血液透析患者长期生存与冠状动脉钙化积分的关系

Impact of coronary artery calcification score measured with electron beam computed tomography on cardiovascular disease and its mortality in hemodialysis patients

目的长期随访冠状动脉钙化积分(coronary artery calcification score,CACS)与维持性血液透析(maintain hemodialysis,MHD)患者心血管疾病(cardiavascular disease,CVD)的发生与死亡的关系。方法通过追踪随访电子束CT(electron beam computed tomography,EBCT)测定CACS的MHD患者22例,在2002年至2009年期间CVD的发生及其死亡情况,分析CACS与CVD的关系,通过Kaplan-Meier生存曲线比较CACS≥100分组和CACS<100分组的平均生存率。结果在2002年,22例患者中的21例(95.5%)存在不同程度的血管钙化(CACS>0分),CACS平均为1935.54分(0～9833分)。随访至2009年12月31日,17例发生过CVD(81.0%);14例死亡(66.7%),全部死于CVD相关疾病。在CACS≥100分组,15例患者中有14例发生CVD(93.3%),12例死亡(80.0%);其显著高于CACS<100分组的CVD发生率(50.0%,3/6)和死亡率(33.3%,2/6),差异均有统计学意义(P<0.05)。CACS≥100分组与<100分组比较,hs-CRP分别为(0.006±0.005)g/L和(0.002±0.002)g/L,Alb分别为(38.00±1.56)g/L和(42.00±3.79)g/L,差异均有统计学意义(P<0.05)。Kaplan-Meier生存曲线显示CACS≥100分组的平均生存时间111.3个月,CACS<100分组的平均生存时间222.7个月,两者之间差异有统计学意义(P=0.042)。结论 CACS与MHD患者CVD的发生和死亡相关,微炎症和营养不良可能是重要的风险因素,CACS<100分组生存时间明显长于CACS≥100分组。

Objective To investigate the correlation of coronary artery calcification score （CACS） with morbidity and mortality of cardiovascular disease （CVD） in hemodialysis patients. Methods Twenty-two patients undergoing maintenance hemodialysis （MHD） were enrolled. CACS was determined by electron beam computed tomography （EBCT） in 2002. On Dec. 31,2009,the correlation of CACS with morbidity and mortality of CVD was analyzed retrospectively. Results In 2002,there were twenty-one patients （95.5%） with coronary artery calcifica-tion （CACS〉0）. The mean CACS was 1935.54 （0～9833）. During the follow-up period of 7 years,17 of the 21 patients （81.0%） had CVD,and 14 cases （66.7%） died,of which all died of CVD related diseases. Patients with CACS ≥ 100 had significantly higher morbidity and mortality rates of CVD than those with CACS〈100. Serum hs-CRP was higher and serum albumin was lower in CACS ≥ 100 group than in CACS100 group （P〈0.05）. Kaplan-Meier curve demonstrated that the average survival time was longer in CACS100 group than in CACS≥ 100 group （222.7 vs. 111.3 months,P=0.042）. Conclusions CACS is correlated with morbidity and mortality of CVD in hemodialysis patients. Microinflammation and malnutrition may be the important risk factors. The survival time was longer in CACS〈100 group than in CACS ≥100 group.