规律血液透析患者甲状旁腺激素水平对腹主动脉钙化的效应分析

Effect Analysis of Parathyroid Hormone on Abdominal Aortic Calcification for Maintenance Hemodialysis Patients

目的探讨维持性血液透析(MHD)患者腹主动脉钙化(AAC)的相关危险因素。方法通过X线腹部侧位片对177例MHD患者进行AAC评分,按腹主动脉钙化有无将患者分为钙化组和非钙化组,比较两组患者的人口学特征、透析龄、心血管事件、高血压病史、高脂血症病史、糖尿病病史、碳酸钙及活性维生素D用药史以及血钙、血磷、全段甲状旁腺激素(i PTH)、高敏C反应蛋白(hs-CRP)等实验室指标的不同,通过Logistic回归分析AAC发生的相关危险因素,并比较不同PTH水平组患者AAC的发生率。结果 177例MHD患者中58.2%(103例)存在腹主动脉钙化,钙化组患者心血管事件的发生率显著高于非钙化组(33.3%vs 9.4%,P=0.001)。单因素分析显示钙化组患者高龄、长透析龄、高hs-CRP、高脂血症、高血压、碳酸钙用药史、活性维生素D用药史人数显著高于非钙化组,差异有统计学意义(P<0.005)。Logistic回归分析显示:高龄、高脂血症、高血压、长透析龄、高i PTH、高hs-CRP、活性维生素D和碳酸钙用药史是AAC的危险因素。随着血清i PTH水平的增高,AAC的发生率也随之增加,即使在矫正了年龄、性别、吸烟、透析龄、高血压、糖尿病、高hs-CRP、活性维生素D用药史、碳酸钙用药史等影响因素后,这种作用依然存在。结论 MHD患者腹主动脉钙化发生率明显高于正常人群。研究发现年龄、高脂血症、高血压、透析龄、高PTH、高hs-CRP、活性维生素D和碳酸钙用药史是AAC的危险因素,其中高i PTH水平是MHD患者AAC的独立危险因素。

Aim To investigate the risk factors of abdominal aortic calcification( AAC) for maintenance hemodialysis( MHD) patients. Methods The lateral X-ray plain films of abdomen were used for AAC evaluation in MHD patients. 177 MHD patients were divided into calcified group( AAC > 0) and non-calcified group( AAC = 0). The demographic characteristics,dialysis vintage,clinical history as cardiovascular events,hypertension,hyperlipidemia,diabetes,medication history of calcium carbonate and active vitamin D,laboratory markers as serum calcium,phosphorus,intact parathyroid hormone( i PTH) and hypersensitive c-reactive protein( hs-CRP) were compared between the two groups. The risk factors of AAC were analyzed by Logistic regression model. The probability of AAC among patients with different level of i PTH was evaluated. Results There are 103( 58. 2%) MHD patients with AAC. The incidence of cardiovascular events was significantly higher in calcified group compared with non-calcified group( 33. 3% vs 9. 4%). The results of univariable analysis showed that the number of patients with aging,longer history of dialysis,higher levels of hs-CRP,history of hyperlipidemia or hypertension,medication history of calcium carbonate or nonselective active vitamin D in calcified group was more than that in non-calcified group. The difference was statistically significant. The results of Logistic regression analysis showed that aging,hyperlipidemia,hypertension,longer dialysis vintage,higher i PTH and hs-CRP levels,medical history of nonselective active vitamin D or calcium carbonate were risk factors of AAC. Serum i PTH level was positively correlated with the incidence of AAC even after adjusted by age,gender,smoking,dialysis vintage,history of hypertension or diabetes,high hs-CRP,medication history of nonselective active vitamin D or calcium carbonate. Conclusion The incidence of AAC is higher in MHD patients,which might affect the prognosis of cardiovascular events. Aging,hyperlipidemia,hypertension,dialysis vintage,higher hs-CRP,nonselective active vitamin D and calcium carbonate use are risk factors of AAC. The higher levesl of i PTH might be one of the most important risk factors of AAC for MHD patients.