中国血液净化

中国血液净化 ›› 2021, Vol. 20 ›› Issue (02): 77-81.doi: 10.3969/j.issn.1671-4091.2021.02.002

• 临床研究 • 上一篇    下一篇

慢性肾脏病3～5 期患者冠状动脉钙化危险因素分析及其与铁代谢指标的相关性

邢爱荣1,王雪荣1,陶舒曼1,王德光1   

  1. 1安徽医科大学第二附属医院肾脏内科
  • 收稿日期:2020-09-14 修回日期:2020-10-27 出版日期:2021-02-12 发布日期:2021-02-23
  • 通讯作者: 王德光 wangdeguang@ahmu.edu.cn E-mail:wangdeguang@vip.163.com
  • 基金资助:
    安徽省自然科学基金(2008085MH244)；安徽医科大学校科研基金(2019xkj140）

Analysis of risk factors of coronary artery calcification and its relation with iron metabolism in patients with chronic kidney disease stage 3～5 

  1. 1Department of Nephrology, The Second Hospital of Anhui Medical University, Hefei 230601, China
  • Received:2020-09-14 Revised:2020-10-27 Online:2021-02-12 Published:2021-02-23

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摘要： 【摘要】目的探讨慢性肾脏病(chronic kidney diseases，CKD)3～5 期患者冠状动脉钙化(coronary artery calcification，CAC)的危险因素以及铁代谢指标与CAC 相关性。方法纳入安徽医科大学第二附属医院CKD 3～5 期患者162 例，收集临床资料及实验室指标，检测血清铁、铁蛋白、转铁蛋白、总铁结合力(total iron- binding capacity，TIBC)，计算转铁蛋白饱和度(transferrin saturation，TSAT)，铁蛋白＞800μg/L 和(或)TSAT＞50%定义为铁超载。采用多层螺旋计算机断层扫描测定冠状动脉钙化积分(coronary artery calcification score，CACs)，CACs＞10 为钙化组。分析CAC 危险因素及其与铁代谢指标的相关性，探讨危险因素对CAC 的预测价值。结果合并CAC 的患者92 例，占56.8%。转铁蛋白、TIBC 与CACs 负相关(r 值分别为-0.293、-0.253，P 值分别为＜0.001、0.001)。二元Logistic回归分析显示高龄(OR＝1.050，95% CI：1.013～1.088，P＝0.007)、糖尿病(OR＝4.712，95%:CI：1.445～
15.371，P=0.010)、高中性粒细胞与淋巴细胞比值(neutrophil-lymphocyte，NLR)(OR＝1.253, 95% CI: 1.025～1.533, P＝0.028)、高血磷(OR＝3.981，95% CI：1.791～8.849，P＝0.001)以及转铁蛋白水平降低(OR＝0.130，95%CI：0.044～0.378，P＜0.001)是CAC 的独立危险因素。ROC 曲线显示，年龄、糖尿病、NLR、血磷、转铁蛋白联合预测CAC 的曲线下面积为0.828（95％ CI 0.766～0.891，P＜0.001），灵敏度为79.3％，特异度为75.7％。结论CKD3～5 期患者CAC 发生率较高，高龄、糖尿病、高磷血症、高NLR 和血转铁蛋白水平减低是CAC的独立危险因素，以上危险因素的联合指标对CAC的发生有较好的预测价值。

关键词: 冠状动脉钙化, 慢性肾脏病, 铁, 转铁蛋白

Abstract: 【Abstract】Objective To evaluate the risk factors of coronary artery calcification (CAC) in patients with chronic kidney disease (CKD) stage 3～5 and the relationship between iron metabolism indices and CAC. Methods One hundred and sixty-two patients with CKD stage 3～5 in the Department of Nephrology of the Second Hospital of Anhui Medical University were recruited. Clinical data and laboratory indices were collected. Serum iron, ferritin, transferrin and total iron binding capacity (TIBC) were examined, and transferrin saturation (TSAT) was calculated. Ferrin> 800 μg/L and/or TSAT> 50% were defined as iron overload. The coronary artery calcification score (CACs) was measured by multi-slice spiral computed tomography. According to CACs>10, patients were divided into calcification group and non-calcification group. To investigate the correlation between iron metabolism and CAC, and to explore the predictive value of risk factors on CAC. Result Ninety-two patients (56.8%) had CAC. Transferrin and TIBC were negatively correlated with CACs (r=-0.293, -0.253, P < 0.001, 0.001, respectively). Binary logistic regression analysis showed that old age(OR=1.050, 95% CI=1.013～1.088, P=0.007), diabetes (OR=4.712, 95% CI=1.445～15.371, P=0.010), higher neutrophil- lymphocyte (NLR) (OR=1.253, 95% CI=1.025～1.533, P=0.028), higher blood phosphorus (OR=3.981, 95% CI=1.791～8.849, P=0.001), and lower transferrin (OR=0.130, 95% CI=0.044～0.378, P< 0.001) were independent risk factors of CAC.ROC curve showed that the area under the curve of combined prediction of CAC by age, diabetes, NLR, blood phosphorus and transferrin was 0.828 (95% CI 0.766～0.891, P<0.001), the sensitivity was 79.3%, and the specificity was 75.7%. Conclusion The incidence of CAC was high in patients with CKD stage 3～5. Old age, diabetes, hyperphosphatemia, high NLR and decreased blood
transferrin level are independent risk factors of CAC. The combined indicator including the above risk factors has good predictive value for the occurrence of CAC.

Key words: coronary artery calcification, chronic kidney disease, iron, transferrin

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