中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (11): 746-750.doi: 10.3969/j.issn.1671-4091.2017.011.007

• 临床研究 • 上一篇    下一篇

慢性肾脏病患者心外膜脂肪体积与生化、炎症指标的相关性研究

王敬东1,盛亚楠2,马千里3,高岩4   

  1. 1山东省青岛市中心医院ICU
    2山东省平度市人民医院肾内科
    山东省青岛市市立医院(东院区) 3放射科，4肾脏科
  • 收稿日期:2017-06-12 修回日期:2017-09-28 出版日期:2017-11-12 发布日期:2017-10-27
  • 通讯作者: 高岩wjdwyd@163.com E-mail:wjdwyd@163.com

The relationship between epicardial fat volume and changes of biochemical and inflammatory indices in chronic kidney disease patients

  • Received:2017-06-12 Revised:2017-09-28 Online:2017-11-12 Published:2017-10-27

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摘要： 目的研究慢性肾脏病(chronic kidney disease，CKD)患者心外膜脂肪体积(epicardial fat volume，EFV)与生化、炎症等临床血清学指标的关系。方法将30 例查体中心的健康人作为对照组，120 例慢性肾脏病(CKD3、4、5、5D 期)患者作为患者组，通过AW4.3 工作站的Volume 软件手动逐层追踪心脏，获得心外膜脂肪体积(EFV)，同时检测其他血清学指标，测定血白蛋白、血肌酐、血钙、血磷、碱性磷酸酶(alkaline phosphatase, ALP)、空腹血糖、全段甲状旁腺激素(intact parathyroid hormone, iPTH)、超敏C 反应蛋白(high-sensitivity C-reactive protein,hs-CRP)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterin, LDL-C)，收集年龄、体质量指数(body mass index,BMI)，分析慢性肾脏病患者心外膜脂肪体积与血清学指标之间的关系。结果①CKD4、5 和5D 期组的患者心外膜脂肪体积平均值均高于对照组 [(140.03±54.71)、(145.01±64.56)和(141.45±62.04) cm³比(92.42±39.56)cm³，P 分别为0.007、0.015 和0.001]。②相关性分析显示：在患者组各期患者中，心外膜脂肪与血肌酐呈正相关(r=0.675，P=0.006；r=0.512，P=0.043；r=0.794，P=0.011；r=0.449，P=0.013)；在CKD4 期、5 期和5D 期患者组中，EFV 与血磷呈正相关(r=0.556，P=0.025；r=0.713，P=0.031；r=0.417，P=0.022)；在CKD4 期、5 期及5D 期中,EFV 与iPTH 呈正相关(r=0.510，P=0.044；r=0.811，P=0.001；r=0.399，P=0.032)；CKD3、4、5 及5D 期患者的EFV 与年龄(r=0.292，P=0.005；r=0.605，P=0.013；r=0.502，P=0.008；r=0.662，P=0.005)、hs-CRP(r=0.723，P=0.005；r=0.604，P=0.022；r=0.593，P=0.020；r=0.574，P=0.005)呈正相关；CKD3、4、5 及5D 期患者的EFV 与HDL-C 呈负相关(r=-0.625，P=0.013；r=-0.608，P=0.012；r=-0.679，P=0.005；r=-0.433，P=0.024)；CKD 4、5 及5D 期患者的EFV 与体质量指数呈正相关(r=0.256，P=0.026；r=0.521，P=0.046；r=0.648，P=0.009)。③多元线性回归分析示：EFV 与年龄(β=0.250，P=0.005)、BMI(β=0.192，P=0.020)、血磷(β=0.309，P＜0.001)、HDL(β=-0.335，P＜0.001)、hs-CRP(β=0.186，P=0.023)显著相关。结论在慢性肾脏病患者中，心外膜脂肪体积可以作为慢性肾脏病合并矿物质与骨代谢紊乱患者钙化进展的非侵袭性早期预测指标。

关键词: 慢性肾脏病, 心外膜脂肪体积, 血磷

Abstract: Objective To evaluate whether epicardial fat volume (EFV) is related to biochemical and inflammatory indices in chronic kidney disease (CKD) patients. Method A total of 30 healthy people from medical checkup center as the control group and 120 CKD patients were subjected to heart scanning by multislice
computed tomography. Cross-sectional tomographic cardiac slices from base to apex were traced semiautomatically using a volume viewer of AW4.3 off-line workstation. EFV was measured by assigning Hounsfield units ranging from -30 to -250 for fat. Serological indicators including serum albumin, creatinine (Scr), calcium, phosphorus (P), alkaline phosphatase, fasting glucose, parathyroid hormone (iPTH), high-sensitivity C-reactive protein (hs-CRP), high density lipoprotein (HDL) and low density lipoprotein (LDL) were measured. Age and body mass index (BMI) were collected. The relationship between EFV and changes of biochemical and inflammatory indices was then analyzed in CKD patients. Results ①EFV was apparently higher in CKD patients at stage 4, 5 and 5D compared with the control group (140.03 ± 54.71, 145.01 ± 64.56, 141.45±62.04 and 92.42±39.56 cm³ for stage 4, 5 and 5D CKD patients and healthy controls, respectively; P=0.007, 0.015 and 0.001 compared with control for stage 4, 5 and 5D patients, respectively). ②In CKD patients at stage 3, 4, 5, and 5D, EFV was positively correlated with Scr, hs-CRP and age (for Scr: r=0.675, P=0.006; r=0.512, P=0.043; r=0.794, P=0.011; r=0.449, P=0.013; for hs-CRP: r=0.723, P=0.005; r=0.604, P=0.022; r=0.593, P=0.020; r=0.574, P=0.005; for age: r=0.292, P=0.005; r=0.605, P=0.013; r=0.502, P=0.008; r=0.662, P=0.005), and was negatively correlated with HDL (r=- 0.625, P=0.013; r=- 0.608, P=0.012; r=-0.679, P=0.005; r=- 0.433, P=0.024). In CKD patients at stage 4, 5 and 5D, EFV was positively correlated with P, iPTH and BMI (for P: r=0.556, P=0.025; r=0.713, P=0.031; r=0.417, P=0.022; for iPTH: r=0.510, P=0.044; r=0.811, P=0.001; r=0.399, P=0.032; for BMI: r=0.256, P=0.026; r=0.521, P=0.046; r=0.648, P=0.009). (c) Multiple linear regression showed that EFV was significantly correlated with age (β =0.250, P=0.005), BMI (β=0.192, P=0.020), P (β=0.309, P＜0.001), HDL (β =-0.335, P＜0.001) and hs-CRP (β=0.186, P= 0.023). Conclusions Measurement of EFV may provide a useful and noninvasive indicator for coronary artery calcification in CKD patients with mineral and bone disorder.

Key words: chronic kidney disease, epicardial fat volume, Serum phosphorus