖君 LIN Changwei;YUAN Xinzhu;YUAN Zujun(Nanchong Hospital of Beijing Anzhen Hospital CMU,NanchongCentral Hospital,Nanchong 637000,Sichuan,China)

机构地区：[1]首都医科大学附属北京安贞医院南充医院/南充市中心医院,四川南充637000

出　　处：《中西医结合心脑血管病杂志》2025年第8期1203-1209,共7页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

摘　　要：目的:分析慢性肾脏病(CKD)3~5期非透析病人心血管钙化的病变特点及个性化处理策略。方法:选取2020年5月—2023年5月我院收治的157例3~5期CKD病人作为研究对象。比较病人的临床资料,分析病人心血管钙化的病变特点及影响CKD 3~5期非透析病人心血管钙化的危险因素。构建列线图模型,并对模型效能进行评价。结果:CKD 3~5期病人超敏C反应蛋白(hs-CRP)、血肌酐(Cr)、血磷明显升高,血钙明显降低,血钙、血磷达标率明显降低(P<0.05),冠状动脉钙化不明显比例逐渐降低,重度冠状动脉钙化比例逐渐升高,腹主动脉钙化严重程度逐渐增加。年龄、高血压、糖尿病、hs-CRP、碱性磷酸酶(ALP)、血磷和血钙水平均为影响CKD 3~5期非透析病人发生心血管钙化的独立危险因素(P<0.05)。列线图模型的受试者工作特征(ROC)曲线下面积为0.807,C-index为0.812,校准曲线拟合度良好,临床决策曲线阈值概率在0.04~0.91范围内有较高的净获益值,表明列线图模型的区分度较高,准确度良好,有效性较好,安全可靠。结论:心血管钙化发生早,且随着CKD进展心血管钙化严重程度增加。年龄、高血压、糖尿病、hs-CRP、ALP、血磷水平均为影响CKD 3~5期非透析病人发生心血管钙化的独立危险因素,临床可据此采取个性化处理策略,以降低心血管钙化的发生率。Objective:To analyze the pathological characteristics and personalized management strategies of cardiovascular calcification in chronic kidney disease(CKD)stage 3-5 non-dialysis patients.Methods:A total of 157 patients with stage 3-5 CKD admitted to our hospital from May 2020 to May 2023 were selected as the study subjects.The clinical data of CKD stages 3-5 patients were compared,and the pathological characteristics of cardiovascular calcification in these patients were analyzed.Additionally,the independent risk factors affecting the occurrence of cardiovascular calcification were analyzed,and a column chart model was built to verify its effectiveness.Results:In CKD stage 3-5 patients,Hypersensitive C-reactive protein(hs-CRP),serum creatinine(Cr),and blood phosphorus increased significantly,and blood calcium decreased significantly.From stage 3 to stage 5 of CKD,the rate of reaching the standard for blood calcium and phosphorus in patients significantly decreased(P<0.05).The proportion of inconspicuous coronary artery calcification decreased gradually,while the proportion of severe coronary artery calcification increased gradually.The severity of abdominal aortic calcification gradually increased.Age,hypertension,diabetes,hs-CRP,ALP,blood phosphorus,and blood calcium levels were independent risk factors for cardiovascular calcification in non-dialysis CKD patients at stages 3-5(P<0.05).The area under the receiver operating characteristic curve of the nomogram model was 0.807,and the C-index was 0.812.The calibration curve fits well.The threshold probability of the clinical decision curve showed a high net benefit value in the range of 0.04-0.91,indicating that the nomogram model showed high discrimination,better accuracy,and calibration,and was safe and reliable.Conclusion:Cardiovascular calcification occurs early and increases with severity as CKD progresses.Age,hypertension,diabetes,Alb,hs-CRP,ALP,and blood phosphorus levels are all independent risk factors for cardiovascular calcification in non-dialysis CKD

关 键 词：慢性肾炎 心血管钙化 病变特点 处理策略 

分 类 号：R692[医药卫生—泌尿科学]