心脏瓣膜钙化对维持性血液透析患者心血管预后的影响

Association of heart valve calcification with cardiovascular outcomes in patients on maintenance hemodialysis

目的探讨心脏瓣膜钙化（HVC）对维持性血液透析（MHD）患者心血管预后的影响。方法入组2009~2011年302例MHD患者（其中99例伴HVC）,所有患者随访2年,采用生存曲线分析心血管终点事件,Cox回归分析心脏瓣膜钙化对心血管预后的影响。结果患者初始透析的平均年龄为58.2岁,男性占53.6%。随访2年,HVC与非HVC组患者全因死亡、心血管死亡和新发心血管事件发生率分别为30.3%vs 16.3%、22.2%vs 6.9%和48.5%vs 25.6%（P〈0.05）。生存曲线分析显示两组在全因死亡率（Log Rank P=0.006）、心血管死亡（P〈0.001）和新发心血管事件（P〈0.001）方面均存在统计学差异。Cox回归分析显示,校正后HVC仍然显著增加患者全因死亡[HR 1,88,95%CI：（1.11-3.19）]、心血管死亡[3.47（1.76-6.84）]和新发心血事件风险[1.64（1.09-2.47）]。结论 HVC是MHD患者心血管死亡及新发心血管事件的独立危险因素。

Objective To investigate the impact of heart valve calcification（HVC） on cardiovascular outcomes in patients on maintenance hemodialysis（MHD）.Methods We enrolled 302 Chinese patients on MHD between 2009 and 2011 including 99 with HVC identified by echocardiography screening.All the patients were followed up for 2 years and survival analysis was performed with all-cause mortality,cardiovascular mortality and new onset cardiovascular events as the endpoints.Cox regression analysis was used for analyzing the impact of heart valve calcification on the cardiovascular outcomes of the patients.Results The mean age of the total patients was 58.2±15.0 years when receiving the initial MHD,and 53.6% were male patients.The overall mortality,cardiovascular mortality and new on-set cardiovascular events in HVC and non-HVC groups were 30.3% vs 16.3%,22.2% vs 6.9%,and 48.5% vs 25.6%,respectively（P〈0.05）.Kaplan-Meier survival analysis showed a significant difference in all-cause mortality（P=0.006）,cardiovascular mortality（P〈0.001） and new-onset cardiovascular events（P〈0.001） between HVC and non-HVC groups.After adjustment,Cox regression analysis identified HVC as a risk factor for increased all-cause mortality（HR=1.88; 95% CI： 1.11-3.19）,cardiovascular mortality（HR=3.47,95% CI： 1.76-6.84） and cardiovascular events（HR=1.64,95% CI： 1.09-2.47）.Conclusions HVC is an independent risk factor for increased cardiovascular mortality and new cardiovascular events in patients on MHD.