维持性腹膜透析患者心脏瓣膜钙化的相关因素及干预

Cardiac valve calcification in patients with chronic renal failure undergoing maintenance peritoneal dialysis

【目的】探讨慢性肾功能衰竭维持性腹膜透析患者心脏瓣膜钙化病因及干预治疗的方法。【方法】将入选的40例慢性肾功能衰竭维持性腹膜透析患者随机分为2组:A组(常规腹透液治疗组)与B组(低钙腹透液治疗组),观察治疗80周前后心脏瓣膜钙化及血生化指标的变化。【结果】A组患者80周后发生二尖瓣钙化3例,二尖瓣返流1例,二尖瓣面积减少致狭窄1例,主动脉瓣钙化4例,主动脉瓣返流1例;B组80周后仅发现二尖瓣钙化1例。瓣膜钙化发生率与患者血钙、血磷水平及钙磷乘积相关。【结论】慢性肾功能衰竭维持性腹透患者心脏瓣膜钙化相当常见,高钙、高磷血症为心脏瓣膜钙化的危险因素。低钙透析液能显著减少维持性腹透患者心脏瓣膜钙化风险。

[ Objective] To investigate the etiology and characteristics of cardiac valve calcification and its effects on cardiac structure and function in patients with chronic renal failure （CRF） on maintenance peritoneal dialysis. [Methods] A total of 40 patients were equally divided into A （normal-calcium dialsate） and B （low-calcium dialysate） groups randomly. The calcification, surface area, stenosis and insufficiency of cardiac valves were measured in a follow up period of 80 weeks. [Results] Among A group patients, the echocardiographic findings were mitral valve calcification （MAC） in 3 cases, mitral regurgitation （MR） in 1 cases, mitral stenosis （MS） in 1 cases, aortic valve calcification in 4 cases and aortic regurgitation in 1 cases. Among B group, the echocardiographic findings were mitral valve calcification （MAC） in 1 cases. The degree of calcification was closely related to hyperealcemid, hyperphosphoremia and calcium x phosphate. [Conclusion] Mitral and aortic valves ave vulnerable to ealcif＇lcation which is the major change of heart valve in patients with CRF on maintenance peritoneal dialysis. Hyperphosphoremia, hyercalcemid and calcium x phosphate are the major risk factors on cardiac valve calcification. Low-calcium dialysate can cut down the risk factors on cardiac valve calcification.