中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (09): 478-482.doi: 10.3969/j.issn.1671-4091.2016.09.009

• 临床研究 • 上一篇    下一篇

血液透析患者心脏瓣膜钙化与颈动脉粥样硬化的关系及影响因素

王艳艳1,卞维静1,杨娇2,杨娅2,程虹1   

  1. 1. 首都医科大学附属北京安贞医院肾内科
    2. 首都医科大学附属北京安贞医院超声诊断科
  • 收稿日期:2016-03-29 修回日期:2016-07-21 出版日期:2016-09-12 发布日期:2016-09-12
  • 通讯作者: 卞维静 13911530708@163.com E-mail:bianweijing65@163.com

The relationship between cardiac valve calcification and carotid atherosclerosis and its influential factors in hemodialysis patients

  • Received:2016-03-29 Revised:2016-07-21 Online:2016-09-12 Published:2016-09-12

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摘要： 目的探讨维持性血液透析(maintenance hemodialysis patients, MHD)患者心脏瓣膜钙化(cardiac valve calcification,CVC)与颈动脉粥样硬化(carotid atherosclerosis, CAS)的关系及影响因素。方法对MHD 1 年以上的患者进行心脏超声心动图和颈动脉彩色多普勒超声检查，并统计矿物质代谢、脂代谢、炎症及营养不良相关指标。结果共纳入80 例患者，平均年龄(61.2±13.2)岁，透析龄(64.8±55.8)月。同时有CVC 和CAS 的患者41 例与无CVC 和CAS 的患者20 例比较，年龄(t=7.160，P＜0.001)、体质量指数(body mass index,BMI)(t=2.530，P=0.014)、超敏C 反应蛋白(hypersensitive C-reactive protein,hsCRP)(t=4.290，P＜0.001)、三酰甘油(triglyceride, TG)(t=2.660，P=0.010)及血清钙(calcium,Ca)(t=2.560，P=0.013)均有显著性差异。有CVC 的47 例患者与无CVC 的33 例患者比
较，年龄(t=3.470，P＜0.001)、透析龄(t=2.130，P=0.036)、hsCRP(t=4.230，P＜0.001)、Ca(t=4.450，P＜0.001)及主观综合评估表(subjective global assessment,SGA)(t=2.140，P=0.038)有显著性差异。有CAS 的54 例患者与无CAS 的26 例患者比较，年龄(t=7.810，P＜0.001)、罹患糖尿病(χ2=3.760，P=0.047)、BMI(t=2.400，P=0.024)、hsCRP(t=2.940，P=0.004)、血清白蛋白(t=2.140，P=0.038)、TG(t=3.320，P=0.001)、Ca(t=2.740，P=0.008)、SGA (t=2.010，P=0.048)及Kt/V(t=2.410，P=0.023)有显著性差异。Logistic回归分析显示，年龄(OR 1.194，95% CI 1.053～1.353，P=0.006)和hsCRP(OR 3.996，95% CI1.349～11.894，P=0.012)是同时患CVC 和CAS 的危险因素；hsCRP(OR 1.709，95% CI 1.236～3.364，P=0.01)和Ca(OR 38.561，95% CI 2.440～609.495，P=0.09)是CVC 的独立危险因素；年龄(OR 1.163，95%CI 1.079～1.255，P＜0.001)和hsCRP(OR 1.700，95% CI 1.092～2.646，P=0.019)是CAS 的独立危险因素。结论CVC 与CAS 常常伴发，CVC 和/或CAS 与MHD 患者的年龄、hsCRP、高钙血症有关。

关键词: 心脏瓣膜钙化, 颈动脉粥样硬化, 血液透析

Abstract: Objective To investigate the relationship between cardiac valve calcification (CVC) and carotid atherosclerosis (CAS) and its influential factors in maintenance hemodialysis (MHD) patients. Methods MHD patients with dialysis duration of ≥1 year were enrolled in this study. Cardiac echocardiography and carotid artery color Doppler ultrasound examination were performed in the patients. Mineral metabolism, lipid metabolism, inflammation and malnutrition related indicators were collected and analyzed. Results Eighty MHD patients (50 males and 30 females) were included in this study. The average age was 61.2±13.2 years, and the average dialysis duration was 64.8±55.8 months. Age, body mass index (BMI), hypersensitive C-reactive protein (hsCRP), hypertriglyceridemia and hypercalcinemia were significantly different between 41 patients with CVC and CAS and 20 patients without CVC and CAS (P＜0.05). Age, dialysis duration, hsCRP, hypercalcinemia and subjective global assessment (SGA) were significantly different between 47 patients with CVC and 33 patients without CVC (P＜0.05). Age, diabetes, BMI, hsCRP, serum albumin (Alb), hypertriglyceridemia, Ca, SGA and Kt/V were significantly different between 54 patients with CAS and 26 patients without CAS (P＜0.05). Logistic regression analysis showed that age and hsCRP were the common risk factors for CVC and CAS (P＜0.05), hsCRP and serum Ca were the independent risk factors for CVC (P＜0.05), and age and hsCRP were the independent risk factors for CAS (P＜0.05). Conclusion CVC often accompanied with CAS. The presence of CVC and CAS in MHD patients was related to their age, hsCRP level and hypercalcinemia.

Key words: cardiac valve calcification, carotid atherosclerosis, hemodialysis