中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (06): 388-390.doi: 10.3969/j.issn.1671-4091.2018.06.007

• 临床研究 • 上一篇    下一篇

维持性血液透析患者冠状动脉钙化相关危险因素分析

江杰1, 郑东文1, 李仪1, 周红梅1, 刘国辉1   

  1. 1. 南方医科大学附属东莞市人民医院肾内科
  • 收稿日期:2018-01-10 修回日期:2018-03-23 出版日期:2018-06-12 发布日期:2018-06-20
  • 基金资助:

    东莞市社会科技发展项目(强化降磷预防维持性血液透析患者血管钙化的研究)课题编号：2014108101026

The risk factors for coronary artery calcification in maintenance hemodialysis patients

  • Received:2018-01-10 Revised:2018-03-23 Online:2018-06-12 Published:2018-06-20

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摘要： 【摘要】目的回顾性研究单个血液透析中心接受维持性血液透析(maintenance hemodialysis，MHD)患者发生转移性钙化的危险因素及心血管死亡危险因素。方法纳入340 例MHD 患者，对2008 年6 月至2017 年6 月随访9 年间发生的首要终点事件(心血管疾病死亡)及次要终点事件(MSCT 检查发现冠状动脉钙化)证据的相关因素进行COX 回归检验，分析临床终点事件的危险因素。结果维持性血液透析患者冠状动脉钙化的独立危险因素为透析龄(HR=1.218，95% CI 0.987～1.586，P＜0.001)，血清磷(HR=1.126，95% CI 0.092～2.638，P=0.005)，全段甲状旁腺激素(HR=1.112，95% CI 0.806～1.132，P=0.032)，与使用非含钙降磷药呈负相关(HR=0.627, 95% CI 0.223～1.164, P=0.037)。心血管因素死亡的独立危险因素为年龄(HR=1.016, 95% CI 0.935～1.062, P=0.014)，透析龄(HR=1.233, 95% CI 0.872～1.418, P＜0.001)，血清磷(HR=1.146, 95% CI 0.898～2.674, P=0.007)，与血红蛋白(HR=0.880, 95%CI 0.806～1.203, P=0.033)呈负相关。结论透析时间越长，血清磷越高，甲状旁腺激素水平越高，MHD 患者发生冠状动脉钙化的风险越高，使用非含钙降磷药则降低冠状动脉钙化的风险。年龄越大，透析龄越长，血红蛋白越低，血清磷越高，MHD 患者发生心血管死亡的风险越大。

关键词: 血液透析, 矿物质和骨代谢异常, 转移性钙化, 血管钙化, 非含钙降磷药, 心血管疾病

Abstract: 【Abstract】Objective The risk factors for coronary artery calcification and cardiovascular death in maintenance hemodialysis (MHD) patients in a hemodialysis center were investigated. Methods The primary event (cardiovascular death) and secondary event (coronary artery calcification) were analyzed in a total of 340 MHD patients who were followed up between June 2008 and June 2017. Cox regression models were used to investigate the risk factors for end events. Results The independent risk factors for coronary artery calcification were dialysis vintage (HR=1.218, 95% CI 0.987～1.586, P＜0.001), serum phosphorus level (HR=1.126, 95% CI 0.092～2.638, P=0.005) and intact parathyroid hormone level (HR=1.112, 95% CI 0.806～1.132, P=0.032). A negative correlation was found between the risk of coronary artery calcification and the administration of non-calcium phosphate binder (HR=0.627, 95% CI 0.223～1.164, P=0.037). The independent risk factors for cardiovascular death were age (HR=1.016, 95% CI 0.935～1.062, P=0.014), dialysis vintage (HR=1.233, 95% CI 0.872～1.418, P＜0.001) and serum phosphorus level (HR=1.146, 95% CI 0.898～2.674, P= 0.007). Hemoglobin level was negatively correlated with the risk of cardiovascular death (HR=0.880, 95% CI0.806～1.203, P=0.033). Conclusion The risk for coronary artery calcification increased in MHD patients
with longer dialysis vintage, higher levels of serum phosphorus and intact parathyroid hormone, while decreased in MHD patients using non-calcium phosphate binder. The risk for cardiovascular death increased in MHD patients with older age, longer dialysis vintage, lower hemoglobin and higher serum phosphorus.

Key words: Hemodialysis, Mineral and bone disorder, Coronary artery calcification, Vascular calcification, Non-calcium phosphate binder, Cardiovascular disease