血液透析患者心脏瓣膜钙化与颈动脉粥样硬化的关系及影响因素

The relationship between cardiac valve calcification and carotid atherosclerosis and its influential factors in hemodialysis patients

目的 探讨维持性血液透析（maintenance hemodialysis patients,MHD）患者心脏瓣膜钙化（cardiac valve calcification,CVC）与颈动脉粥样硬化（carotid atherosclerosis,CAS）的关系及影响因素。方法 对MHD 1年以上的患者进行心脏超声心动图和颈动脉彩色多普勒超声检查,并统计矿物质代谢、脂代谢、炎症及营养不良相关指标。结果 共纳入80例患者,平均年龄（61.2±13.2）岁,透析龄（64.8±55.8）月。同时有CVC和CAS的患者41例与无CVC和CAS的患者20例比较,年龄（t=7.160,P〈0.001）、体质量指数（body mass index,BMI）（t=2.530,P=0.014）、超敏C反应蛋白（hypersensitive C-reactive protein,hs CRP）（t=4.290,P〈0.001）、三酰甘油（triglyceride,TG）（t=2.660,P=0.010）及血清钙（calcium,Ca）（t=2.560,P=0.013）均有显著性差异。有CVC的47例患者与无CVC的33例患者比较,年龄（t=3.470,P〈0.001）、透析龄（t=2.130,P=0.036）、hs CRP（t=4.230,P〈0.001）、Ca（t=4.450,P〈0.001）及主观综合评估表（subjective global assessment,SGA）（t=2.140,P=0.038）有显著性差异。有CAS的54例患者与无CAS的26例患者比较,年龄（t=7.810,P〈0.001）、罹患糖尿病（χ2=3.760,P=0.047）、BMI（t=2.400,P=0.024）、hs CRP（t=2.940,P=0.004）、血清白蛋白（t=2.140,P=0.038）、TG（t=3.320,P=0.001）、Ca（t=2.740,P=0.008）、SGA（t=2.010,P=0.048）及Kt/V（t=2.410,P=0.023）有显著性差异。Logistic回归分析显示,年龄（OR 1.194,95%CI 1.053-1.353,P=0.006）和hs CRP（OR 3.996,95%CI1.349-11.894,P=0.012）是同时患CVC和CAS的危险因素;hs CRP（OR 1.709,95%CI 1.236-3.364,P=0.01）和Ca（OR 38.561,95%CI 2.440-609.495,P=0.09）是CVC的独立危险因素;年龄（OR 1.163,95%CI 1.079-1.255,P〈0.001）和hs CRP（OR 1.700,95%CI 1.092-2.646,P=0.019）是CAS的独立危险因素。结论 CVC与CAS常常伴发,CVC和/或CAS与MHD患者的年龄、hs CRP、高钙血症有关。

Objective To investigate the relationship between cardiac valve calcification （CVC） and ca- rotid atherosclerosis （CAS） and its influential factors in maintenance hemodialysis （MHD） patients. Methods MHD patients with dialysis duration of ≥ 1 year were enrolled in this study. Cardiac echocardiography and carotid artery color Doppler ultrasound examination were performed in the patients. Mineral metabolism, lipid metabolism, inflammation and malnutrition related indicators were collected and analyzed. Results Eighty MHD patients （50 males and 30 females） were included in this study. The average age was 61.2±13.2 years, and the average dialysis duration was 64.8±55.8 months. Age, body mass index （BMI）, hypersensitive C-reactive protein （hsCRP）, hypertriglyceridemia and hypercalcinemia were significantly different between 41 patients with CVC and CAS and 20 patients without CVC and CAS （P〈0.05）. Age, dialysis duration, hsCRP, hypercalcinemia and subjective global assessment （SGA） were significantly different between 47 patients with CVC and 33 patients without CVC （P〈0.05）. Age, diabetes, BMI, hsCRP, serum albumin （Alb）, hyper- triglyceridemia, Ca, SGA and Kt/V were significantly different between 54 patients with CAS and 26 patients without CAS （P〈0.05）. Logistic regression analysis showed that age and hsCRP were the common risk factors for CVC and CAS （P〈0.05）, hsCRP and serum Ca were the independent risk factors for CVC （P〈0.05）,and age and hsCRP were the independent risk factors for CAS （P〈0.05）. Conclusion CVC often accompa- nied with CAS. The presence of CVC and CAS in MHD patients was related to their age, hsCRP level and hypercalcinemia.