维持性血液透析患者冠状动脉钙化的相关因素分析

Analysis of related factors of coronary artery calcification in maintenance hemodialysis patients

目的观察维持性血液透析（maintain hemodialysis,MHD）患者冠状动脉钙化情况,探讨MHD患者钙磷代谢、成纤维细胞生长因子23（fibroblast growth factor 23,FGF23）、胎球蛋白A的水平与冠状动脉钙化之间的关系。方法选取MHD患者54例,应用酶联免疫分析法测定血清FGF23、胎球蛋白A水平,同时测定血清甲状旁腺激素、血钙、磷等指标。所有患者应用64层螺旋CT行冠状动脉钙化扫描并计算冠脉钙化积分（coronary artery calcium score,CCS）。根据CCS是否大于400分将所有患者分为CCS≤400分组和CCS〉400分组。比较两组间基本资料及FGF23、胎球蛋白A情况,采用多元线性回归分析影响CCS的危险因素。结果 （1）54例MHD患者CCS为826分（P25-P75为144-2044分）。其中大于0分者占94.44%,大于100分者占79.63%,大于400分者占59.26%。（2）根据CCS是否大于400分分组后,CCS≤400分组年龄〔（58.15±14.18）岁〕明显小于CCS〉400分组年龄〔（68.22±13.82）岁〕,CCS≤400分组FGF23〔（210.22±250.91）pg/m L〕明显小于CCS〉400分组〔（600.84±625.91）pg/m L,P〈0.05〕。CCS≤400分组冠状动脉粥样硬化性心脏病者所占比例明显低于CCS〉400分组所占比例。两组间透析龄、血钙、血磷、尿酸、白蛋白、甲状旁腺激素、糖尿病者所占比例差异无统计学意义。（3）直线相关分析显示：FGF23水平（r=0.363,P=0.007）和CCS呈正相关。（4）Logistic回归显示：年龄及FGF23水平为影响CCS的独立危险因素。结论维持性血液透析患者冠状动脉钙化严重,血FGF23水平为影响冠脉钙化的独立危险因素。

Objective To observe the level of coronary artery calcification in maintain hemodialysis （MHD） patients and explore the relationship between calcium and phosphorus metabolism, fibroblast growth factor 23 （ FGF23 ）, fetuin-A and coronary artery calcification. Methods Fifty-four MHD patients were enrolled in this study. Phosphate, calcium in their serum were determined. The level of FGF23 and fetuin-A in serum were detected by the method of ELISA. The degree of coronary artery calcification was detected by 64 slice spiral CT and the coronary artery calcium score（CCS） was calculated. The patients were divided into CCS≤400 group and CAC〉400 group according to the CCS. Results （ 1 ） The mean CCS in 54 MHD patients is 826 （ P25 - P75 is 144 - 2044 ）. The patients of more than 0 points accounted for 94.44%, more than 100 points accounted for 79.63%, more than 400 points accounted for 59.26%. （2） The FGF23 and age in CCS ≤400 group was lower than CCS〉400 group. The proportion of coronary disease in group CCS ≤400 is lower than that in group CCS〉400. The duration of dialysis, calcium, phosphorous, uric acid, albumin, parathyroid hormone, fetuin-A has no significant difference between the two groups. （3） Logistic regression analysis revealed that the level of FGF23 and age was the influencing factor of coronary artery calcification in MHD patients. Conclusion The degree of coronary artery calcification in MHD patients is serious, and the elevation of FGF23 is relevant to the coronary artery calcification.