中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (09): 545-549.doi: 10.3969/j.issn.1671-4091.2015.09.009

• 临床研究 • 上一篇    下一篇

探讨不同部位X线平片评估血液透析患者血管钙化的意义

赵伟1,高秀1,王田力2,王悦3   

  1. 1北京大学首钢医院肾内科
    2 北京大学第三医院放射科 3肾内科
  • 收稿日期:2015-04-13 修回日期:2015-05-30 出版日期:2015-09-12 发布日期:2015-09-12
  • 通讯作者: 高秀 junxiugao@sina.com E-mail:junxiugao@sina.cn

The significance of artery tree images in different regions on plain X-ray films to evaluate vascular calcification in hemodialysis patients

  • Received:2015-04-13 Revised:2015-05-30 Online:2015-09-12 Published:2015-09-12

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摘要： 【摘要】目的探讨不同部位的X 线平片对评估血液透析患者血管钙化的意义。方法选取82 例稳定血液透析的患者，行前后位胸片、骨盆平片及双手平片的检查，评估大动脉(主动脉)、中动脉(髂、股动脉)和小动脉(桡及指间动脉)钙化的发生率，收集患者的一般资料、生化资料(血钙、血磷、血iPTH、血脂及白蛋白、血红蛋白)及心血管合并症资料，分别比较各类型动脉钙化组与非钙化组上述资料的差异，分析影响各类型动脉钙化的危险因素、不同血管钙化对总钙化的评估意义及对心血管合并症的诊断价值。结果大、中、小动脉钙化的发生率分别为为64.6%(53/82)、48.8%(40/82)、26.8%(22/82)，年龄是大动脉钙化的危险因素，透析龄及糖尿病史是中、小动脉钙化的危险因素，中、小动脉钙化是心血管合并症的危险因素，大、中、小动脉钙化组的总钙化积分中位数分别是4 分、6 分和8 分，3 组差异显著(P=0.006)，小动脉钙化患者的总钙化程度重，ROC 曲线分析提示中动脉钙化积分对诊断心血管合并症有意义(AUC=0.720, P=0.006)。结论大动脉钙化发生率最高，存在小动脉钙化者提示总钙化程度重，透析龄是中、小动脉钙化的影响因素之一，中动脉钙化积分对心血管合并症具有诊断意义。

关键词: 维持性血液透析, X线平片, 血管钙化

Abstract: 【Abstract】Objective To investigate the significance of artery tree images in different regions on plain X-ray films to evaluate vascular calcification in maintenance hemodialysis patients. Methods Eighty-two patients were enrolled in this cross- sectional study. Their demographic and clinical data were collected and biochemical parameters relating to vascular calcification were examined. We used plain X-ray films of postanterior chest, pelvis and hands to determine the vascular calcification of aortic arch, medial and radial arteries. We then compared these indicators in patients with various types of artery calcification and those without vascular calcification, analyzed the risk factors for various types of vascular calcification, and evaluated the significance of calcification in different arteries on vascular calcification and diagnosis of cardiovascular complications. Results The prevalence of arterial calcification was 64.6% (53/82), 48.8% (40/82) and 26.8% (22/82) in aortic arch, medial artery and radial artery, respectively. Regression analysis showed that age was the risk factor for aortic arch calcification, dialysis duration and diabetes history were the risk factors for medial and radial artery calcification, and medial and radial artery calcification were the risk factors for cardiovascular disease (OR=9.580, P=0.001 for medial artery calcification; OR=3.104, P=0.044 for radial artery calcification). The total calcification score was 4, 6 and 8 for aortic arch, medial artery and radial artery (P=0.006), respectively. The overall vascular calcification was higher in patients with radial artery calcification. ROC curve analysis found that the total calcification score for medial arteries was useful for the diagnosis of cardiovascular
complications (AUC=0.720, P=0.006). Conclusion The incidence of aortic arch calcification was the highest in various types of arterial calcification in hemodialysis patients. The overall calcification was higher in patients with radial artery calcification than in those with aortic arch or medial artery calcification.
Dialysis duration was the risk factor for medial artery calcification and radial artery calcification. The total calcification score for medial arteries was useful to predict cardiovascular complications.

Key words: Hemodialysis, plain X-ray films, Vascular calcification