组织病理学法对终末期肾脏病患者桡动脉钙化的评估

Histopathological assessment of calcification in radial artery from patients with end-stage renal disease

目的探讨组织病理学法对终末期肾脏病(end-stage renal disease,ESRD)患者桡动脉钙化(radial artery calcification,RAC)的评估。方法收集ESRD患者行自体动静脉內瘘(arteriovenous fistula,AVF)成形术废弃的桡动脉,茜素红S染色后分组观察,记录一般情况和检测生化指标,多因素Logistic回归分析RAC钙化的危险因素。结果 180例ESRD患者中38例(21.1%)存在不同程度的RAC。钙化组透析时间大于5年比例(χ~2=24.626,P=0.022)、糖尿病发生率(χ2=24.626,P<0.001)、糖化血红蛋白(t=2.736,P=0.009)较非钙化组差异有统计学意义;多因素Logistic回归分析结果显示,透析时间大于5年[OR=14.314,95%CI(2.666,36.502),P<0.001]、糖尿病[OR=16.099, 95%CI(2.796,34.597),P<0.001]是ESRD患者发生RAC的独立危险因素。重度钙化组透析时间大于5年比例(χ~2=11.378,P=0.001)、糖尿病发生率(χ~2=14.741,P<0.001)较无钙化组明显增高,差异有统计学意义;轻中度钙化组在糖尿病发生率(χ~2=14.684,P<0.001)、糖化血红蛋白(P=0.026)较无钙化升高,差异有统计学意义。结论 ESRD患者RAC以中膜钙化为主,透析时间大于5年及糖尿病是导致组织病理学RAC的独立危险因素,RAC是多方面因素在一定时间上共同作用的结果。

Objective To investigate clinical and biochemical factors for radial artery calcification （RAC） in end-stage renal disease （ESRD） patients through histopathological assessment of the arteries. Methodology Segments of radial artery were obtained during arteriovenous fistula （AVF） operation for ESRD patients. RAC samples were examined after alizarin red S staining. Clinical and biochemical data of the patients were collected. The parameters relating to RAC were analyzed by binary logistic regression analyses. Results Among 180 ESRD cases, 38 cases （21.1%） developed RAC at different degrees. Dialysis vintage 〉5 years （χ2=24.626, P=0.022）, diabetes （χ2=24.626, P〈0.001）, glycosylated hemoglobin （HbA1c） （t=2.736, P=0.009） were statistical different between calcification and non-calcification groups. Binary logistic regression analyses showed that dialysis vintage 〉5 years [OR=14.314, 95% CI （2.666, 36.502）, P〈0.001] and diabetes [OR=16.099, 95% CI （2.796, 34.597）, P〈0.001] were the independent risk factors for RAC. Dialysis vintage 〉5 years （χ2=11.378, P=0.001） and diabetes （χ2=14.741, P〈0.001） were significantly higher in patients with severe RAC than in patients without RAC. Diabetes （χ2=14.684, P〈0.001） and HbA1c （P=0.026） were significantly higher in patients with mild to moderate RAC than in patients without RAC. Conclusions RAC manifested as arterial media calcification was frequently observed in ESRD patients. Dialysis vintage 〉5 years and diabetes were the independent risk factors for RAC. Therefore, multiple factors persistent for a period of time promote the development of RAC.