中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (04): 189-194.doi: 10.3969/j.issn.1671-4091.2013.04.00

• 临床研究 • 上一篇    下一篇

腹主动脉钙化评分可预估血液透析患者的冠状动脉钙化程度

蔡宏1,严玉澄1,陆任华2,张敏芳2,颜佳毅2,庞慧华3,朱铭力2,张伟明2,倪兆慧1,钱家麒3   

  1. 1. 上海交通大学医学院附属仁济医院
    2. 上海交通大学医学院附属仁济医院肾脏科
    3. 上海交通大学医学院附属仁济医院肾脏内科
  • 收稿日期:2012-10-29 修回日期:2013-01-04 出版日期:2013-04-12 发布日期:2013-07-01
  • 通讯作者: 蔡宏 E-mail:chcaicai@hotmail.com
  • 基金资助:
    上海市科委重大科技专题攻关项目

Abdominal aortic calcification score to estimate the degree of coronary artery calcification in hemodialysis patients

  • Received:2012-10-29 Revised:2013-01-04 Online:2013-04-12 Published:2013-07-01

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摘要： [摘要] 目的：观察维持性血液透析患者腹主动脉钙化与冠状动脉钙化之间的关系，探讨应用腹主动脉钙化评分预估冠状动脉钙化情况的可能性。方法：选择维持性血液透析患者，腹部侧位平片检测腹主动脉钙化情况，应用Kauppila半定量积分法计算腹主动脉钙化（AAC）积分。应用多层螺旋CT（MSCT）评估冠状动脉钙化情况，运用Agaston评分进行量化，Pearson相关性分析腹主动脉钙化和冠状动脉钙化之间的相关性，运用受试者工作特征曲线（ROC）评价腹主动脉钙化评分预估冠状动脉钙化的准确性。结果：共入选66例患者，平均年龄57.65±13.10岁，透析龄95.50(28.00-143.00)月，30.3%的患者合并糖尿病，透析的Kt/V 1.61(1.41-1.88)。72.7%的患者存在腹主动脉钙化，中位AAC为8.5(0，15.00)；78.3%的患者存在冠状动脉钙化，中位冠状动脉钙化积分（CACs）为400.8(4.2，1476.23)。相关性分析显示CACs与AAC呈显著正相关（r=0.664，P400）的敏感性和特异性分别为84.4%和81.2%。Logistic 回归分析显示随着腹主动脉钙化程度的升高，患者发生重度冠状动脉钙化的风险也显著升高。传统心血管危险因素和CKD相关危险因素联合AAC积分具有更强的预测维持性血液透析患者冠状动脉重度钙化的能力。 结论：维持性血液透析患者腹主动脉钙化和冠状动脉钙化之间存在显著相关性，应用腹部侧位平片对腹主动脉钙化情况进行评分可以较好地预估患者冠状动脉的钙化程度。

关键词: 维持性血液透析, 血管钙化, 心血管疾病

Abstract: [Abstract] Objective: To determine the relationship between the abdominal aortic calcification and coronary artnary calcification in maintenance hemodialysis patients and to explore the possibility of diagnosing coronary artery calcification (CAC) by abdominal aortic calcification(AAC) score. Methods: Maintenance Hemodialysis Patients were selected. Abdominal lateral plain radiograph and Multislice spiral CT (MSCT) were used to detect the calcification of abdominal aorta and coronary artery respectively. Kauppila score was used to assess the degree of AAC while Agaston score for CAC. Pearson correlation Coefficient was used to analyze the relationship between AAC and CACs. We also assess the accuracy and sensitivity of AAC score in diagnosing coronary artery calcification using receiver operator characteristic (ROC) curves. Results: 66 patients were enrolled. Average age, dialysis vintage and Kt/V were 57.65±13.10 years, 95.50 (28.00-143.00) months and 1.61(1.41-1.88) respectively. 30.3% patients were with diabetes mellitus. 72.7% patients were detected abdominal artery calcification with the median AAC of 8.5(0-15.00) while 78.3% patients were detected coronary artery calcification with the median CACs of 400.8 (4.2-1476.23). Correlation analysis showed that AAC were positively related with CACs (r=0.664, P400) were 84.4% and 81.2% respectively. Logistic regression analysis showed that with the increasing of the abdominal aorta calcification, the risk of patients with severe coronary artery calcification are increasing. United AAC，traditional cardiovascular risk factors and CKD-related cardiovascular risk factors have a stronger ability to predict severe coronary artery calcification in maintenance hemodialysis patients Conclusions: There is a significant correlation between abdominal aortic calcification and coronary artery calcification. AAC can well predict the degree of coronary artery calcification in maintenance hemodialysis patients.

Key words: maintenance hemodialysis, vascular calcification, cardiovascular disease