血液透析患者冠状动脉电子束CT扫描钙化积分及其相关因素

Coronary artery calcification measured with electron beam computed tomography and its correlative factors in hemodialysis patients

目的探讨血液透析患者冠状动脉钙化的相关因素。方法以冠状动脉电子束CT(EBCT)扫描钙化积分确定冠状动脉钙化的程度,回顾性分析心血管疾病的危险因素及钙磷代谢异常等因素对冠状动脉钙化的影响。结果22例维持性血液透析患者进行了EBCT检查,有21例患者(95郾4%)存在不同程度的冠状动脉钙化(EBCT钙化积分>0分),EBCT钙化积分平均1935郾54分(0分～9833分)。EBCT钙化积分≥100分的患者心血管疾病的发病率、血清磷、钙磷乘积和C鄄反应蛋白显著增高而血清白蛋白显著降低(P<0.05)。多元逐步回归分析的结果显示,冠状动脉钙化的影响因素有透析龄和低密度脂蛋白(HDL鄄C)(P<0.05)。结论尿毒症血液透析患者普遍存在冠状动脉钙化,但确切的机制不清楚。冠状动脉钙化(EBCT钙化积分)与高血磷、高钙磷乘积等有关,透析龄、HDL鄄C是冠状动脉钙化的独立影响因素。

Objective To investigate the factors correlated to coronary artery calcification in hemodialysis patients. Methods Quantification of coronary artery calcification was determined by electron beam computed tomography(EBCT), known as the calcification score. The relationship of coronary artery calcification to risk factors of cardiovascular disease, metabolism of calcium and phosphorus, etc was analyzed retrospectively. Results Twenty-two patients undergoing maintenance hemodialysis were enrolled. Twenty-one patients(95.4%) had coronary artery calcification (calcification score>0),whose mean calcification score was 1935.54(0～9833). Patients with calcification score ≥100 had significantly higher morbidity of cardiovascular diseases, serum phosphate level, calcium-phosphate product, C-reactive potein concentration and lower serum albumin than patients with calcification score <100. Multiple regression analysis demonstrated that the duration of hemodialysis and high-density lipoprotein cholesterol were independent predictors of coronary artery calcification. Conclusions Coronary artery calcification is common and widespread in hemodialysis patients, but pathogenesis of coronary artery calcification is not clear. Serum phosphate and calcium-phosphate product correlate with coronary artery calcification. The duration of hemodialysis and high-density lipoprotein cholesterol are independent predictors of coronary artery calcification.