腹主动脉钙化评分可预估血液透析患者的冠状动脉钙化程度

Abdominal aorta calcification score can be used to estimate the calcification degree of coronary artery in hemodialysis patients

目的观察维持性血液透析患者腹主动脉钙化与冠状动脉钙化之间的关系,探讨应用腹主动脉钙化评分预估冠状动脉钙化情况的可能性。方法选择维持性血液透析患者,腹部侧位平片检测腹主动脉钙化情况,应用Kauppila半定量积分法计算腹主动脉钙化(AAC)积分。应用多层螺旋CT(MSCT)评估冠状动脉钙化情况,运用Agaston评分进行量化,Pearson相关性分析腹主动脉钙化和冠状动脉钙化之间的相关性,运用受试者工作特征曲线(ROC)评价腹主动脉钙化评分预估冠状动脉钙化的准确性。结果共入选66例患者,平均年龄57.65±13.10岁,透析龄95.50(28.00～143.00)月,30.3%的患者合并糖尿病,透析的Kt/V1.61(1.41～1.88)。72.7%的患者存在腹主动脉钙化,中位AAC为8.5(0,15.00);78.3%的患者存在冠状动脉钙化,中位冠状动脉钙化积分(CACs)为400.8(4.2,1476.23)。相关性分析显示CACs与AAC呈显著正相关(r=0.664,P<0.001)。AAC积分诊断各种程度冠状动脉钙化的曲线下面积在0.852～0.902。当AAC≥8时,其诊断冠状动脉重度钙化(CACs>400)的敏感性和特异性分别为84.4%和81.2%。Logistic回归分析显示随着腹主动脉钙化程度的升高,患者发生重度冠状动脉钙化的风险也显著升高。传统心血管危险因素和CKD相关危险因素联合AAC积分具有更强的预测维持性血液透析患者冠状动脉重度钙化的能力。结论维持性血液透析患者腹主动脉钙化和冠状动脉钙化之间存在显著相关性,应用腹部侧位平片对腹主动脉钙化情况进行评分可以较好地预估患者冠状动脉的钙化程度。

Objective To determine the relationship between abdominal aorta calcification and coronary artery calcification in maintenance hemodialysis （MHD） patients, and to explore the possibility of diagnosing coronary artery calcification （CAC） by using abdominal aorta calcification （AAC） score. Methods MHD patients were selected. Abdominal lateral plain radiograph and multi-slice spiral CT （MSCT） were used to detect the calcification of abdominal aorta and coronary artery, respectively. Kauppila score was used to assess the degree of AAC, and Agaston score for the degree of CAC. Pearson correlation coefficient was used to analyze the relationship between AAC and CACs. We also used receiver operator characteristic （ROC） curves to assess the accuracy and sensitivity of AAC score for the diagnosis of coronary artery calcification. Results We recruited 66 MHD patients, of whom 30.3% had diabetes meUitus. Their average age, dialysis vintage and Kt/V value were 57.65 ± 13.10 years, 95.50 （28. 00± 143.00） months, and 1.61 （1.41 ± 1.88）, respectively. Abdominal aorta calcification was detected in 72.7% patients with the median AAC score of 8.5 （0± 15.00）, and coronary artery calcification was detected in 78.3% patients with the median CAC score of 400.8 （4.2±1476.23）. Correlation analysis showed that AAC score were positively correlated with CAC score （r=0.664, P 〈 0.001）. The area under the receiver-operating characteristic curve （AUC） of AAC score for diagnosing various degrees of coronaryartery calcification was 0.852±0.902. When AAC score =8, the sensitivity and specificity for diagnosing severe coronary artery calcification （CAC score 〉 400） were 84.4% and 81.2%, respectively. Logistic regression analysis showed that the risk of severe coronary artery calcification increased in association with the increased degree of abdominal aorta calcification. When AAC score combined with the traditional cardiovascular risk factors and the CKD-related cardiovascular risk factors were used, the prediction of severe coronary artery calcification became more powerful for MHD patients. Conclusions Abdominal aorta calcification and coronary artery calcification are significantly correlated. AAC score can be used to predict the degree of coronary artery calcification in MHD patients.