糖尿病肾病尿毒症患者血管钙化其及危险因素分析

Cardiovascular calcification in diabetic nephropathy patients in uremic stage and analysis on its risk factors

目的:观察尿毒症患者动脉血管钙化情况及危险因素,探讨糖尿病对尿毒症血管钙化的影响。方法:选取初次诊断为尿毒症的未透析患者,按照其原发病分为糖尿病肾病(DN)组和非糖尿病肾病(NDN)组。随机选取该院同期体检中心年龄、性别匹配的健康人作为对照组。行双手及腕关节正位、腹侧位及髋关节正位X线平片检查,并按照X线平片血管钙化程度对各部位积分累加计算总分;双能X线骨密度仪测定患者股骨颈骨密度;检测患者甲状旁腺激素(iPTH)、肝肾功能、Ca、P、SCr等生化指标,计算矫正Ca值及Ca×P。对各参数的相互关系进行统计学分析。结果:①尿毒症患者39例,其中DN组患者20例(51.28%),其糖尿病患病时间为(8.11±7.39)年;NDN组患者19例(48.72%);对照组20例。②39例尿毒症患者中有29例(74.36%)存在动脉血管钙化,其中血管钙化总积分1～3分23例(58.97%),3～6分6例(15.38%);对照组未见血管钙化。骨密度测量显示39例患者中骨量减少者14例(35.90%),股骨颈骨密度T值为-0.81±0.87;矫正Ca值为(2.01±0.43)mmol·L-1;血清磷(2.08±0.49)mmol·L-1;Ca×P(49.94±9.54)mg2·dL-2。③线性相关分析显示:尿毒症血管钙化程度与血清矫正Ca值及血磷水平相关(r=0.026,P<0.05;r=-0.639,P<0.05),与骨密度无相关性(P>0.05);与糖尿病患病时间呈显著正相关(r=0.790,P<0.001)。Logistic回归分析显示:随着糖尿病患病时间的延长尿毒症患者血管钙化程度加重,糖尿病患病时间是尿毒症患者血管钙化程度的独立危险因素(P<0.05),患者矫正Ca值及血磷水平对血管钙化程度的影响被剔除(P>0.05)。④DN组血管钙化发生率(95.0%)高于NDN组(42.1%,P<0.05);DN组血管钙化积分(3.18±1.77)高于NDN组(1.56±0.97,P<0.05)。结论:与非糖尿病肾病尿毒症患者相比,糖尿病肾病血管钙化的发生率和程度显著增高,糖尿病患病时间是尿毒症患者血管钙化的独立危险因素,早期积极干预高血糖可能有助于控制糖尿病肾病尿毒症患者血管钙化。

Objective To investigate the prevalence of arterial vascular calcification （VC）in uremic patients undergoing diabetic nephropathy（DN）and explore its risk factors.Methods Demographic and clinical data were collected in the patients latest diagnosed as uremia and not received dialysis treatment.The uremic patients were divided into DN group and non-diabetic nephropathy（NDN）group.And 20healthy subjects were chosen as control group from the Physical Examination Room.The patients＇sex and ages were similar in the 3groups.VC was semi-quantitatively evaluated by plain radiographic films from abdomen,pelvis and hands.The clinical and laboratorial parameters related to VC were detected and analyzed.Results ①The present study included 20 （51.28%）DN uremic patients and 19 （48.72%）NDN uremic patients.The average diabetic duration in the DN patients was （8.11±7.39）years.②Among the 39uremic patients,VC was found on radiographic films in 29cases（74.36%）,including 23cases（58.97%）with the con-score 1-3and 6cases（15.38%）with 3-6scores.And VC was not detected in control group.Bone density analysis showed that osteopenia occupied 14cases（35.90%）in all and the T-score was-0.81±0.87.③Linear correlation analysis revealed that VC was correlated with serum calcium and phosphate（r=0.026,P〈0.05;r=-0.639,P〈0.05）,and uncorrelated with bone density （P〉0.05）.VC score was significantly correlated with the diabetic duration （r=0.790,P〈0.001）.Logistic regression revealed that the diabetes duration was the independent risk factors（P〈0.05）for VC.The reflections of serum calcium and phosphate were rejected.④The prevalence of VC in DN gourp（95.0%）was higher than that in NDN group （42.1%,P〈0.05）.And the VC score in DN group（3.18±1.77）was higher than that in NDN group（1.56± 0.97,P〈0.05）.Conclusion There is a higher VC prevalence rate and more VC severity in DN uremic patients than in NDN patients.Diabetes duration is an independent risk factor for VC.Preventing from the high serum glucose maybe plays an effective role in controlling the VC in diabetic nephropathy patients in uremic stage.