维持性血液透析患者腹主动脉钙化发病情况及与心血管疾病的关系

Incidence of abdominal aortic calcification and its relationship with cardiovascular diseases in patients undergoing maintenance hemodialysis

目的探讨维持性血液透析(MHD)患者腹主动脉钙化(ACC)的发病情况及其与心血管疾病的关系。方法以接受MHD的164例慢性肾脏病5D期患者作为研究对象。检测肾功能、空腹血糖、血脂、血清高敏C反应蛋白(hs-CRP)、血钙、血磷、总铁结合力、血清全段甲状旁腺素(iPTH)和血清铁蛋白(SF)等指标,计算血液透析充分性指标Kt/V;利用腹部侧位X线片评估腹主动脉钙化(AAC)积分。分析AAC的发生率、分布特点和严重程度;分析AAC与患者各项临床指标的相关性;比较钙化与非钙化患者的心血管疾病(CVD)发生情况,以受试者工作特征曲线下面积(AUCROC)评价AAC诊断MHD患者CVD发生的准确性。结果 164例MHD患者中,腹主动脉钙化的发生率为68.9%;从腰椎L1向L4钙化发生率逐渐增高(P<0.05),且钙化程度逐步加重(P<0.001)。相关分析结果显示:AAC与患者年龄(r=0.290,P<0.001)、透析龄(r=0.225,P=0.004)、iPTH(r=0.342,P=0.043)、骨化三醇剂量(r=0.214,P=0.006)呈正相关。与非钙化组比较,钙化组患者CVD的发生率显著增高(52.2%和29.4%,P=0.007);发生CVD患者的AAC显著高于未发生CVD的患者(P<0.001)。AAC诊断CVD发生的AUCROC为0.658(95%CI 0.573～0.742,P<0.001)。结论 MHD患者腹ACC的发生率较高,由远端向近端发展并由近端向远端逐渐加重,且与CVD的发生有关。

Objective To determine the incidence of abdominal aortic calcification （ACC） and its relationship with cardiovascnlare diseases （CVD） in patients undergoing maintenance hemodialysis （MHD）. Methods One hundred and sixty- four patients with chronic kidney disease of stage 5D undergoing MHD were selected as study objective. The parameters of renal function, fasting blood glucose, blood lipid, serum high-sensitivity C-reactive protein （hs-CRP）, blood calcium, blood phosphorus, total iron binding capacity, serum intact parathyroid hormone （iPTH） and serum ferritin （SF） were measured, the urea clearance index Kt/V was calculated, and abdominal aorta calcification （AAC） score was assessed with abdominal lateral X-ray examination. The incidence, distribution characteristics and severity of AAC were analysed, the relationship between AAC and clinical parameters was explored, the incidences of CVD were compared between patients with calcification and those without calcification, and area under the receiver operating characteristic curve （AUC,oc） was used for evaluation of accuracy of AAC in diagnosis of CVD in patients undergoing MHD. Results The incidence of AAC was 68.9%. The incidence of calcification and degree of calcification increased from L~ to L4 （ P 〈 0.05, P 〈 0. 001）. Correlation analysis indicated that AAC was positively related to age（ r = 0. 290, P 〈 0. 001）, dialysis vintage （ r = 0. 225, P = 0. 004）, iPTH （ r = 0. 342, P = 0. 043） and calcitrol dosage （ r = 0.21, P = 0. 006）. The incidence of CVD in patients with calcification was significantly higher than that in patients without calcification （52.2% vs 29.4%, P = O. 007）. AAC score in patients with CVD was siznificantlv higher than that in patients without CVD （P 〈 0. 001）. AUCrocof AAC indiagnosis of CVD was 0.658 （95% CI 0.573 -0.742, P 〈0.001）. Conclusion The incidence of ACC is higher in patients undergoing MHD. ACC develops from the distal part to the proximal part, and the severity of ACC increases from the proximal part to the distal part. The incidence of ACC is related to the development of CVD.