中国血液净化

中国血液净化 ›› 2020, Vol. 19 ›› Issue (11): 742-746.doi: 10.3969/j.issn.1671-4091.2020.11.006

• 临床研究 • 上一篇    下一篇

维持性血液透析患者血管钙化的危险因素分析

魏萌1,魏丽敏1,王萌1,何荃1,严森辉1,党喜龙1,蒋红利1   

  1. 1西安交通大学第一附属医院血液净化科
  • 收稿日期:2020-05-12 修回日期:2020-08-31 出版日期:2020-11-12 发布日期:2020-11-05
  • 通讯作者: 蒋红利 j92106@sina.com E-mail:j92106@sina.com
  • 基金资助:
    国家自然科学基金(No.81900674)；陕西省重点研发计划项目(No.2019SF-074)

Risk factors for vascular calcification in maintenance hemodialysis patients

  1. 1Department of Blood Purification, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
  • Received:2020-05-12 Revised:2020-08-31 Online:2020-11-12 Published:2020-11-05

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摘要： 【摘要】目的研究单中心维持性血液透析(maintenance hemodialysis，MHD)患者血管钙化(vascular calcification，VC)的发生率及其危险因素。方法选择西安交通大学第一附属医院规律血液透析慢性肾脏病(chronic kidney diseases，CKD)5 期患者154 例，收集基线资料、完成营养不良微炎症评分(nutrition inflammatory score，MIS)问卷以评估其营养不良-微炎症状态(malnutrition-inflammation
complex syndrome，MICS)；透析前空腹采血检测血红蛋白，超敏C 反应蛋白、血清白蛋白、碱性磷酸酶、血钙、血磷、甲状旁腺激素、25-(OH)D3等生化指标，ELISA 测定血清维生素K2(vitamin K2,VK2)水平；腹部侧位片评估腹主动脉血管钙化情况，比较2 组间指标的差异。结果①血管钙化的阳性率48.7%；均合并不同程度的MICS，钙化组MIS 评分显著高于非钙化组(t=-5.095，P＜0.001)，且随着MICS 程度加重，血管钙化阳性率显著增加(χ2=21.673，P＜0.001)；②患者血清VK2均值为(1.88±0.38)nmol/L，钙化阳性组VK2水平显著低于钙化阴性组[(1.77±0.39)nmol/L 比(1.97±0.35)nmol/L，t=2.473，P=0.016]；③多因素Logistic 回归分析校正透析龄、钙磷乘积、25-(OH)D3、冠状动脉粥样硬化性心脏病史后发现：年龄(OR 1.165，95% CI：1.055～1.286；P＜0.001)及MICS (OR1.440，95% CI：1.009～1.910，P=0.045)是VC的主要危险因素，而VK2(OR 0.062，95%CI0.007～0.559，P=0.013)为保护性因素。结论MHD 患者VC 发生率高于普通人群；年龄较大、营养不良-微炎症状态是MHD 患者VC 的独立危险因素，而提高血清VK2水平有利于预防血管钙化。

关键词: 血液透析, 血管钙化, 营养不良-微炎症, 维生素K2

Abstract: 【Abstract】Objective To investigate the prevalence and the influencing factors involved in vascular calcification (VC) in maintenance hemodialysis (MHD) patients. Method A total of 154 patients treated with MHD at the Department of Blood Purification, the First Affiliated Hospital of Xi'an Jiaotong University were enrolled in this study. Demographics data at baseline were collected. Malnutrition-inflammation complex syndrome (MICS) was evaluated using the nutrition inflammatory score (MIS). Laboratory examinations including hypersensitive C-reactive protein (hs-CRP), calcium (Ca2+), phosphorus (P), albumin (ALB), parathyroid hormone (PTH) and serum vitamin K2 were conducted. Patients were divided into two groups based on the presence or absence of abdominal aortic calcification assessed by lateral lumbar radiography. Results ①The rate of VC was 48.7%. All of the patients with VC had different degrees of MICS; MIS score was significantly higher in VC group than in non-VC group (8.27±3.52 vs. 5.56±3.07, t=-5.095, P＜0.001), and MIS score increased along with the increase of VC rate (χ2=21.673, P＜0.001). ②The mean value of serum vitamin K2 in this cohort of MHD patients was 1.88±0.38nmol/L, and the level was significantly lower in VC group than in non-VC group (1.77±0.39 vs. 1.97±0.35nmol/L, t=2.473, P=0.016). ③Multivariate regression analysis indicated
that age (OR=1.165, 95% CI 1.055～1.286, P＜0.001) and MICS (OR=1.440, 95% CI 1.009～1.910, P=0.045) were the risk factors for VC, and serum vitamin K2 was the protective factor for VC (OR=0.062, 95% CI 0.007～0.559, P=0.013) after corrections of dialysis age, Ca2 +xP product, 25-(OH) D3 and the history of coronary arteriosclerosis heart disease. Conclusion The incidence of VC in MHD patients is higher than that in the general population. Older age and malnutrition-microinflammatory state are the independent risk factors for VC in MHD patients, and increase of serum vitamin K2 is a favorable factor for the prevention of VC.

Key words: Hemodialysis, Vascular calcification, Malnutrition inflammation complex syndrome, Vitamin K2

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