糖尿病肾脏病维持性血液透析患者心脏瓣膜钙化易发因素分析

Risk factors for cardiac valve calcification in patients with diabetic kidney disease

目的通过检测糖尿病肾脏病(diabetic kidney disease,DKD)患者心脏瓣膜钙化(cardiac valve calcifieation,CVC)情况,对其相关因素进行分析,探讨DKD的易发因素。方法选择2013年1月至2015年12月在我院血液净化中心行维持性血液透析的患者118例,其中DKD患者57例(DKD组),非DKD患者61例(非DKD组),观察2组吸烟比率及年龄有无统计学差异,完善超声心动图、血压、血三酰甘油、血钙、血磷、C反应蛋白、血白蛋白的检测,比较2组之间有无差异,并对DKD组透析时间、血磷、C反应蛋白进行单因素分析。结果 DKD组发生瓣膜钙化44例(占77.2%),非DKD组发生瓣膜钙化24例(占39.3%),2组比较差异有统计学意义(P<0.01)。2组患者中单纯主动脉瓣钙化共24例(占20.3%),DKD组17例(占29.8%),非DKD组7例(占11.4%);单纯二尖瓣膜钙化17例(占14.4%),DKD组10例(占17.5%),非DKD组7例(占11.4%);主动脉瓣加二尖瓣同时钙化27例(占22.9%),DKD组17例(占29.8%),非DKD组10例(占16.4%)。2组患者吸烟比率比较差异无统计学意义(P=0.89),2组年龄比较无统计学差异。2组收缩压、舒张压、透析时间、血钙、血磷、钙磷乘积、血三酰甘油比较,差异有统计学意义(P<0.05);DKD组收缩压高于非DKD组,舒张压低于非DKD组,透析时间明显短于非DKD组;DKD组血钙、血磷、钙磷乘积明显低于非DKD组,血三酰甘油、C反应蛋白均高于非DKD组,体质量指数、血白蛋白无统计学差异。DKD组CVC的危险因素结果提示透析时间、血磷升高是发生CVC的主要危险因素。结论血钙、钙磷乘积不是DKD瓣膜钙化的预测因子,血磷、血脂、透析时间等是影响瓣膜钙化的独立危险因素。

Objective To explore risk factors for cardiac valve calcification （CVC） in patients with diabetic kidney disease by detecting diabetic kidney disease heart valve calcification and analyzing the related factors. Methods 118 patients undergoing maintenance hemodialysis （MHD） were enrolled, and divided into two groups., diabetic kidney disease group （57 cases）, and nondiabetic nephropathy group （61 cases）. The smoking rate and age were observed. CVC was evaluated by the color Doppler ultrasonography. The clinical and laboratorial parameters related to CVC were detected and analyzed. Results CVC in diabetic kidney disease group 44（77. 2%） is more than nondiabetic nephropathy group 24（39.3%）, Х^2 = 17. 29,P〈0. 01 ; There are statistically significant in systolic blood pressure, diastolic blood pressure, hemodialysis vintage, blood calcium, serum phosphate, calcium-phosphorus product, triglyceride in two group （P〈0. 05）. But there aren＇t statistically significant in smoking rates, age, BMI（body mass index）, C-reactive protein, albumin. We found in nephropathy group serum phosphate, triglyceride, hemodialysis vintage are risk factors through single factor analysis of variance. Conclusions Blood calcium, calcium-phosphorus product aren＇t risk factors in diabetic kidney disease. Serum phosphate, triglyceride, hemodialysis vintage are risk factors in diabetic kidney disease.