维持性血液透析患者心脏瓣膜钙化及其危险因素分析

CARDIAC VALVE CALCIFICATION IN MAITENANCE HAEMODIALYSIS PATIENTS AND ANALYSIS FOR RISK FACTORS

目的观察终末期肾病维持性血液透析(MHD)患者心脏瓣膜钙化(VC)的发病情况并对相关危险因素进行分析。方法对稳定透析6个月以上的MHD患者96例使用HP-550型彩色超声诊断仪进行心脏VC情况检测,将患者分为VC组与无VC组,比较二组患者的年龄、性别、透析时间、吸烟、血压、糖尿病肾病、SGA评分、血清白蛋白(Alb)、前白蛋白(pA)、血脂、血钙、血磷、钙磷乘积、全段甲状旁腺激素(iPTH)以及心脏室间隔厚度(IVS)、左室舒张期内径(LVID)、射血分数(EF)和左室肥厚(LVH)的发生率等指标。结果 96例MHD患者中34例(35.42%)发生VC。VC组透析时间显著长于无VC组,中重度营养不良的发生率、钙磷乘积明显增高(>4.43 mmol2/L2)者、CRP、室间隔厚度(IVS)、左室舒张期内经(LVID)、左室肥厚(LVH)发生率等均显著高于无VC组,此外,血清白蛋白(Alb)、前白蛋白(PA)、EF显著低于无VC组,吸烟、高血压、糖尿病、血脂异常、血钙、血磷、iPTH等指标二组比较差异无统计学意义,但是二组患者的iPTH显著高于正常人群。结论钙磷乘积增高,甲状旁腺功能亢进、炎症、营养不良等均为MHD患者VC发生的危险因素。VC发生后,MHD患者更容易出现心脏结构和功能改变。

Objective To observe the cardiac valve calcification（VC） in maintenance haemodialysis （MHD） patients and to analyse the related risk factors. Methods we studied 96 patients on MHD for more than 6 months. The color doppler ultrasonography was carried out to detect the cardiacVC and ventricular geometry. The patients were divided into two groups：VC group and no VC group. The SGA score, plasma albumin,pre - albumin, lipid profile, calcium, phosphate and calcium - phosphorus product （Ca P） ,parathormone,C responsive protein（CRP） were determined. Results 34 patients（35.42%） presented with VC Compared with patients with no VC, Patients with VC were＇older, had longer time on haemodialysis, higher Ca × P product and CRP, higher proportion of patients with moderate to severe malnutrition, lower serum albumin and prealbumin,poor ventricular geometry. Conclusion Aging,Time on haemodialysis, high Ca × P product,inflammation and malnutrition are associated with cardiac VC.