终末期肾脏病患者冠状动脉钙化的影响因素

Risk factors for coronary artery calcification in patients with end-stage renal disease

目的 探讨终末期肾脏病（ESRD）患者冠状动脉（冠脉）钙化的影响因素.方法 选取2014年8月至2015年3月在河北医科大学第四医院血液净化中心行规律血液透析（3次/周）的ESRD患者53例,根据冠脉钙化评分（CACs）分为钙化阴性组（13例）、钙化阳性组（轻度钙化组11例、中度钙化组12例、重度钙化组17例）.收集临床一般资料,采集1周首次透析前动脉血测定白蛋白、尿酸、钙、磷、镁、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、C反应蛋白（CRP）、β2微球蛋白（β2-MG）、游离甲状旁腺素（iPTH）、碱性磷酸酶、纤维蛋白原、血红蛋白（HGB）、铁蛋白等;并同次测定透析前、透析后动脉血pH值,计算△pH（透后pH-透前pH）.通过冠脉钙化评分与一般资料、血生化指标进行相关性、logistic回归等统计学分析,探讨ESRD患者冠脉钙化的发生情况及其影响因素.本研究通过河北医科大学第四医院伦理委员会批准及患者知情同意.结果 冠脉钙化程度与年龄（r =0.269）、透析龄（r=0.341）、血钙水平（r=0.358）、血磷水平（r=0.186）及透前pH（r =0.275）呈正相关,与白蛋白（r=-0.192）、△pH（r=-0.302）呈负相关,均P＜0.05;logistic回归分析结果显示,年龄、透析龄、血磷及△pH是ESRD患者CACs的独立影响因素（均P＜0.05）;轻、中、重度钙化3组患者的冠脉钙化部位均以左前降支受累为主（均P ＜0.05）.结论 ESRD患者冠脉钙化受年龄、透析龄、血磷、△pH等多种因素的影响,其中△pH对冠脉钙化的作用主要受透前pH影响;ESRD患者冠脉钙化主要累及左前降支.

Objective To explore risk factors for coronary artery calcification （CAC） inpatients with end-stage renal disease （ESRD）.Methods A total of 53 ESRD patients undergoing regular hemodialysis （3 times a week） from August 2014 to March 2015 in the Fourth Hospital of Hebei Medical University were enrolled in the study.The patients were divided into the negative control group （13 cases） and three positive groups （11 mild calcification cases,12 moderate calcification cases and 17 severe calcification cases） based on coronary artery calcification score （CACs）.Clinical data of all patients at study entry were collected.Arterial blood samples were also collected at the start of the first hemodialysis （HD） session of the week to measure the levels of serum albumin,uric acid,calcium （Ca）,phosphorus （P）,magnesium,high density lipoprotein cholesterol （HDL-C）,low density lipoprotein cholesterol （LDL-C）,C reactive protein（CRP）,beta-2 microglobulin（β2-MG）,free parathyroid hormone （iPTH）,alkaline phosphatase,fibrinogen,hemoglobin （HGB） and ferritin.Meanwhile,levels of blood pH were detected after collecting pre-and post-HD blood samples to calculate △pH （post-HD pH subtracted pre-HD pH）.Logistic regression analysis was performed to analyze the correlation of CACs with clinical data and previously-reported blood biochemical indicators,followed by analysis of the incidence of CAC and influential factors in ESRD patients.Results Severity of CAC was positively correlated with age （r =0.269）,HD duration （r =0.341）,serum calcium （r =0.358）,serum phosphorus （r =0.186） and pre-HD pH （r =0.275）,but negatively correlated with serum albumin （r =-0.192） and △pH （r =-0.302）,all P 〈 0.05.Logistic regression analysis revealed that age,HD duration,serum phosphorus level and △pH were independent risk factors for CAC in ESRD patients （P 〈 0.05）.In CAC positive groups,CAC was predominantly involved in the left anterior descending artery （P 〈 0.05,P 〈 0.01 and P 〈 0.01 in mild,moderate and severe calcification group,respectively）.Conclusions CAC in ESRD patients seems to be affected by multiple factors,such as age,HD duration,serum phosphorus level and △pH.Moreover,△pH affects CAC mainly by pre-HD pH.Furthermore,left anterior descending artery is predominantly affected by CAC in ESRD patients.