中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (01): 19-24.doi: 10.3969/j.issn.1671-4091.2017.01.006

• 临床研究 • 上一篇    下一篇

维持性腹膜透析患者血管钙化的发生情况及其相关因素研究

蔡士铭1,赵慧萍1,武蓓1,吴舰2,张萌2,左力1,王梅1   

  1. 1. 北京大学人民医院肾内科
    2. 北京大学人民医院放射科
  • 收稿日期:2017-08-15 修回日期:2017-10-24 出版日期:2018-01-12 发布日期:2018-01-12
  • 通讯作者: 赵慧萍:huipingzhao2009@163.com E-mail:huipingzhao2009@163.com
  • 基金资助:

    教育部留学回国启动基金(jwsl451)

Studies on the prevalence and influence factors of vascular calcification in maintenance peritoneal dialysis patients

  • Received:2017-08-15 Revised:2017-10-24 Online:2018-01-12 Published:2018-01-12

PDF

748

摘要： 目的探讨维持性腹膜透析(peritoneal dialysis,PD)患者血管钙化的发生情况、钙化的严重程度及其相关影响因素。方法选择北京大学人民医院病情稳定的PD≥6 个月、规律随诊的PD 患者，通过侧位腹平片、骨盆正位片、双手正位X 线片检测大动脉(腹主动脉)、中动脉(髂动脉、股动脉)、小动脉(桡动脉、手指动脉)的血管钙化，2 位放射科医师盲法阅片及评分。收集入选者一般资料、Charlson合并症评分(charlson comorbidity index,CCI)，自PD 开始后的基线和时间平均实验室指标，包括钙磷代谢指标、白蛋白、血脂、透析充分性等。应用logistic 回归分析血管钙化的影响因素，多元线性回归分析血管钙化程度的影响因素。结果①154 例PD 患者入选本研究，其中男性78 例(50.64%)，平均年龄(60.41±13.88)岁,平均透析龄(30.63±20.74)月。糖尿病肾病是主要的原发病，占38.96%。②111例患者存在不同程度、不同部位的血管钙化(72.07%)。111 例血管钙化的患者中83.78%存在腹主动脉钙化，61.26%存在中动脉钙化，35.13%存在小动脉钙化。另外，中重度血管钙化者占45.04%。③Logistic回归分析显示年龄(OR 1.092, 95% CI 1.047～1.139, P＜0.001)、糖尿病(OR 12.982, 95% CI3.258～51.722, P＜0.001)、透析龄长(OR 1.049, 95% CI 1.017～1.081,P=0.002)、基线全段甲状旁腺激素(intact parathyroid hormone,iPTH)水平低(OR 0.996, 95% CI 0.992～0.999,P=0.010)是血管钙化的独立危险因素。④与轻度钙化的患者相比，中重度血管钙化的患者CCI 更高(t=-4.575,P＜0.001)、合并糖尿病的患者更多(χ2=9.617, P=0.002)、基线碱性磷酸酶水平更高(t=-2.018,P=0.047)。多元线性回归结果显示CCI(Β =0.258,P=0.003)、性别(Β =1.136,P=0.042)、是否合并糖尿病(Β =0.242, P =0.008)是血管钙化严重程度的独立影响因素。结论维持性PD 患者血管钙化的发生率高，血管钙化最常发生于腹主动脉，在合并糖尿病、高龄、男性、透析龄长、基线iPTH 水平低的患者中更易发生。在发生血管钙化的患者中，男性、合并糖尿病及合并症多的患者血管钙化的程度更重。

关键词: 腹膜透析, 血管钙化, X线平片, 腹主动脉钙化

Abstract: Objective To investigate the prevalence, severity and related factors of vascular calcification in maintenance peritoneal dialysis (PD) patients. Methods This cross-section study enrolled the PD patients at stable status and treated in Peking University People’s Hospital for more than 6 months. We used plain X-ray films of abdomen, pelvis and hands to quantitatively evaluate vascular calcification of large artery (abdominal aorta), medium arteries (iliac arteries, femoral arteries), and small arteries (radial arteries and digital arteries). Two radiologists blindly read and scored the vascular calcification. Demographic data, clinical characteristics, Charlson comorbidity index (CCI), baseline and time- averaged laboratory indexes including parameters of calcium phosphorus metabolism, serum albumin and PD adequacy were collected. The factors related to vascular calcification were analyzed by logistic regression. The factors relating to the degree of vascular calcification were analyzed by multiple linear regression method. Results ①A total of 154 PD patients (78 male patients, mean age 60.41±13.88 years, average PD duration 30.63±20.74 months) were enrolled in this study. The major primary disease was diabetic nephropathy (39%). ② A total of 111 patients (72.07%) were found to have vascular calcifications, including abdominal aorta calcification (83.78%), medium artery calcification (61.26%) and small artery calcification (35.13%). Moderate to severe degree of vascular calcifications were detected in 45.04% patients. ③ Logistic regression showed that diabetes (OR 12.982, 95% CI 3.258～51.722, P＜0.001), older age (OR 1.092, 95% CI 1.047～1.139, P＜0.001), longer dialysis duration (OR 1.049, 95% CI 1.017～1.081, P=0.002), and lower baseline intact parathyroid hormone (iPTH) (OR 0.996, 95% CI 0.992～0.999, P=0.010) were the independent risk factors for vascular calcification. (d) Compared to patients with mild calcification, patients with moderate to severe degree of calcification had higher proportion of diabetes (χ2=9.617, P=0.002), higher CCI ( t=- 4.575, P＜0.001) and higher baseline alkaline phosphatase (t=-2.018, P=0.047). Multiple linear regression results demonstrated that CCI (Β =0.258, P=0.003), gender (Β=1.136, P=0.042), and diabetes (Β=0.242, P=0.008) were the independent factors for calcification severity. Conclusions Vascular calcification is commonly present in maintenance PD patients. Vascular calcification in abdominal aorta is most frequently seen. It is more likely to occur in patients with diabetes, older age, male, longer dialysis duration, and lower baseline iPTH. In patients with vascular calcification, the degree of vascular calcification is severer in male patients and the patients with diabetes and more comorbidities.

Key words: Peritoneal dialysis, Vascular calcification, X-ray films, Abdominal aorta calcification